Mini-facelifts: Are they Quick, do they Suit your Lifestyle?

There's a lot of confusion amongst patients about the mini-facelift, especially when it comes to the various franchised varieties, such as the Quick-Lift, the Lifestyle Lift, the Smart Lift, the S-lift, and so on.

These are all variations on a similar theme:
a) somewhat shorter incisions, avoiding a little of the incision that goes behind the ear
b) some plication sutures of the SMAS* layer, rather than an actual repositioning of the SMAS layer
c) claims of quicker recovery
d) may use local anesthesia.

I do mini-facelifts. Sometimes. It's really great when you can get a good result with less surgical intervention. The key, of course, is knowing which patients would do well with just a mini-facelift technique, and which ones need the full face and neck lift. It's a bit like knowing which patients just need a mini tummy tuck, and which ones need a full tummy tuck. When I do choose a mini-facelift, I use a proven method, called the MACS lift, developed in Europe. It works well - for the right patients, usually those with early signs of facial aging.

I don't think I've ever run into a patient that says "Doc, just tighten my cheeks....I don't care about my jowls and loose neck." Most people would say "I want my jowls and neck fixed, too. Those drive me crazy!"

Secret #1: if you have more than just a tiny bit of neck looseness, it's not going to be corrected with a mini-facelift. You are going to need an extra step. This may be called different things at these franchised practices - a "neck-firming procedure", a "sub-chin tuck", an "optional necklift"...but you get the point. The Mini-facelift does not have the power to fix a loose neck.

Secret #2: If you have a lot of loose skin on the cheeks, especially down by the corner of the jaw, the mini-facelift may not work for you. Why? Skin re-draping. If you have a short incision length, there's only so much you can do to take in the skin, before you get puckering, weird-looking wrinkles, or are left with uncorrected loose skin. Just like tailoring fabric, if there's a lot of looseness, you need a longer hemline to make things smooth. And these problems don't go away with time, once you have them...

Secret #3: Sometimes you have to do more, to get more of a result. Less tissue manipulation may sound appealing, but only if the results are comparable, right??

As for local anesthesia versus I.V. sedation versus general anesthesia, that's a preference thing. I can certainly do a mini-facelift with I.V. sedation, but the anesthesia expense for the patient is the same as having general anesthesia - because the MD anesthesiologist is still there with the patient, monitoring all the vital signs, making sure the patient's airway is OK, and doing all the safety-oriented things that anesthesiologists do. You want that. Safety is, to borrow Ford Motor's old phrase, "job 1". I won't do a facelift under local anesthesia only - I think that would be against the "cruel and unusual punishment" section of the Geneva convention!

I have met a few patients that had previously had a mini-facelift done elsewhere under local anesthesia. Uniformly, they told me it was the worst experience of their life!

Finally, it's also about the choice of surgeon. When patients come to see me about a facelift, they see me personally. We talk in detail about their evaluation, and I recommend what I think is best for them. In me, they're getting an experienced Board-Certified Plastic Surgeon, who has completed a Fellowship in cosmetic surgery of the face. They're getting a surgeon who enjoys doing facelifts, and who wants each one to be a work of art. They know that I am personally responsible for every single suture. And that my team and I will be there to help them through their recovery.

You can't say the same about the various franchised organizations. Those are more of a hit-and-miss prospect.

But that's OK. Some people want a 5 star chef. Others are OK with fast food. Just don't confuse the two.



* SMAS: the layer of tissue between the skin, but above muscles and bone. It's a fibro-fatty layer, called the superficial musculo-aponeurotic system, and it allows you to lift cheeks and jowls without pulling so hard on the skin.

Mini tummy tucks - are you a candidate?

"Doctor, will a mini tummy tuck fix my tummy or do I need the full tummy tuck?"

The mini tummy tuck (abdominoplasty) is the smaller cousin of both the "regular" or the "extended" abdominoplasty. These latter two operations do have a longer incisional length, but are much more powerful in terms of skin tightening and muscle repair, so they give a bigger degree of improvement.

Like many things in life, it's a matter of "choosing the right tool for the job".

A mini-tummy tuck incorporates:
- a small amount of skin removal from the lower abdomen, with a scar similar to a caesarian section incision;
- repair of the lower half of the rectus muscles;
- possibility for some abdominal liposuction, if needed.

Unlike it's bigger cousins, a mini tummy tuck does not:
- move the umbilicus (navel). This means that tightening of the upper abdominal skin is limited.
- doesn't repair the upper half of the rectus muscles, so bulging in this area will remain.
- take care of loose skin near the hip bones.

So, if you have a small problem area of loose skin or separated abdominal muscles in just the lower, central zone of the abdomen, then a mini tummy tuck might work for you.

If, however, you have a lot of loose skin that you can pinch when you bend forward, and that loose skin extends towards the sides of your waist line, then you really do need a more involved surgery, because a mini tummy tuck will not correct these problems. It's just not powerful enough. You would be left with a tightened zone in the middle of the abdomen, but loose zones on each side if you had the mini abdominoplasty - which wouldn't look good.

About one or two patients out of every ten that I see are good candidates for a mini tummy tuck. The other eight or nine people need more work to get a nice looking result.