New Orleans — Less scarring, fewer complications and shorter recovery times are among the main reasons minimally invasive facelifts are growing in popularity. Surgeons are using various techniques to get the job done. At the American Society for Aesthetic Plastic Surgery's (ASAPS) Aesthetic Meeting 2005 here, a panel of doctors from various parts of the world met to talk about a number of different approaches to the surgery and to compare the benefits of each.
Renato Saltz, M.D., of Salt Lake City, generally uses endoscopy to rejuvenate the midfacial area. He uses a scalp incision and a fixation device to elevate the tissues of the cheek and support it from a temporal position behind the hairline.
"We've been able to avoid making an incision in the mouth. Anytime you can avoid an incision in the oral cavity, there is less chance of contamination and fewer problems," Dr. Saltz says.
Antonio Fuente del Campo, M.D., professor of plastic surgery at the Universidad Nacional Autonoma de Mexico, Mexico City, also uses an endoscopic approach with a novel incision inside the very front part of the ear.
Dr. Fuentedel Campo
"To make a full rejuvenation of the face, it's important to redrape and reposition the deep soft tissues — not just the skin. You have to detach the deep layer of the soft tissues from the zygomatic arch from the forehead to the neck. Then, move the entire long layer upward and redrape it."
He says this used to be done by making an incision in the bottom of the hair from one ear to the other. Later, it would be done endoscopically through a small incision in the hairline. Then, Dr. Fuente del Campo found a better way.
"I realized I could get closest to the zygomatic arch from the lateral end through the ear in just a 1.5 cm incision. It's an easy, fast, and safe approach that allows us to detach the structures and liberate them to be elevated to the new position," he says.
Minimal access cranial suspension
Alexis Verpaele, M.D., of Gent, Belgium, does the minimal access cranial suspension (MACS), with a shorter scar than a standard facelift incision. It is placed in front of the ear and doesn't go behind the ear at all but continues in front of the sideburn to the level of the eyebrow — about 8 cm to 9 cm.
Renato Saltz, M.D. uses a scalp incision and a fixation device to elevate the tissues of the cheek and support it from a temporal position behind the hairline.Photos: Renato Saltz, M.D.
Dr. Verpaele says the pull is directly upward to offset the pull of gravity downward.
"That gives a much more natural correction and allows us to repeat the procedure as the patient ages without ending up with a frozen, flattened look that often comes from a standard facelift."
Unlike the standard cable suture some surgeons use, Dr. Verpaele uses purse string sutures to grab the malar fat pad, which brings up the cheek.
"The technique has proven to be very powerful and provides long-term results," she says.
Because the skin is undermined in a very limited area, Dr. Verpaele says the procedure can be done comfortably under local anesthesia, the recovery period is short and works better for smokers than many standard procedures.