Orlando, Fla. — As the
minimally invasive facelift procedure is becoming readily
accepted as a popular alternative to the traditional
comprehensive approach, patients are anticipating the same
results from the less invasive procedure — a misunderstanding
that may lead to dissatisfaction.
"Novice facelift surgeons
need to be careful to not use these minimally invasive
procedures as a panacea or 'one-surgery-fits-all' treatment,"
Joe Niamtu III, D.M.D., tells Cosmetic Surgery Times.
"Performing a small
procedure on a patient who needs a big surgery can lead to a
disappointed patient who will be more than happy to discredit
the surgeon's ability."
While not a new procedure,
with the first form of a mini-facelift described in 1919 by
the French surgeon Raymond Passot, today's most utilized
counterpart is the anterior-incision-only facelift (AIOF).
This "half-of-a-facelift" approach is designed for those with
mild to moderate mid-facial and jowl aging without extensive
Most importantly, the
anterior-only approach is for patients in their fourth or
fifth decades who need minor to moderate changes and
improvements, according to Dr. Niamtu, a cosmetic facial
surgeon in Richmond, Va.
"For patients with advanced
aging who opt for the conservative procedure, I further
explain that the results from the mini-facelift will not be as
dramatic as a conventional facelift, and they will not last as
long," Dr. Niamtu says.
The movement toward
conservative procedures with less recovery time has fueled the
popularity of the anterior-only facelift. Advances in
anesthesia, instrumentation and technology and the trend for
accredited office-based surgery centers have helped simplify
the surgery. Yet the most important part of the minimally
invasive approach remains patient education.
appointment is the most important time spent with a patient.
It is imperative to listen and to educate them on the various
surgical alternatives," Dr. Niamtu says. "My patients who are
undergoing minimally invasive facelift surgery must also sign
a special form entitled 'What Your Facelift Won't Do.' This
form underlines my preoperative conversations, reminding the
patient that they are undergoing the most conservative of
facelift procedures, and the results cannot and will not be as
dramatic as larger procedures and will not last as long."
With a basic protocol, the
anterior incision is also combined with adjunct procedures
including liposuction to the submental and jowl areas, SMAS
plication or, more commonly, SMASectomy, and suspension of the
"I rarely perform midline
platysmal plication in this patient group, but they are
usually excellent candidates for malar and/or chin
augmentation," Dr. Niamtu says. "It is the combination of
these small techniques that makes a dramatic difference with a
conservative procedure like the anterior-only approach."
Details for success
The proper technique
underlies a successful anterior-only facelift. By
"pretunneling" the area to be undermined with a
micro-liposuction cannula, the surgeon is better able to
define the correct plane and facilitate the scissor
dissection. Beginning in the temporal tuft area, an incision
is made several millimeters into the hair.
"I feel it's imperative to
preserve the temporal tuft and not utilize a superior temporal
incision, which can elevate the sideburn and leave a telltale
sign of a bad lift. I continue this incision inferiorly and
typically use a retrotragal approach to hide the scar," Dr.
Niamtu says. "Since recreating a natural tragus is an art,
novice surgeons may want to use a preauricular incision, which
is faster and easier and avoids a tell-tale blunted tragus."
In order to better manage
tissue bunching that occurs with anterior-only approaches, a
small posterior auricular extension is necessary. Although a
small 90-degree incision over the mastoid area is often used,
this approach may also result in unsightly and
difficult-to-conceal scars, according to Dr. Niamtu.