Facial Surgery

My Philosophy on Facial Rejuvenation

My preference for facial rejuvenation is mini-incisional to get a natural restoration with minimal scarring and downtime. Unfortunately, the term “mini-incision” is confusing because it has two meanings:

What is minimal incision facial surgery?

# 1: Endoscopic full facelifting of the upper, mid and lower face can be done through SMALL 1/2” to 1” INCISIONS PLACED INCONSPICUOUSLY IN THE SCALP. This is done using a tiny fiber optic lens attached to a camera and television monitor to allow visualization during surgical manipulation. Through these four or five incisions, tiny scissors, elevators, and sutures are passed and manipulated internally while the physician views the surgery on the TV monitor.

# 2: For older patients with more lower facial ptosis and neck fullness, MINI INCISION LOWER FACELIFT surgery is also used to describe SMALL S-like incision around the ear (1/2 the size of the traditional scar with nearly equivalent results.)

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Am I a candidate FOR MINI-INCISIONAL FACELIFTING?

The endoscopic full facelift is great for the younger patient with early facial ptosis (drooping) where the removal of excess skin is not required. This is excellent for elevating, recontouring and smoothing out facial tissue.

For the 50-year old plus patient with a full neck, the upper and mid-facial ptosis can be corrected with the endoscopic technique but the lower third of the face and neck may need to be rejuvenated with a small mini-incision S-lift facelift procedure.

The results of the endoscopic facelift or mini-incision facelift surgery are optimized with laser skin resurfacing and/or fat transfer to help tighten and reinflate the face.

A review a photographs from your 20’s and 30’s helps Dr. Hughes determine the best choice with you.

WHAT AREAS OF MY FACE ARE IMPROVED WITH A MINI-INCISION ENDOSCOPIC FACELIFT?

Facts:

First know that the face is divided into thirds.

1. The UPPER THIRD= forehead, eyebrow, upper lids.

   This is lifted with an endoscopic browlift to elevate the forehead, the eyebrows, and the eyelids, and reduce the crow's feet and the frown lines. Because this raises drooping eyelids, in many cases this browlift postpones the need for an upper lid blepharoplasty or eyelid surgery.

2. The MIDDLE-THIRD= lower lid, cheeks, jowls. This is rejuvenated with an endoscopic mid-facelift.

   Endoscopic mid-facelift: The mid-face begins where the lower lid and cheekbone meet and goes down to the nasolabial fold area. A mid-face elevation lifts the sagging skin and cheek fat and reduces the nasolabial fold and the jowls, and lifts up the corners of the mouth.

   Contrary to what patients expect, the mid-face will not elevate with an incisional facelift and must be done with a superolateral vector endoscopically. Attempts to fix the aging changes in this area with traditional facelift gives the face a windswept look. The endoscopic mid-facelift is usually performed with an endoscopic browlift, on an outpatient basis with local anesthesia and IV sedation, and takes between 1.5 and 2 hours.

3. The LOWER THIRD= jowls lower marionette lines, jawline and neck.

   This can be improved in younger patients endoscopically with only small scalp incisions.

   Endoscopic lower facelift: This is appropriate for patients with minimal neck banding and fullness and is done with an endoscopic upper and mid-facelift. It requires a more extensive facial dissection.

   Over 55 years of age, a neck lift with or without a mini-incision facelift is often added.

How do I rejuvenate the neck?

1. LIPOSUCTION alone is fine up to the age of 40.

   Over the age of 40, the loose neck bands will be revealed, so usually a neck sling is recommended.

2. An isolated neck lift (sling) this is for reduction of sagging neck tissue under the jawline only. This can be done as an isolated procedure with local anesthesia in about 1.5 hours. The necklift does not work if there is excess skin that needs removal. It works best in men who often need a chin implant at the same time, or in younger women who get fat transplants in their deflated chin, especially if they get an endoscopic facelift. Decreased scarring, numbness, hair loss and a quicker recovery are benefits of this procedure.

   * Most incisional lower facelifts (S-lifts) have a necklift added to insure longer lasting results with a nice neck angle.

   * It also can be performed in some women, but this is a more appropriate procedure for men with weak chins.

   It can also be performed with a total endoscopic facelift if the patient has minimal jowling and neck ptosis.
3. A MINI-INCISION FACELIFT (S-lift, "quick lift") is my preferred facelift for most patients, and is 1/2 the length of the usual facelift incision with nearly the same results. In most cases, a neck sling is added.
   This improves the neck, jawline, jowls and the lower 1/2 of the marionette lines. A lower facelift will not improve the upper marionette line, and it will not elevate the corner of the mouth, and will not improve the nasolabial fold. That entire area needs to be addressed through a more superior vector using the endoscopic cheeklift technique. This is the greatest misconception for all woman and men considering lower facial rejuvenation. The incisions are 1/2 the length of a traditional facelift and are hidden across the sideburns, in the ear wrinkles, and inside the ear. The best results are achieved in many cases with the addition of fat transfer, laser skin resurfacing, and the necklift if required.
4. An EXTENDED LOWER FACELIFT with the long incision is required for the rare patient with more than usual excess skin and laxity, and those with expectations for a tight look.

FOR THE BEST FACELIFT RESULT, THE ADDITION OF FACIAL FAT TRANSFERS, OR LASER SKIN RESURFACING CREATES A MORE NATURAL IMPROVEMENT.

Most patients get an endoscopic upper and mid-facelift before, during or after the lower facelift.

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