- Laser-assisted incisional technique is becoming more popular in cosmetic surgery
- The facelifting technique a surgeon chooses should be based on physician and patient preference, degree of skin laxity and amount of lifting required
Facelifting techniques have evolved over the years and are trending toward minimally invasive procedures with less downtime. New and innovative approaches, such as the use of laser-assisted incisional techniques, can be used alone or in combination with traditional or less-invasive short-scar facelifting techniques, optimizing aesthetic outcomes.
"It is the early days for this novel and still evolving laser-assisted facelifting technique; however, in the right hands, the aesthetic results achieved can be significant," says Patrick McMenamin, M.D., past president of the American Academy of Cosmetic Surgery, who is based in Sacramento, Calif.
Minimally invasive laser-based technologies are coming of age and are now being used as a minimally invasive surgical approach in cosmetic surgery. The laser-assisted incisional technique is quickly becoming more popular in cosmetic surgery because the results achieved can rival those achieved by more invasive surgical approaches, and in some areas, even surpass those cosmetic results achieved with traditional approaches. "Traditional and short-scar facelifts do not always adequately address certain areas of the face including the nasolabial folds, jowls, oral commissure and lower part of the lip. The laser-assisted technique can help lift and tighten these areas for more pronounced cosmetic outcomes," Dr. McMenamin says.
HOW IT'S DONE Under tumescent anesthesia, Dr. McMenamin typically will make four small incisions — one behind each earlobe and one at each lateral aspect of the submental crease, just inside the inner cortex of the mandible. Using a Blugerman rasp and 4 mm spatula, tunnels are created under the skin throughout the lower two-thirds of the face and neck. Specially designed cannulas are then inserted through the incisions and laser energy is applied within pre-marked multiple grids in the target areas.
In the laser-assisted facelift procedure, Dr. McMenamin uses Sciton's JOULE with its combined Nd:YAG 1,064 nm and 1,319 nm wavelengths. Many different laser manufacturers promote their technology and wavelengths used as the best in terms of inducing controlled trauma in the subcutaneous tissues. According to Dr. McMenamin, no singular technology or laser platform has yet scientifically proven its technology to be optimal for this indication.
"Using the laser-assisted technique, we can create trauma under the skin similar to the way you would in standard facelift techniques. In my opinion, both the mechanical and heat trauma that we exact in the targeted tissues and the ensuing healing ability of the body are what is in part responsible for the cosmetic outcomes achieved," Dr. McMenamin says.
Regardless of the laser technology used, it is important to apply the laser energy and heat the targeted subcutaneous tissues to a constant temperature ranging between 40 and 42 degrees Celsius. This subcutaneous heating will induce neocollagenesis and reorganization of the architectural structure of the skin, which can result in an aesthetically pleasing outcome.
A 69-year-old female patient before (left) and at age 70, 13-and-a-half months postop. The patient received Smartlipo (Cynosure) of the neck and as assistance for the face with facelift. (Photos credit: Robert H. Burke, M.D., F.A.C.S.)
"In essence, we are creating a traumatic wound, and it is our knowledge of the body's ability to heal and how it is going to heal that can potentially create positive aesthetic results," Dr. McMenamin says. "The premise is that the laser technology applied to the undersurface of the skin is easier and gentler on the tissue when compared to more invasive surgical approaches."