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 a small S-like incision around the ear (1/2 the size of the traditional scar with nearly equivalent results.)

Get more information on the mini-incision facelift.

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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 crowsfeet and the frown lines.
2. The mid-third (lower lid, cheeks, jowls). This is rejuvenated with an endoscopic mid-facelift. It is almost always done with an endoscopic browlift. This puts your cheek fatpads back where they were, reduces the nasolabial fold and the jowls, and elevates the outer corners of the mouth.
3. The lower face (jowls and jawline). This can be improved in younger patients endoscopically with only small scalp incisions. Over 55 a neck lift. Or usually a mini incision facelift is added. (see #5)
4. An isolated neck lift (sling) 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.
5. An advanced lower facelift is required for patients 50+ and requires mini-incisions around the ear (S-lift, quick-lift). Most patients get an endoscopic upper and midfacelift before, during or after the lower facelift.
6. The neck lift is usually done along with a mini-incision S-lift quick-lift.

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Am I a candidate?

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, the upper and mid-facial ptosis can be corrected with the endoscopic technique but the lower third of the face and neck should be rejuvenated with a small mini-incision S-lift -quick lift procedure.

The result 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.

The procedures:

• Endoscopic Browlift: This mechanically corrects loose skin and the droopy forehead and eyelid tissue, smoothes out the forehead wrinkles between the nose and crowsfeet area and raises drooping eyelids. In may cases this postpones the need for an upper lid blepharoplasty.
• 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 lift the corners of the mouth up, 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. This procedure is performed on an outpatient basis with local anesthesia and IV sedation and takes between 1.5 and 2 hours.
• Endoscopic lower facelift:This is appropriate for patients with minimal neck banding and fullness (see 5) and is done with an endoscopic upper and midfacelift. It requires a more extensive facial dissection.
• Neck Lift: 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.
• Small mini-incision (S-lift, quick lift) lower facelift: 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 address 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.

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The Bottom Line:

For full facial rejuvenation: the brows, the cheek, and lower face need attention with the appropriate lift. Adding fat to re-inflate the aging face and C02 resurfacing of the skin to smooth it out, creates the youthful three-dimensional restoration.

Mini-incision facelift surgery equals:

• Most natural-looking, youthful face
• Smaller incisions
• Reduced scarring
• Less hair loss and less numbness
• Quicker recovery
• Outpatient, IV sedation

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