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Short-scar facelift presents safer alternative

Article-Short-scar facelift presents safer alternative

Boca Raton, Fla. — Short-scar facelifts benefit patients because they are safer and impose less downtime than traditional facelifts, says William Lindsey, M.D., who presented at the Combined Otolaryngology Spring Meeting here.

According to Dr. Lindsey, facial plastic surgeon, clinical assistant professor, George Washington University, Washington, "The change is more modest than a traditional facelift, but patients can be happy with the changes for the rest of their lives."

He adds that after undergoing the procedure, patients tell him they are asked if they have lost weight, changed their hair or been on vacation. "But (they) aren't usually asked if they had a facelift. ... The change is more subtle," he says.

Discussing a retrospective review of 500 cases of short-scar facelifts performed over an 18-month period with at least six months of follow-up, Dr. Lindsey says one of the keys to a successful outcome is the use of liposuction on the neck and jowls.

"Overall, you achieve a smoother look," he says. "There are very few cases where I don't suggest liposuction. The skin adapts well to the change."

Procedure details, results

The short-scar facelift involves peri-auricular incisions and sharp elevation of skin flaps. When liposuction is performed, Dr. Lindsey makes an additional submental incision and uses a blunt-tipped 4 mm liposuction cannulae in the neck and to clean SMAS and sculpt the jowls. In 132 cases, Dr. Lindsey also performed blepharoplasty or eyelid surgery on patients.

There were no cases of emergent postoperative bleeding or facial nerve injury. Suture extrusion was the most frequent complication. Four small, localized hematomas occurred, as did three hypertrophic scars behind the ear. Two of the patients responded to steroid injections while the other patient required revision. Overall, four major revisions and three minor touch-ups were required.

"The advantages include decreased risk to patients, decreased cost and decreased downtime," Dr. Lindsey says, noting patients wear a head wrap for a week if they have undergone liposuction in addition to the mini facelift.

"With the traditional facelift, it will be about two-and-a-half or three weeks before a person can go to a party. With the mini facelift and liposuction, it will take about a week before a person can go to a party; less, if liposuction is not performed."

Most patients do not experience much pain with the mini facelift, but patients are prescribed postoperative antibiotics for five days while patients who smoke are prescribed the antibiotics for seven days, Dr. Lindsey says.

Traditional facelift vs. 'mini-lift'

Indeed, patients who undergo a traditional facelift require general anesthesia, while patients who have the "mini-lift" undergo the procedure with only local anesthesia (lidocaine and epinephrine plus a tumescent solution if they are undergoing liposuction).

Patients may also receive a mild oral sedative when they are initially placed on the operating table. The mini-lift carries less risk of postoperative bleeding and infection, and the recovery period is such that patients can return to work in about a week's time without looking swollen or bruised.

Patient selection

Patient selection is an important factor in determining the success of the procedure, Dr. Lindsey explains. If patients have significant medical conditions or are heavy smokers, Dr. Lindsey says, they are undesirable candidates. A surgeon also needs to pay special attention to diabetic patients interested in the procedure, ensuring they have adequate glucose control and are being followed by an internist.

The ratio of female to male patients who undergo the procedure is about 20 to 1, according to Dr. Lindsey. The demand for short-scar facelifts is growing because of the quicker recovery. Moreover, there are concerns about general anesthesia. The popularity of makeover television programs has prompted inquiries about facial plastic surgery.

'Steep learning curve'

For the surgeon, there is a "steep learning curve" in performing mini facelifts, Dr. Lindsey says.

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