Surgery generally provides the most efficient treatment of skin folds and sagging tissue.
Lifting techniques are based on skin undermining, repositioning of deeper tissues that are sagging, and removal of excess skin where the scars are difficult to see (e.g. around the ear or in the hear-bearing scalp). In endoscopic procedures even deeper soft tisues are released and repositioned through small stab incisions.
A face-lift does not necessarily require general anaesthesia. Some limited and still efficient variations of this operation can be performed under local anaesthesia (cheek-lift through lower lid incision, mini-lift, MACS-lift, S-lift, …). The bigger operations, inluding the endoscopic techniques, are extensive procedures. They cause important swelling for several weeks. Complete softening of the tissues and the evolution to a completely natural result can take several months.
For folds on the lower part of the cheeks and over the border of the jaw, "classical" face-lift or a smaller variant of this operation is performed.
The incision begins in the hair bearing skin just above the ear. It follows the anterior border of the ear, disappears behind the tragus (the small valve in front of the ear) to reappear at the anterior border of the earlobe. In more extensive corrections, or when a neck-lift is performed at the same time, the incision continues in the fold behind the ear upwards into the hair-baring skin of the head and the neck.
A small lift under local anaesthesia cannot yield the same result as extensive surgery. Sometimes compensation of facial volume loss by injections is a simpler way to treate an early stage of soft tissue sagging.
A facelift may be combined with a neck lift, partially or sometimes completely through the same incisions.
Under deep sedation or general anaesthesia the soft tissues of the forehead and the sagging eyebrows are lifted. Most often this is an endoscopic procedure: the lifted tissues do not cause skin folding in the scalp. The scars are five lines of six to twelve millimetres in the hair-bearing scalp. For patients with a high hair line skin excision may be required. Then the scar is placed at the hair line.
The position of the eyebrows can be improved with botulinum toxin and with minimally invasive operations such as with suspension sutures under the skin. Therefore there are few indications left for an "open" or endoscopic forehead lift.
Ageing makes the fat over the cheekbones slide downwards to form the nasolabial folds (the folds between the nose and the angles of the mouth). These tissues are repositioned through a 3 cm incision in the hair-bearing skin of the temples, an incision in the "crow's foot" and a third incision in the mouth in the fold between the upper lip and the jaw. This procedure also enhances the support of the lower eyelids, that rest on the soft tissues of the cheeks. Further eyelid correction can be combined with this procedure.
The advent of efficient, less invasive treatments led to a decrease of endoscopic facelifts.