Short Scar Facelift

Facelift surgery is relatively new; it's been around for about 100 years.

It started out as removal of loose skin around the ears and hairline to more complex surgeries involving the SMAS (superficial musculoaponeurotic system) which invests the mimetic muscles of the face and neck and the deep fat compartments. Tightening the SMAS became popular in the late 1970's to the present. This surgery gave nice improvement in wrinkle removal, but often left the patients looking too tight with flattened cheeks and a "wind tunnel appearance". The directional tightening of the tissues is superior-lateral in front of the ear and posterior in the neck. With continued aging and skin relaxation, these patients often developed the "Nike swish" wrinkle lines of the lower face. This two directional facial rejuvenation is limited in turning back the clock. It makes people look different, but not younger.

Around 2000, the concept of volumetric rejuvenation was introduced. The face is three dimensional and it was realized that returning to a youthful facial volume and contour is more important than removing wrinkles and flattening of the nasolabial folds. Aging happens in all layers of the face; skin, fat, muscle and the underlying skeleton. A lot of techniques (minimal incisions, endoscopic, etc.) were developed from deep subperiosteal (on top of the bony skeleton) dissections to more superficial techniques involving minimally invasive superficial suture suspensions (Quick lift, Lifestyle lift, Thread lift, etc.). The former give excellent long lasting results at the cost of prolonged postoperative recovery and swelling, and the later give you quick results with variable improvements that last a short time. Many of the suture suspension techniques mentioned are franchises and these techniques are taught at seminars to any M.D. not necessarily with a surgical background.

Plastic surgery's quest for the "ultimate facelift" over the past century was a journey that started at the skin level, with better understanding of the facial anatomy progressed to more involved and complicated procedures, from two dimensions to three dimensions and more recently back to more superficial techniques. A lot of ancillary techniques are used concurrently, including fat grafting for facial volume, laser skin resurfacing to remove wrinkles and tighten the skin.  Rejuvenation of the aging face is both a craft and art based on sound surgical principles that have evolved over time in the hands of pioneering plastic surgeons. We do have a better understanding about soft tissue aging, bony changes and intrinsic and extrinsic skin changes due to gravity and time.

How does this tie in with a short scar facelift, you might ask? With the realization that volume shifting is more important than skin tightening and facial flattening and that gravity pulls downward and not backward, we started rethinking the placement and length of the incisions as well.  The purpose of a skin incision is three fold: gain access to the surgical field, to redrape and to resect excess skin. Since volumetric correction is more important than skin excision, the next step was to try to obtain similar results as with the standard long incisions.

The S-lift was one of the first short scar facelift techniques which removed a small predetermined amount of skin in front of the ears and used minimal suture suspension. The S-lift produces variable results, will not affect the jowls and neck significantly. It is best in the younger patient. A further development from this is the MACS lift (minimal access cranial suspension). The scars are kept as short as possible, I use strong suture suspension of the SMAS, which is not undermined, but accordions the tissues to enhance the volume of the cheeks. It is a purely vertical vector pull and the facial soft tissues are anchored to the strong temporalis fascia above the cheek bones. There's minimal skin excision, no earlobe distortion, no scars behind your ears, removal of the jowls and overall natural improvement of the neck lines. You do not end up with an "operated look"! You have to remember that a short scar facelift is not a classical facelift with a short scar. The volume shifting is purely vertical and the skin redraping is in the same vertical direction. The recovery from this procedure is significantly faster, minimal to no risks of nerve injury and the stigmata of the classic facelift. Today's facelift is not your mother's facelift. These newer approaches can turn back the clock and give you a more youthful look and not make you tight, flat faced and different, so even your pet has difficulty recognizing you.

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