The recent May 2020 issue of Aesthetic Plastic Surgery Journal had an article, “Optimal Facelift Vector and its Relation to the Zygomaticus Major Orientation.”
I get this is a tough title, and you may wonder why you should care.
Facelifts can either reverse time, so you look like you are a younger version of yourself, or they can change the way you look. Everyone has seen the poor victim of a facelift where they no longer look human, or they look weird, with a face that pulled in one direction and their neck skin in another, what the authors called “a distortion and ‘facelifted appearance.'”
Why is one facelift so seamless and the other so obvious?
This study was to try to look at how we tighten when we do a facelift, and answer the question- Is there an optimal direction when you tighten?
This study looked at 100 deep plane facelift patients. As part of the procedure, the tissue over the zygomaticus muscles are elevated and allows for muscle reorientation. This gave them 200 facelifted sides.
- The average Zygomaticus muscle angle was 59 degrees, (range 6 degrees)
- It showed a statistically significant pattern of change with advancing age- more acute angle when young, becoming more obtuse over the age of 60.
- Findings: The native vector varied significantly between facelift patients. When looking at common pull vectors- superior lateral, vertically oblique, pure vertical–they stated every patients is individual in what they need.
Why do you care?
When doing a facelift, at least in my hands, we want you to look natural. I don’t want someone to look at you and think, “what did she do?” I want them to think you look rested and “good for your age.” When I go to plastic surgical talks on facelifts, there are iconic surgeons who preach their technique. It can be confusing, as some people tighten the face in a pure vertical lift, where others pull up and out. They all have slightly different bents to their technique. So for those learning from them, is there a “best” way?
And the answer from this study is that every patient is different, and that difference changes as your age changes. So when you have a facelift, what direction the tightening should be in will be unique to you.
Seems obvious perhaps, but for many issues we see in the body, there are common standards and norms- the ideal position of the nipple, eyebrow arch peak, or belly button.
But your face is unique.