A facelift procedure actually treats the lower third of the face and the neck at the same time. It tightens the skin and tissue along the jawline and into the area under the chin. The skin is incised in front of and around the ear and the tissue elevated out onto the cheek and neck. Sometimes a deeper level of fibrous tissue (the SMAS fascia) is incised and tightened for a deeper, more stable correction of the laxity. The deep tissue is pulled backward under the earlobe then up and back above the earlobe and stitched into the new position. The skin and fat is then stretched back over top and the excess is trimmed away. This hides the scar around the ear instead of out in the open on the neck or face. Oftentimes, liposuction is done at the same time to thin that area as the skin is stretched.
The nasolabial folds and marionette lines are improved some by a facelift, but they do not completely correct. If you wish to have the NLF and ML’s dealt with at the same time, then either fat grafting or fillers need to be considered. These fill in the indentation of the wrinkles to soften their appearance. Fillers (such as Juvederm/Restylane/Sculptra) are temporary solutions to the problem because the injected material is gradually absorbed by the body, and to maintain the correction the injections will need to be repeated over time. Fat grafting is a long-term solution. Fat from other parts of the body are harvested, concentrated and injected back into the face to correct wrinkles. If the fat ‘takes’ (survives the transfer) then the volume that is injected will stay. This is a more invasive technique, but if you are going to be in surgery anyway, it does not add a lot of time or expense to the facelift.
Facelifts and fat grafting are wonderful procedures that complement each other in order to combat the aging process and rejuvenate the face. Combining procedures, especially in the face, can create a harmonious final result and do so more economically than if each is performed separately. Start with an evaluation by your board-certified plastic surgeon.