Age-related changes occur in all layers of the face, including the skin, superficial fat tissue, superficial connective tissue, deep fat tissue, and bone. Fat tissue in the face experiences both volume loss and sagging. Therefore, targeting only one layer of the face, such as the outer layer (skin), does not yield lasting results in facial rejuvenation. A careful pre-operative assessment provides the surgeon with crucial information regarding the underlying aesthetic diagnosis of the face, the dominant age-related changes, and the selection of the appropriate method for each patient. Increasing volume, and even reducing volume in some areas, should be considered in all facelift surgeries. Facelifts require very meticulous and careful work because the nerves that control the function of the mimic muscles are located directly beneath the surgical area. Therefore, it is similar to dancing on ice. A wide variety of techniques are used in facelifts, depending on the location and length of the incision site; the depth and location of the lifted area; and the nature and location of the fixation method. The most commonly used method is the technique where the incision site is in front of the ear. If the goal is to address aging in the lower face and neck, the incision site can be extended from behind the ear to the hairline. If only mid-face rejuvenation is targeted, an incision of approximately 4 cm just above the lower eyelid and eyebrow may suffice. In this case, an incision in front of the ear is not necessary. In this method, which we call mid-face lift, since the incision sites are the lower eyelid and hairline, there is no visible scar. It can be preferred in young patients with minimal signs of aging in the lower face and neck, and in those who do not want any visible scars.

We perform this surgery endoscopically in our clinic. It yields very good results in patients with sagging and volume deficiency in the cheek and cheekbone area. To achieve lasting results in a facelift, changes must be made in the superficial connective tissue just below the subcutaneous fat tissue. When sufficient tension is provided, this layer acts like the armor of the face and firmly supports the underlying tissues. In some techniques, this connective tissue is folded in a pleated manner after the skin is lifted and sutured to the healthy deep tissue, thus creating a narrowed and shortened lining and eliminating sagging and looseness in the skin. In other methods, this layer is also lifted and secured by suspending it further upwards. This method yields the best results; however, since it involves a two-layer release and lift, it may not be suitable in cases that negatively affect tissue circulation, such as smoking, diabetes, and hypertension.

In both methods, excess skin is removed and sutured to its new position in a way that is not tight. Which technique is suitable for which patient is determined after a detailed facial analysis, assessment of the patient’s expectations, and general health status. Recently, non-surgical facelifts, thread lifts, and spiderweb lifts have received considerable attention in the visual media. In these types of procedures, the anatomical layers of the face are not separated or released in any way; only a thread is used to lift them upwards. It is not difficult to predict that the tissues will easily detach from this suspension and tend to return to their original position. Therefore, unlike a “true” facelift, where a tissue layer is separated from its connected points, tension is applied in the desired vector, and then it is fixed and permanently adhered to its new position, thread lift methods inevitably result in the tissues returning to their original state after the threads are removed, and the results are very short-lived. This method, which generates considerable excitement due to its “non-surgical” nature, is not an alternative to a facelift, and dimpling and suture-related reactions can occur. Therefore, patients should be thoroughly informed before opting for this method.