This combination is most common for men and women over 45, and corrects the common combination of loose facial and neck skin, loose muscles, visible vertical bands in the neck, and often, falling fat in the cheek and jaw areas.
There are a variety of different names used for a facelift, such as MACS lift, S-lift, Lifestyle lift, and Minilift. In all of these surgeries, incisions are made around the ear to tighten the face and neck skin. They vary in the amount of dissection done, and the technique for tightening the deeper tissues.
In a standard facelift, an incision is made starting either just in front of the temporal hair tuft, or up behind the hairline. The incision then goes down in front of the top part of the ear. It then goes inside the tragus, so that there is no visible line directly in front of the ear. (In men the incision usually stays in front of the tragus so that the sideburn is not pulled into the ear). The incision then passes down under and up behind the ear and back into the hair. An incision done in this way should heal well and be minimally visible post-op.
The skin is then elevated over the cheek and neck to expose the fat, muscles and SMAS, which is a type of membrane connecting all of the deeper layers. The SMAS is tightened with a row of deep sutures which elevates in a uniform fashion the deeper muscle layers. The skin is then draped superiority, the excess skin excised and the wound closed with sutures and staples.
A platysmaplasty is also routinely performed on facelift patients. This is done for any patient who has noted banding in the neck. There is a neck muscle called the platysma which is directly under the fat. With age, the muscle can separate in the middle and become more visible producing bands that run from the chin down into the neck. To eliminate these bands, an incision must be made under the chin, and the muscle is stitched together in the center. Any excess fat can be removed at the same time, creating a sharper, more youthful jawline. Even if there is no significant banding, a plastymaplasty will help to sharpen the angle of the jawline.
A facelift surgery is usually done with local sedation anesthesia, although it can be done with just local. There is swelling and bruising which will last for at least 10 days to 2 weeks. Sutures and staples are removed after 8-10 days. Actual pain is surprisingly minimal with a facelift.
The direction of pull of the facelift will determine how "natural" you will appear post-op. In the past, many surgeons would pull the skin horizontally creating a wind-blown appearance. I pull mostly in a vertical direction which will not affect the lip position, and gives a much nicer tightening of the neck.