Our main surgical procedures for facial sagging include the following methods. We recommend this method for patients who are seeking more effective and continuous results.
Deep Plane Facelift
The most modern and effective facelift surgery available today
Neck Lift
From Extended method to a new neck lift
Temple Lift
Rejuvenation of around the eyes and temple
Forehead Lift
(Brow Lift)
Endoscopic removal of sagging forehead, brow lift to rejuvenate around the eyes
Midface Lift
Rejuvenation of the midface, various approach methods
Sub-brow Lift
Approach to the orbicular muscle of the eye, treatment for mild ptosis
Deep Plane Facelift
Deep plane facelift (DPL) is considered the most effective facelift surgery, especially in Europe and the United States. In recent years, it has been spreading rapidly in Asian countries such as China and Korea. Our Dr. Takashi Nakao was one of the first to perform this procedure on Japanese patients and he has been making efforts to adapt the method to Asian patients.
The history of DPL dates back to Hamra's composite graft in the 1990s. Since then, improvements have been made from an anatomical viewpoint. Recently, with the spread of SNS such as Instagram and the excellent surgical results of Jacono in New York, the pioneer of DPL, has made it available for everyone to see and is rapidly gaining recognition and spreading to surgeons around the world.
Facelift Surgery
Facelift surgery can be performed in a variety of ways. The surgical technique differs depending on how the skin, SMAS, and ligaments are treated. We use the superficial musculoaponeurotic system (SMAS), which raises the inside of the face by approaching and pulling on the fascia of the face. The face ligament stretches with age and its supportive role diminishes. When traction is applied to the SMAS during facelift surgery, the ligaments are separated to maximize the lifting effect. By firmly lifting the inside of the SMAS and not relying solely on skin traction, the patient's face will look younger and more natural after the surgery.
Advantages of DPL
There was a time when Baker's lateral SMASectomy was the mainstream method in Japan. Although this method is minimally invasive and effective in approaching the SMAS, there was weakness in midface lifting and overall mild effect had left it unsatisfactory for patients seeking better results.
The classic SMAS lift is effective in rejuvenating the facial contours. Marten's high SMAS technique can be used to address midface sagging, which has been considered a weak point of facelift surgery. We have also performed Marten's high SMAS before, but the results were not as good as Marten's. Marten's high SMAS has the risk of damage to the temporal branch of the facial nerve and may be a difficult method to achieve higher results.
Therefore, we have been working on DPL facelift surgery since 2019.
DPL is a method that can approach the midface like the extended SMAS lift of Mr.Stuzin while efficiently transmitting the traction force of the SMAS to the skin by pulling up the skin and SMAS in one lump in the cheek area. There are many excellent surgeons in Europe and the United States who perform facelifts using this method. In Asia, the DPL facelift has become a trend such as Wong in Singapore, Lee in Korea and Ryu in China. We have also studied the surgical methods suitable for Asian patients and perform DPL with our original technique.
DPL surgery at our clinic
The skin incision line extends from the temple hairline to the low posterior neck hairline through the front of the ear, ear lobe and behind the ear.The skin incision is made and the subcutaneous skin is peeled off to reach the line from the outer canthus to the mandibular angle, the SMAS is incised and underneath the SMAS is peeled off. The skin and SMAS are lifted from the same area in a single lump. After the skin is stripped down to the jawline area, this skin SMAS flap is pulled up to improve facial sagging. After the SMAS flap is pulled, elevated, and secured with thread, the excess skin is removed and the wound is closed. Several drains are inserted into the wound and pressure is applied with gauze and a face band to prevent postoperative blood accumulation under the skin. Washing hair is allowed on the third postoperative day. The face band must be worn at all times until the stitches are removed on the seventh postoperative day. Our clinic aims to increase the effect of the facelift by changing the direction of traction of the SMAS skin flaps in each area. We also perform a neck lift at the same time to create a more youthful face line.
Neck lift
Many patients are concerned about sagging and flabbiness of the facial line. A neck lift is recommended for patients who want a strong facelift. The neck lift can be performed at the same time as a facelift or as a stand-alone procedure. If performed at the same time as a facelift, the neck lift fee is included in the facelift fee.
There are three methods of neck lift in the DPL surgery mentioned above and we have mainly used Hamra’s method, Jacono's Extended method, and Nayak's Transposition method. Hamra’s method with an incision is called the Extended method, which does create a good facial line, but it also has a disadvantage of tenting. Nayak's Transposition method is a good way to compensate for this disadvantage. Currently, we are using the neck composite flap method for more effective traction.
The center of the neck, platysma muscle (the muscles connected to the SMAS mentioned earlier) and the skin are pulled as a single mass to efficiently transmit the traction effect of the platysma muscle. By performing this method, the chance of performing deep neck lift (platysma muscle binding, a surgery to remove sagging under the chin known as pelican surgery) has decreased. The goal is to form the neck so that the facial line is maintained even when the neck is bent forward.
In the case of a neck lift alone, we do not make an incision in the front part of the ear, but instead approach through an incision from the earlobe to the posterior surface of the auricle or pinna.
See also Deep neck lift
This is a submental sagging surgery in which the skin under the chin is incised and the fat above and below the SMAS is removed by lipectomy.
This is a surgical method to improve the sagging of the neck by suturing and fixing the platysma muscle to the hyoid bone and applying tension to the right and left platysma muscle by suturing them together.
Temporal lift
This surgery is rarely performed in Japan.
This surgery improves sagging in the corner of the eyes, which cannot be achieved through under-eye brow incision. The temple area tends to become saggy with age and is often rejuvenated with hyaluronic acid or fat injections. We propose a new method of rejuvenation by applying traction to this area. This method involves making an incision at the hairline, peeling off the skin and applying traction to the SMAS at the outer canthus. The direction of traction can make the eyes look foxy or larger. This is very effective for patients whose upper eyelid heaviness could not be removed by an under-eye brow incision and furthermore, traction of the SMAS can also be expected to lift the midface. It is also possible to enhance the effect of facelift by performing DPL at the same time.
Forehead lift, Brow lift
We mainly use an endoscopic approach to address sagging and wrinkles in the forehead area. Elevation of the frontal forehead can also eliminate sagging of the upper eyelids and also the elevation of the eyebrows can improve sagging of the outer upper eyelids. Several incisions are made in the hair, the top and temporal area of the head as the forehead and eyebrows are elevated through subperiosteal and supraperiosteal dissection. For Asian patients, who have flatter facial features than Westerners, the eyebrows are rotated and raised in a direction that does not cause startled eyes. The procedure is performed using an endoscope and surgical instruments specially designed for forehead lifts. Alternative to a forehead lift, in which an incision is made along the entire frontal hairline and excess skin is removed, but due to the risk of postoperative nerve damage, we often recommend endoscopic surgery. The brow lift is an effective technique for the sagging outer upper eyelid. However, the method that only excises the skin at the hairline or the method that tucks the temporoparietal fascia may cause postoperative regression, so the method that firmly detaches and raises the eyelid under an endoscope is more effective.
Mid Facelift
Our midface lift is performed using a variety of approaches.
There is a method of lifting the midface at the same time as the Hamra procedure, which is a removal surgery of dark circles around eyes and wrinkles. This method involves treating dark circles and then lifting the drooping midface tissue. There are two types of tissue removal methods: supraperiosteal and subperiosteal. Supraperiosteal removal is milder and has a shorter downtime. Subperiosteal removal provides greater elevation and is more effective, but has a longer downtime than supraperiosteal dissection. The choice of technique depends on the purpose of the procedure. In recent years, cheek lifting has become popular in Europe among young people and it is possible to make a younger look by enhancing their cheeks. A direct approach to the cheek area is the endoscopic midface lift. An incision is made at the temporal hairline or within the hairline, the temporal fascia is dissected and the fat body of the cheek is pulled with a thread. In younger patients or those with relatively mild sagging, a midface rejuvenation can be achieved with just a temple incision.
Sub-brow lift
This is the most commonly performed surgery in Japan to remove sagging skin on the upper eyelid. There are a variety of procedures including skin excision, ROOF excision, orbicularis oculi treatment and orbital septal treatment. For mild sagging, we believe that skin excision alone is sufficient. In cases of mild ptosis, our clinic not only performs skin excision, but also approaches orbicularis oculi muscle lifting, septal incision and orbital fat transfer to reduce the burden on the muscles that raise the eyelids and provide support for better improvement.