"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 cervical aging.
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.
Approaching truthful results
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.
"The consultation 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 lateral platysma.
"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.