This question is the pandora’s box of Facelift. There are many ways to skin a cat would be the perfect etiology to answer this question. Facelift entails raising the skin layer of your face, and there is resection of skin involved to tighten your face. However, things get really interesting when dealing with the SMAS, which is the layer of soft tissue under your skin.
A technique that provides optimal aesthetics for one patient may not provide the same result for another. There is no doubt that a skin-only facelift, sometimes called mini Facelift, will not have long lasting results. The SMAS needs to be lifted along with the skin for optimal and long lasting results. Different options available for SMAS lifting include SMAS plication, Lateral smasectomy, High SMAS technique, and deep plane facelift. Multiple studies have been done to figure out which technique is the best. One of the most interesting studies evaluated different techniques of Facelift on 8 identical twin subsets.
At long term follow-up, No one facelift technique performed in this study produced a superior result as compared with another when performed on the appropriate patient. I have operated on multiple patients for Facelift and have used different SMAS technique in different patients. I also have had the experience interviewing and spending time with multiple plastic surgeons to get an overall sense of their input. Everyone, myself included, have some degree of implicit bias. It does seem that each plastic surgeon has a specific technique of SMAS lift that works best in their hands, and then they have other techniques in their back pocket to use as and when required.
In my honest opinion, the best SMAS technique is the one that works best for that specific patient. So, when your surgeon tells you that their specific way of doing the SMAS lift is the best way to do it – take it with a grain of salt. This is, by no means, suggesting that you should not trust your surgeon. It’s just that there is no conclusive evidence of the superiority of one technique of Facelift over other.