What is an 8-point face lift and what are the considerations and alternatives for the procedure?

8-Point Face Lift: Definition and Clinical Approach

What is an 8-Point Face Lift?

The "8-point face lift" is a non-surgical facial rejuvenation technique using injectable dermal fillers strategically placed at 8 specific anatomical points to restore facial volume, improve contour, and create a lifting effect without surgery. 1

This approach evolved from the MD Codes system and represents an alternative to traditional surgical face-lifting procedures, providing immediate visible results through strategic volumization rather than tissue excision and repositioning. 1

Key Anatomical Targets

The 8-point technique focuses on:

• Midface (cheek) foundation: Strategic filler placement creates structural support and addresses volume loss in the malar and submalar regions 1
• Lower face contouring: Targets the chin and jawline to define facial borders and indirectly improve jowls, nasolabial folds, and marionette lines 1
• Indirect improvement of aging signs: By addressing foundational structure, secondary benefits include reduction of lines, folds, jowls, and submental laxity without directly treating these areas 1

Clinical Considerations

Patient Selection Criteria

Ideal candidates have mild to moderate facial volume loss and skin laxity, but NOT significant lower neck skin laxity, which requires surgical intervention. 2

• Patients seeking facial rejuvenation without surgical downtime are appropriate candidates 3, 1
• Those with realistic expectations about non-surgical limitations should be selected 4
• Medical comorbidities that preclude surgery make non-surgical approaches particularly valuable 3

Contraindications and Limitations

• Severe lower neck skin laxity cannot be adequately addressed with injectable techniques and requires surgical face-lifting 2
• Significant platysmal banding in the erect position necessitates surgical platysmal plication 2
• Patients with extensive skin redundancy and advanced ptosis are poor candidates for non-surgical approaches 4, 2

Surgical Alternatives

Limited-Incision Techniques

For patients requiring more definitive correction than injectables can provide:

• Limited-incision face lift (LIFT): Uses 5-6 cm undermining from preauricular incision with SMAS plication, performed under local anesthesia with sedation 2
• Micro-face-lift: Biplanar composite technique with minimal complications (9.8%), short recovery, and high patient satisfaction (average 4.27/5 on Likert scale) 3
• Both techniques avoid the extensive dissection of traditional face-lifting while providing superior results to injectables alone 3, 2

PRESTO Facelift Approach

The PRESTO (Preservation of Retaining ligaments and SMAS Tethering) technique preserves facial identity by maintaining retaining ligaments and SMAS intersegmental connections, avoiding the "overdone" appearance of traditional face-lifting. 5

• Retaining ligaments serve as "guardians of facial identity" and should be preserved rather than released 5
• This approach maintains individual phenotype while achieving rejuvenation 5
• Particularly valuable for patients concerned about losing their natural appearance 5

Complications and Risk Mitigation

Non-Surgical (8-Point) Complications

• Bruising, swelling, and asymmetry are temporary and resolve spontaneously 1
• Vascular complications (though rare) require immediate recognition and treatment
• Product migration can occur without proper technique and anatomical understanding 1

Surgical Alternative Complications

Facial nerve weakness is the most common long-term complication of surgical face-lifting, occurring in 7.8% of cases with paresis/paralysis and 1.8% with sensory alterations. 6

• Most facial nerve weakness resolves within 6 months, though persistent temporal branch paralysis may require unilateral brow lift 6
• Hematoma requiring drainage occurs in approximately 0.6% of limited-incision cases 2
• Infection rates are low at 0.7% for surgical procedures 6
• Hypertrophic scarring occurs in 3.8% of micro-face-lift cases 3

Prevention Strategies

• Routine identification of facial nerve branches in the operative field is essential for surgical cases 6
• Careful dissection along fascial planes prevents nerve injury 6
• The preauricular approach provides better access with reduced facial nerve injury risk 6

Clinical Algorithm for Treatment Selection

1. Assess degree of aging changes: Mild volume loss only → 8-point injectable technique 1
2. Evaluate skin laxity: Moderate cheek/jowl laxity without neck involvement → Limited-incision or micro-face-lift 3, 2
3. Check for neck involvement: Significant lower neck skin laxity → Traditional or PRESTO face-lift required 2, 5
4. Consider patient factors: Medical comorbidities, downtime tolerance, and surgical risk → Favor less invasive approaches when appropriate 3
5. Assess identity preservation needs: Patients concerned about maintaining natural appearance → PRESTO technique if surgery needed 5

Adjunctive Procedures

Combining the 8-point technique or surgical face-lifting with complementary procedures maximizes aesthetic outcomes:

• Submental liposuction addresses submental fat (performed in 58.8% of micro-face-lift cases) 3
• Mid-face lipo-filling enhances volume restoration (9.8% of cases) 3
• These combinations should be planned preoperatively based on individual anatomical needs 3