Several different techniques are employed in modern facelift surgery today and aesthetic surgeons often walk a fine line when deciding which procedure to use and in which patients these procedures should best be employed. According to one expert, maximizing aesthetic outcomes while employing minimally invasive procedures is clearly the goal; however, depending on the age of the patient, certain procedures and combination of procedures can prove to be more advantageous than others.
“One of the primary goals when performing a facelift is to have the patient look younger while choosing minimally invasive techniques. Some patients require a single procedure to reach the intended cosmetic goal while others can benefit more from a combination of procedures, depending on the age of the patient and the condition of their skin,” says Alexander Kalantarov, M.D., chief of the Department of Plastic Surgery at the Caraps Medline Clinic, Tbilisi, Georgia.
The endoscopic facelift has become a very popular technique, as the scars left behind in the wake of the procedure are truly minimal, especially when compared to traditional facelift approaches. According to Dr. Kalantarov, this technique can be used in all age groups; however, the older the patient, the more additional procedures that may be necessary to achieve an optimal aesthetic outcome.
STUDY & RESULTS Dr. Kalantarov recently conducted a study in which he compared the aesthetic outcomes of combined endoscopic upper-mid facelift and short-scar cervicofacial rhytidoplasty in patients of three different age groups: 25 to 38 years (20 patients), 39 to 50 years (10 patients) and over 50 years (17 patients). A total of 25 patients underwent an endoscopically assisted subperiosteal facelift and 22 patients underwent combined procedures. Combined procedures included an endoscopic facelift and a short-scar cervicofacial rhytidoplasty that consisted of an upper and mid endoscopically assisted lift and inferior face and traditional SMAS-plasty elements with or without neck plasty.
All patients were content with their aesthetic outcome. In the 25 to 38-year-old group, a single endoscopic facelift proved to be sufficient in reaching the desired aesthetic goals of the patients. The 39 to 50-year-old group required an endoscopic facelift as well as other minimally invasive procedures including pinch blepharoplasty or a minimal neck lift using small incisions (maximum 2 cm long) placed near the earlobe or submental region. The over-50 group received an endoscopic forehead lift resulting in a total facelift with periauricular incisions approximately 15 cm to 16 cm long to satisfy their cosmetic goals.
“We generally expected the single endoscopic facelift to be sufficient in the youngest group as there is less sagging tissue to be lifted. For middle-aged patients up to approximately 50 years of age, I do recommend a combined procedure with a subperiosteal endoscopically assisted rhytidectomy in order to achieve the maximum aesthetic effect,” Dr. Kalantarov says.
OLDER APPROACH According to Dr. Kalantarov, older patients (over 50 years) require a combination of the endoscopic approach, lifting the forehead and periorbital region as well as the classic periauricular approach lifting the cheek and neck regions. He says that additional procedures are needed in this older age group because of the condition of their skin in terms of sagging, especially in lower parts of the face including the periorbital, cheek and submental regions.
Up to five years post procedure, none of the patients needed — nor requested — any additional surgical procedures. After five years, however, some of the patients requested cosmetic interventions such as dermabrasion, peels or other minimally invasive resurfacing procedures to maintain their appearance. According to Dr. Kalantarov, these additional minimally invasive rejuvenation procedures are expected in this older age group simply because the aging process does continue and these procedures are a way to maintain their results.
AT ANY AGE “When approaching the cosmetic patient, it is paramount that the plastic surgeon listens closely to the patient and understand what the patient really would like to achieve, thereby establishing clear and realistic aesthetic goals. Realistic expectations sometimes heavily depend on the experience of the surgeon as well as his or her intimate knowledge of the mechanics all of the facelift procedures and their association with the skin and subcutaneous tissues,” Dr. Kalantarov says. CST
For more information
Alexander Kalantarov, M.D.
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