- To avoid high-forehead look of facelift, surgeon recommends making hairline-preserving, trichophytic incision
- Cosmesis is improved with technique borrowed from hair transplantation, assuring hair growth through scar postsurgery
"Contrary to what one may hear, there is no such entity as a "one-size-fits-all facelift," E. Gaylon McCollough, M.D., told surgeons attending the 2011 annual meeting of the American Academy of Cosmetic Surgery (AACS) in Phoenix.
The ideal facelift must to be tailored to the specific needs of the patient, keeping in mind that early in one's facelifting career, less can be more, Dr. McCollough says.
"To avoid 'career-killer' outcomes, it is better to aim for consistent base hits rather than a few home runs that are offset with an equal number of strikeouts," Dr. McCollough says. "Then, as experience mounts, surgeons can progress toward more aggressive techniques. However, the ideal facelift includes as much surgery as is necessary to achieve a natural-appearing result ... and no more." With that philosophy in mind, Dr. McCollough, founder of the McCollough Institute for Appearance and Health in Gulf Shores, Ala., used the time at the AACS meeting to present a series of tips for achieving predictably good results, minimizing complications and avoiding the telltale signs of surgery.
INCISION PLACEMENT A high forehead due to a raised hairline is one tip-off to a previous facelift procedure. To avoid that outcome, Dr. McCollough recommends making a hairline-preserving, trichophytic incision. Incisions are beveled so that hair grows through — and therefore camouflages — the scar. Hairline-preserving, trichophytic incisions not only preserve a natural appearance for the patient after the original procedure; they also set the stage for a better outcome after future surgeries.
"There are trade-offs to everything we do in cosmetic surgery, and any incision placed farther back into the scalp to lift the tissues of the face and neck will raise the hairline," Dr. McCollough says. "Although the cosmetic consequences may not be too significant for a primary surgery, we need to consider that patients are having facelifts at an earlier age and so may be coming back for a second and even third procedure over time. With each successive incision placed behind the trichial margin, the hairline will continue to move up."
During (left) and after forehead trichophytic incision. Note the hair growing through the scar postoperatively. (Photos credit: E. Gaylon McCollough, M.D.)
Cosmesis is improved using a technique borrowed from hair transplantation that assures hair growth through the scar postsurgery. Starting 1 mm into the hairline, the incision cuts across the follicles (not parallel to them) follows along the hairline and is beveled at the edges. Cutting in a slightly irregular fashion by following the hairline instead of moving in a straight line also helps to reduce scar visibility, Dr. McCollough says.
SMAS flap elevation (left) and SMAS flap suspension with upward and backward vector (right).
The incision is closed using stainless steel staples and by suturing between the staples with 5-0 plain fast-absorbing catgut in order to bring the skin edges together and further optimize scar cosmesis.