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Surgeons share opinions about success with short-scar facelifts

Article-Surgeons share opinions about success with short-scar facelifts

Key iconKey Points

  • Shorter scars are appealing, but limited incision lines limit access to face and neck, and limit skin-excision options
  • Ideal candidate for short-scar lift has mild-to-moderate aging signs along mandibular line with mild or absent platysmal laxity and lacks a "heavy neck," surgeon says
  • Short-scar lifts have a place in the most conservative of aging, in patients with minimal neck-skin redundancy

Mike Nayak, M.D.
St. Louis

Dr. Nayak
"As a facial plastic surgeon, facelifting is a central part of my practice. When possible, I — and patients — prefer the short-scar techniques. Short-scar techniques generally utilize an anterior-only incision, or, less commonly, a posterior-only incision. While shorter scars are appealing, the limited incision lines themselves limit the access to the face and neck and also limit skin-excision options. Given these limitations, only about one in five patients is a good candidate for a short-scar lift.

"In my practice, a good short-scar lift candidate is a patient with excellent skin tone and elasticity who needs limited improvement of the jawline only, or a patient with excellent skin tone and elasticity in need of improvement of the neck only. The anterior-only short-scar technique allows for thorough treatment of the jowls with only modest neck improvement, and the posterior-only technique allows for excellent treatment of the neck with modest jowl improvement.

"Due to the shorter incisions, the vectors of skin excision are limited, and I must rely on the skin's elasticity to accommodate the excess in some dimensions. When elasticity is poor or skin quality is crepey, a full anterior and posterior incision approach allows for complete redraping and tailoring of this skin. On occasion, the degree of laxity and inelasticity is surprising intraoperatively, and I obtain permission from all of my short-scar facelift patients to convert to a full-incision technique if necessary during the surgery.

"Interestingly, as my practice develops, I find myself utilizing the short-scar techniques more infrequently. Well-healed incision lines are generally not cosmetically objectionable, and to achieve excellent redraping and incision approximation, it is often desirable to make longer incisions to allow for appropriate Burrow's triangle tailoring. While these longer incisions take longer to close, the access they afford generally lends efficiency to the deeper portions of the face- and necklift. Due to that efficiency, I generally find that the longer-scar approaches take me no longer to perform than the short-scar techniques.

"On balance, I find the best feature of the short-scar techniques to be their patient appeal, and it is for this reason I continue to offer them. In the appropriate patient, a short-scar facelift can create an amazing change, with less dissection and less recovery."

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