Okemos Michigan Plastic Surgeons Cosmetic Surgery Procedures

Minimal Incision Facelift & Necklift

General Information about Minimal Incision Facelift & Necklift

Background

For the last decade, particularly in Europe and South America, the traditional facelift has been a procedure of last resort. Nonetheless, many plastic surgeons in North America continue to recommend it as the primary surgery for rejuvenation of the lower face and neck. This is unfortunate for patients, because it limits their options and choices.

One of the most difficult concepts for all patients to understand about cosmetic surgery is that "more, longer, riskier" surgery almost always does not produce "better results." In fact, it usually is just the opposite.

What is a Small Incision Facelift?

A traditional facelift creates incisions of 5-9 inches, in front of and behind the ear, up along the hairline, and down along the neck hairline. The facial skin is pulled taunt, which can create abnormalities of the hairline and large scars. A small incision facelift uses a combination of a smaller incision to achieve the same, or an even better, result. Liposuction of the neck and lower face is always performed, through tiny (1 mm) entry points hidden in the neck and behind the ear. Occasionally, an incision of less than 1 inch may be made beneath the chin, to allow a chin implant and/or tightening of the neck muscles. For most patients, small incisions are placed in front of the ear, through which the neck and lower facial muscles are tightened. The vast majority of patients do not require removal of neck skin. Some patients are reluctant to have an incision placed in front of the ear. For some of them, liposuction of the neck and chin alone can provide enough improvement. (see our B& A pictures)

Certainly, a small incision facelift is not for everyone. It can be an effective, safe, comfortable, affordable, and extremely gratifying procedure for many patients with aging and fatty deposits of the lower face and neck. As always, the risks, complications, and results depend upon the technique, the anesthesia, the patient, and the surgeon.

What are the Advantages of the Small Incision Facelift?

Smaller incisions and scars, less skin removal, a more natural looking result.
Can be done under local anesthesia, in the office, avoiding general anethesia and IV sedation.
Avoids the "wind tunnel" look so common after traditional facelifts, even in Hollywood.
Provides improvement of the lower face and neck which equals, and is often superior to, the results of a traditional facelift.

While many of these techniques are not new, their use with facial liposuction is relatively uncommon in cosmetic surgery. For the moment, forget what you have seen on TV, heard, or read about the usual facelift techniques. These techniques have the following distinct advantages when compared to almost all previous facelift methods:

The results are usually very comparable to (or better than) an extensive, traditional facelift.
A "natural looking" result is created. No hair loss or other facelift "stigmata" are present.
Performed in an office setting, these are extremely safe procedures. Risks and complications are 1,000 to 10,000 less than traditional facelift techniques.
Systemic anesthesia and sedation (IV or general) are rarely used. IV fluids and medications are rarely needed.
Very small facelift incisions (2-2.5 inches) are placed at the ear lobe, hidden in skin creases. This avoids the traditional 5-9 inch facelift incision.
Dissection of the facial structures and skin removal are limited.
Blood loss is minimal, less than 1 teaspoon (5 ml.) Surgery is very gentle when compared to other techniques.
You are awake and relaxed. After a snack (if you wish) you are able to walk out of the operating suite and office and return home within 20-30 minutes.
Discomfort after the procedure is much less. Numbness may last for 6-10 hours. Many patients may not require prescription pain medicines. A facial "garment" is worn 24/7 for 48 hours, then at night for 5 days.
Swelling and bruising are much less.
In mid-Michigan, a traditional facelift costs between $6,300 and $10,000, without neck liposcution. We offer these techniques for $2,900 to $5,100, with very similar or better results, safer surgery, and faster recovery.
You may often return to work (and most normal activity) within 3-7 days.
Men and women ages 25 to 85, in good general health, have been safely treated.
Results may last 7-15 years, depending upon the person. The surgery can then be repeated, if needed.
Jowls, fat under the chin and/or on the neck, a sagging jaw line, and "waddle" or "gobbler" can be treated.
While many traditional facelifts do not even address the neck and chin, we almost always combine neck liposcution with the small incision facelift to create a wonderful improvemnt of the entire lower face.

Comparison of Facial Rejuvenation Techniques

Comparisons Traditional Facelift Small Incision Facelift Facial Liposuction

Incision Length 5-9 inchs 2-2.5 inches 1 mm

Where is Surgery Usually Performed? Office, Outpatient, or Hospital Office Office

Anesthesia Used General or IV Sedation Oral sedation & tumescent anesthesia Oral Sedation & tumescent anesthesia

Anesthesia Risk 1 in 2,000-5,000 1 in 100,000 or less 1 in 100,000 or less

Surgical Risk Moderately higher Moderately lower Markedly lower

Risk of Nerve Injury 3-5% 0.5% 0.2%

Bandages surrounding face Usually 24/7 for 1 week Garment for 48 hours Garment for 48 hours

Drains Usually Never Never

Liposuction of Neck Unusual Almost Always Always

Return to Work or Play 2-3 weeks 5-7 days 3-5 days

Cost $6,000 - $10,000 $5,100 (Trillium) $2,700 (Trillium)

What Causes Aging of the Lower Face and Neck?

Gravity, skin laxity and damage, neck muscle weakness, and fat distribution below the chin and beneath the upper neck muscles cause many of the aging changes which are most apparent. Sometimes, a genetic tendency for fat beneath the chin and in the neck cause the unwelcome appearance.

What About Fat in These Areas?

If you can "pinch" about 1/2 inch or more of fatty tissue below your chin, in your jowls, and/or in your upper neck, liposuction of these areas may be very beneficial. Sometimes, particularly in patients from 30-50 years of age, and those with good skin tone, this is all the surgery that is needed. Fatty jowls often respond very well to facial liposuction, restoring the "angle" of the jaw, which often disappears with age and fatty deposits below the chin. This is often combined with tightcan be combined with tightening of the neck muscles through a small (less than 1 inch) incision beneath the chin, hidden in a pre-existing skin crease. In some patients, chin enhancemanet with implant or fat grating may be suggested to enhance the results, and further tighten the skin.

Why is Liposuction of the Lower Face and Neck Used?

Liposuction allows removal of fat without large incisions. Unlike whole body liposuction, much smaller amounts of tumescent fluid are used. This allows surgery of the lower face and neck with a much greater margin of safety. Tiny liposuction cannulas are used, much smaller than those used on the body. Not only is neck fat removed, but the procedure allows the neck skin to "re-drape" in a flatter, tighter position, which is one of the major goals of the surgery. Liposuction of the face and neck is very safe., assuming that it is done correctly.

Can other surgeries be done at the same time as the small incision facelift?

Yes. Although many other surgeries can theoretically be done at the same time, too much additional surgery sometimes defeats the purpose of local anesthesia, which is a quicker recovery and less risk. Some surgeons remove "deep cheek fat" through the mouth, to "enhance" and "thin" the appearance of the lower face. I am not at all convinced that this will benefit the cosmetic result over time, and I will not remove facial fat much above the chin line. The following can be combined with a facelift:

Fat transfer to chin, cheeks, lips, other facial areas
Chin augmentation with fat or artificial implant.
Tightening of the neck muscles below the chin. Is sometimes beneficial.
A "mini-brow lift" can be done during this surgery.
Upper eyelid blepharoplasty.
Facial peels of different depths
Laser resurfacing

What improvements are not possible with the small incision facelift alone?

If the problem is loss of facial volume, a facelift will only make the appearance (above the chin line) worse
Improvement of fine lines and tiny wrinkles
Improvement of the brow and upper third of the face
Improvement of the eyelids
Significant improvement of the naso-labial fold (line between nostrils and corners of mouth)
Improvement of the lips
Removal of very large amounts of excess facial or neck skin

Possible Complications of the Minimal Incision Facelift

30% Dimple behind or below the ear lobe (resolves within 3 months)
8% Neck skin redundancy (usually in patients over 60)
3% Need for IV sedation during surgery
3% Prolonged bruising at the incision or in the face and cheek
2% Excess scarring in front of the ear
2% Abnormality of the earlobe and ear "curvature"
2% Excess scarring of the temporal hairline incision (above the ear)
2% Chronic pain & tenderness of the jaw and cheek (for more than 2 weeks)
1.5% Hematoma (blood clot in surgical wound)
1% Excess scarring under the chin
0.5% Infection of a chin implant, possibly with need for removal
0.5% Fistula of the parotid gland (may require further surgery)
0.5% Necrosis of the skin flap (skin "dies" near the ear incision, usually in smokers)
0.5% Facial nerve injuries (problems with facial movement)
0.5% Lip nerve injuries (problems with lip and mouth closure)
0.5% Keloid formation (patients at risk can usually be identified)