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By Lawrence M. Korpeck, MD

The facelift, one of the most popular of all cosmetic procedures, has progressed. Despite the extensive peels, laser treatments, and dermabrasion techniques available today, the facelift continues to be the technique that patients turn to when their jowls, neckline, and the areas around the mid-face begin to sag, or when their facial wrinkles and creases become deeper.

The face lifts of a few decades ago involved lifting the outer layer of the skin and repositioning it. While patients emerged with tighter skin, results were often unnatural and short lived. As the medical community has come to find, it's not only the skin that becomes lax with age - the underlying muscles and ligaments are also to blame.

The next step in the evolution of the facelift was the SMAS technique. By lifting both the underlying facial muscle layer, as well as the outer layer of skin, a far superior, longer-lasting result was achieved. When lifting the superficial musculoaponeurotic system, or SMAS layer, the link of the fibrous support system to the skin is tightened.

Still, surgeons have recently discovered yet another layer that contributes to the laxity and poor facial definition found in both older and younger patients, as well as in those who are genetically predisposed to undefined necklines and deep facial creases. The most recent advance in the facelift has been to release a third layer of tissue containing suspensory ligaments that support the muscle. These, too, tend to become lax, loosening the muscle and skin and causing premature folds in the cheeks and around the mouth. By tightening these ligaments, the nasolabial fold, a deep wrinkle running from the nose to the mouth on each side of the face, is smoother. In the past, little could be offered to patients who wanted rid themselves of these troublesome folds, short of collagen injections.

The results of the three-layer facelift are longer lasting because physicians simultaneously reposition and tighten three planes of tissue: the skin, muscle, and ligaments.

Patients interested in the three-layer facelift should look for a plastic surgeon that has experience in performing these latest facelift techniques. While the results tend to be better and longer lasting, the new techniques also require a better understanding of facial anatomy in order to avoid complications.

Dr. Lawrence Korpeck is board certified by the American Board of Plastic Surgery. He is a distinguished fellow of the American College of Surgeons and is an active member of both the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgery. Dr. Korpeck is also a member of the North American Lipoplasty Society.

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