Loss of skin elasticity with age (and sun exposure) allows the lateral and lower cheeks, which aren't tightly attached to facial bones, to 'sag'. On either side of the chin are ligaments which hold the skin more tightly against the jawbone (mandible). This is where, and why, 'jowls' develop. I have also observed that many people develop both atrophy of soft tissues and slight recession of the mandible between the chin and the jowl area, which serves to exaggerate the appearance of jowls.
The surgical procedure that has traditionally been referred to as a' facelift' involves mobilizing the skin and soft tissues of the lower face and jawline (and in most cases, the neck), and advancing them upward and laterally to eliminate sagging (jowls) and provide the appearance of improved skin tone. The excess skin is removed.
What is currently referred to as a facelift usually means some combination of surgical lower face rejuvenation with procedures that are designed to improve other facial aesthetic areas: the brow and eyelids, the midface, and the neck. The combination of procedures I perform on any patient are customized for that individual's specific needs and desires, and thus no two 'facelifts' are exactly alike.
The facelift procedure involves incisions that skirt the contour of the ears, using the anatomy of the ear to help conceal them. For a full facelift, the incision starts in the sideburn area, follows the contours of the junction of the ear with the face, curves behind the earlobe into the recess between the posterior ear and the neck/scalp, and then extends into the hairline posteriorly at the top of the ear. When I make these incisions, I design them so that, once fully healed, they may be difficult for even a hairdresser to detect. That goal can often be achieved, and it requires meticulous attention to every centimeter of the closure.
So what about this "Weekend Facelift"?
A standard facelift involves incisions as described in the paragraph above. That pattern of incisions is generally required for patients with prominent jowls and very loose neck skin, who require significant skin advancement and removal. A shorter incision which does not extend into the scalp at either end, but is made only in front of the ear and immediately behind the earlobe, can be used to improve jowls and to tighten the neck somewhat in selected patients with lesser degrees of lower face and neck aging changes.
This latter facelift procedure involves shorter incisions, less dissection, and quicker recovery than a conventional facelift, and has been dubbed by some as "the weekend facelift". This, in my mind, is a marketing strategy designed to make the procedure attractive to those who might shy away from a 'full' facelift. I have seen marketing materials which actually suggest that a patient might "go shopping" immediately after this surgery, or drive themselves home!
I think that "weekend facelift" is a misleading term, as it suggests dramatic surgical improvements are possible with minimal surgery. As with most things which sound too good to be true, so it is with the "weekend facelift". As you might expect, the degree of improvement one obtains from surgery is, in general, directly proportional to the surgeon's effort. An hour of surgery through a shorter incision can not be expected to produce a result approaching that of a conventional facelift.
Patients with relatively small 'jowls' and minimal neck skin laxity, however, can obtain a very nice improvement using the technique described above. A better term, however, might be "Mini-facelift", as no surgeon can guarantee a two-day recovery, and patients' expectations may be inappropriately heightened by the promise of a big improvement by a minimal surgery.
Aesthetic improvement of the neck
The majority of patients having a facelift surgery also have aging changes in the neck, which can be corrected and improved through a variety of surgical procedures. To improve the neck contours, the facelift can be extended over the jawline and onto the anterior and lateral aspect of the neck. In other patients without major aging changes at or above the jawline, neck rejuvenation alone may be performed. The procedures that I employ to rejuvenate the neck are described in detail under the heading Neck Lift in the Facial Rejuvenation menu.