Facelift

Facelifting or Rhytidoplasty has had a tremendous evolution during the past fifteen years, but each facelift needs to be tailored for a patient’s facial features, including their skin quality and bone structure. The patient’s sex, age, medical conditions, medications and habits (tobacco and alcohol use) all have to be considered when planning the facelift. Since almost all of our facelifts include dissection under the chin (submentum) and deep layer dissection (SMAS) and suspension, we generally do two types of Facelifts, the MIFL (Minimal Incision Facelift) - Figure 1, and the FIFL (Full Incision Facelift) - Figure 2.

   

Our version of the “S” Lift, Quick-Lift or Short Incision Lift is called the MIFL (Minimal Incision Facelift), in contrast to the FIFL (Full Incision Facelift). The MIFL extends behind the earlobe for only 2-3 centimeters and it is ideal for men or women in their 40’s, 50’s and 60’s with mild to moderate skin laxity and mild to moderate fat accumulation (jowl and submentum). Incision and dissection behind the ear and into the posterior neck and hairline are avoided and the operating time, convalescence and cost are much less than the FIFL. The MIFL can be done in two hours with a 7 - 10 day recovery. The cost is comparable to the trendy “Lifestyle Lift”, but the procedure is much more predictable and longer lasting. The FIFL is usually for patients with more skin laxity and fat accumulation who require that the cheek and anterior, lateral and posterior neck be dissected, lifted, manipulated and sutured around both the anterior and posterior hairline and the ear.

Incisions for both the MIFL and FIFL are carefully camouflaged around the ear and into the anterior (temporal) hairline. Most women have a post tragal incision, i.e. an incision behind the anterior ear cartilage. The temporal sideburn has to be critically examined so it does not raise and look unnatural after surgery. Since temporal sideburns and ear cartilage vary, we take a close-up Polaroid photograph of the ears and sideburns to help plan the incision with the patient.

Currently, we almost always use a temporal sideburn-sparing incision to preserve its height and natural appearance - Figure 3. Hair quickly grows through the incision for future camouflage.

With few exceptions, all patients for facelifting have some deformity in the submentum (under the chin). Mild to moderate excess fat is removed using liposuction through a 1/4 cm incision. Heavier necks may require the use of scissors lipectomy above and below the platysma muscle, using a larger submental incision. Cording or platysmal banding may also be evident and those bands need to be sutured after fat removal to avoid a recurrence of the original problem. A Neck Lift only using a Corset Platysmaplasty can be done in select patients (see below). Chin implants to lengthen the chin-neck angle and improve the profile can also be placed through the submental incision.

SMAS (superficial musculoaponeurotic system) layer dissection is done in all patients to lift the midface, the jowl and smooth out the melolabial crease or groove (smile lines). Using one or two pursestring sutures through the SMAS with the MIFL, and a partial excision of the SMAS with rotation and suturing for the FIFL, this dissection is done after the skin undermining.

A fibrin sealant is sprayed over the wound under the skin prior to skin tightening and incision closure with the FIFL. The sealant fixes skin quickly and it reduces bruising, fluid accumulation and the need for drains. It is not usually needed for the MIFL

Facelift dressings are removed on the first and third postoperative days with the FIFL. After the third day, patients shampoo daily and apply their own light dressing. Patients can shampoo on the second day and quickly style their hair with the MIFL, and dressings are minimal. We prefer that all patients stay in the area for 7 – 10 days after facelifting.

As mentioned above, a Neck Lift with or without a Facelift can be used in patients with excessive lax skin, excessive fat above and under the platysma muscle and prominent muscle bands. This unique approach entails a layer by layer dissection using a hidden submental incision and a hidden incision behind the ear to redrape rather than remove the neck skin. The platysma edges are sewn together corset style to achieve an excellent long lasting result. A facelift is often unnecessary for patients who only want and only need the neck and jowls improved. It is the procedure of choice for the older male patient who prefers to shave his head.

This represents a summary of our current approach to facelifting. Since our results have been excellent with the MIFL, the FIFL and the Corset Platysmaplasty, I expect that we will use these approaches for a long time.