Preservation Face Lift: A Comprehensive Guide

Facelift techniques have evolved significantly over the years, offering a range of procedures designed to meet diverse patient needs and achieve natural, lasting results. Among the latest advancements in facelift surgery is the Preservation Lift, an innovative approach that is gaining attention for its ability to enhance the natural contours of the face without extensive skin elevation. This blog explores what sets the Preservation Lift apart from other facelift types, how the procedure is performed, and what patients can expect in terms of results, recovery, and overall benefits.

What is a Preservation Lift?

The Preservation Lift is a modern approach to facelift surgery that emphasizes the importance of conserving the natural anatomy of the face. Unlike traditional facelifts, which often involve significant skin dissection and reshaping, the Preservation Lift is designed to preserve the existing attachments between the skin and the deeper facial structures and works within the deep planes of the face. This approach allows for a rejuvenated appearance that respects the original contours, preventing the overly tight or “pulled” look that can sometimes result from more invasive techniques.

How is a Preservation Lift Performed?

In a Preservation Lift, the surgeon works primarily within the deep plane of the face, targeting the underlying structures like the SMAS (Superficial Musculo-Aponeurotic System) in the face and the platysma muscle in the neck. These are critical tissue layers responsible for facial and neck movement and support. Instead of relying on extensive skin manipulation, the Preservation Lift elevates and repositions deeper tissues such as fat pads, muscles, and ligaments while keeping the attachments between these tissues and the skin intact.

The process typically involves:

1. Minimal skin dissection: The skin incisions are similar to other facelift techniques. However, the amount of skin elevation is minimal, preserving most of the attachments of the skin with the underlying tissues.
2. Targeted lifting and repositioning: Working in the deep plane, the surgeon repositions facial fat pads and other supportive structures to enhance volume and lift. This is exactly the same as with other extended deep plane techniques.
3. Preserving natural contours: By repositioning deep facial layers without extensive skin tightening, the natural curves and contours of the face are maintained.

This technique not only delivers a natural, lifted look but also minimizes trauma to facial skin, reducing downtime and improving healing outcomes.

How long does a Preservation Facelift take?

The Preservation Facelift takes 6 hours to complete. The surgery is typically done with general anesthesia, but at Westlake Dermatology we prefer to perform it under local anesthesia with twilight sedation. Patients are comfortable during the surgery, recover faster and have no memory of anything unpleasant during the surgery.

What Results Are Possible?

Patients undergoing a Preservation Lift can expect a dramatic but natural enhancement to their face and neck. This technique is especially effective for treating areas like the mid-face, lower face, and neck, where sagging and volume loss are most prominent as we age. The results often include:

• Enhanced definition: A refined jawline and improved contour in the cheeks and neck area.
• Natural volume restoration: By repositioning fat pads rather than removing them, patients maintain youthful fullness. Fat transfer from other areas into the face is often unnecessary since your own fat is lifted where it needs to be to create natural volume.
• Long-lasting results: Because it works on deeper structures, results from the Preservation Lift tend to be more durable than those from skin-focused facelifts. Typically, the tissue is repositioned to where it was 15 years ago, so as aging continues it takes 15 years for the tissues to descend once more. However, since patients look so much better than they would have over all that time, most do not feel the need to repeat the surgery. When executed properly, the extended deep plane Preservation Lift is the last facelift most patients will need.

What Are the Benefits of a Preservation Lift?

The Preservation Lift offers unique advantages compared to more traditional facelift options:

• Targets deep plane: By addressing deeper facial layers, this technique provides a more natural, durable lift without the need for excessive skin tightening.
• Reduces skin dissection: Minimal skin manipulation reduces the risk of complications such as scarring and skin irregularities, promoting faster recovery.
• Preserves natural contours: The Preservation Lift enhances natural contours, delivering a youthful look without compromising facial identity.
• Versatile application: It can effectively address the mid-face, lower face, and neck, areas often impacted by aging and gravity.

How Does the Preservation Lift Technique Differ from Other Facelift Types?

Compared to other facelift procedures, the Preservation Lift is distinct in its focus and method:

• Traditional facelift: A traditional facelift often involves more extensive skin elevation, creating a tighter, smoother appearance but sometimes lacking the natural look that the Preservation Lift achieves.
• SMAS facelift: SMAS facelifts involve pulling the SMAS layer to tighten it. This requires more extensive skin elevation, does not release tether points that the SMAS is stuck down to (so the tissue must be pulled harder than simply moved like the deep plane lift, leaving a pulled look), and does not improve the midface (so fat transfer must be used to mimic the effects of a midface lift).
• Deep plane facelift: The deep plane lift, whether limited or extended (this refers to the amount of midface release and elevation that is performed), is exactly the same as the preservation lift in its deep release and repositioning (without pulling) of the SMAS, deep facial fat and platysma. The difference is that the Preservation Lift limits how much skin is elevated, so blood flow is maintained to the skin with less swelling and less need for drains.
• Mini lift: The mini lift targets only the jawline and is less invasive, but results are very short-lived (less than 5 years) since only a small amount of SMAS and platysma are pulled to create the definition.

Is it painful?

Pain varies greatly among patients, but most patients find the first two nights are the worst. We prescribe celecoxib (Celebrex), a non-steroidal pain medication like ibuprofen, to manage pain round the clock. Acetaminophen (Tylenol) can supplement this. We give a prescription for narcotic pain medication, but most patients do not need it; those that do only need it for the first few nights after surgery.

What is Recovery Like?

Recovery from a Preservation Lift is similar to other facelift techniques.  Although skin dissection and trauma are minimized, the deeper release creates significant swelling. Most patients can expect:

• Downtime: Many patients can return to light activities within 14 days.
• Swelling and bruising: These side effects are generally moderate, peaking in the first few days before subsiding within 2-3 weeks.
• Temporary numbness: All patients will experience numbness in the areas where the skin is elevated. This typically resolves within a few weeks to months.
• Irregularities: During the contraction phase of healing (2 weeks to 4 months after surgery) skin irregularities are common with all facelift techniques. Since the skin elevation is minimized in preservation lifts, fewer irregularities can be expected.
• Gradual results: While initial improvements are visible immediately after surgery, final results may take up to one year as swelling fully resolves in the deep plane.

Will I need drains?

Even though the Preservation Facelift elevates less skin, so there is less space for fluid to collect, drains are still used. They are typically left in place for 3 days, though some patients need them to stay in longer. Although they are a nuisance, they remove fluid that would otherwise have built up and caused slower healing.

How long are sutures left in place?

Sutures are removed after seven days.

When can I shower?

Incisions can get wet after 72 hours, but the drain sites must be kept dry until the day after they come out. Typically, this means that hair can be washed four days after surgery.

Will I need a compression wrap?

We believe that compression helps swelling to improve more quickly. We recommend compression for one week after surgery, then at nighttime until one month after surgery. However, each patient decides when and for how long to wear compression based upon their own healing.

When can I go out in public without feeling self-conscious?

Most patients venture out of the house after two weeks, but it takes three to four weeks to feel self-confident enough to be social. We recommend two weeks off work and three weeks before flying. Patients can start vigorous exercise after one month. Every patient uses their own body’s feedback to advance their activity level. If you do too much, your body will swell and hurt. Listen to what your body is telling you and adjust your activity level accordingly.

When will I be fully healed?

The body goes through very predictable phases of healing. Initially there is inflammation (swelling). This phase lasts for about two weeks. Then the body enters the contraction phase of healing that lasts from two weeks until four months after surgery. This is when collagen and elastin are deposited and the surgery heals in. This is the lumpy, bumpy phase of healing. Finally there is reorganization, when the collagen and elastin fibers are reorganized and the surgical areas smoothen out. Most patients look good at three weeks, are photo ready by two to three months (with some irregularities still present) and are fully healed after one year. This is why revision or touch-up surgery should wait until one year in most patients, since the body is still healing up until then. No matter who your surgeon is or what surgery was done, these phases of healing are present in everyone. They can be attenuated somewhat with diet, lasers, massage, and various injections, but in general they must be allowed to run their course.

Will There Be Scarring?

One of the key benefits of the Preservation Lift is the minimal scarring associated with the procedure. Because the incisions are well-placed around the ear, visible scarring is usually minimal and can often be concealed within the natural hairline or contours of the ear. Since the skin is not pulled to create the lift, the scars are nearly invisible in most patients.

The Preservation Lift represents a significant advancement in facelift techniques, combining a deep-plane approach with a commitment to preserving natural facial anatomy. By addressing aging at its roots within the deeper facial structures, the Preservation Lift offers a powerful alternative to traditional facelifts, making it an appealing choice for those looking to refresh their appearance without compromising their unique features.

Dr. Minas Constantinides is a board-certified Facial Plastic Surgeon at Westlake Dermatology & Cosmetic Surgery in Austin, Texas. He is on the Executive Committee of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and is a Senior Advisor of the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS).