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Less-invasive surgery, fewer risks of mini-facelifts attract older patients


Patient demand - and age - are on the rise for minimally invasive facelifts. Older patients are willing to accept 'modest' neck tightening in exchange for less-invasive surgery and less risky anesthesia.

Key Points

Westwood, Calif. - Smaller incisions, quicker recovery and lower fees associated with minimally invasive facelifts have refreshed a procedure that was formerly the domain of "mature" patients, whose only hope of a more youthful appearance was in surgery that entailed significant recuperation time and financial investment.

The S-lift, the mid-face suspension lift and the J-lift are examples of mini-facelift techniques that are making inroads into the surgical repertoire of dermatologists who perform facial plastic and reconstructive surgery.

What is new here, according to Ronald L. Moy, M.D., is that in contrast to a few years ago, patients are coming in and requesting mini-facelifts, as opposed to first hearing about them in the physician's office.

Dr. Moy was recently elected to the board of directors of the American Academy of Dermatology.

Dr. Moy, who along with Edgar F. Fincher, M.D., Ph.D., edited the recently released Advanced Facelifting (Elsevier), says patients have been presenting in his office with requests for mini-facelifts or S-lifts, and the public awareness is probably due to the preponderance of promotion surrounding the "lifestyle lift."

"These mini-lifts can give patients as dramatic a result as the old-fashioned facelifts, and that's probably due to the fact that the tightening of the SMAS (superficial muscular aponeurotic system) can be the same as with a regular facelift. That is why the mid-face portion looks as good as with any other deep plane facelift," Dr. Moy says.

However, not all mini-facelifts are created equal. For instance, Dr. Moy says, when the SMAS is tightened with a SMAS-ectomy, the results are often better than some of the old methods of tightening the SMAS, such as with plication or with loop sutures.

"We have also found that it helps to tighten up the malar fat pad at the same time," he says.

Typical 'mini' patient

Until recently, the typical patient to opt for a mini-fact lift was in the 40-to 50-year-old age range. Today, Dr. Moy says, "We find that the overall population of patients is expanding. We used to say that it was mostly for young patients, because if a patient had a lot of neck sagging, a traditional facelift - which uses a large incision behind the ear - was required.

"But, we have now found that by pulling the vector up, we can get a fair amount of neck tightening without having to make the cut behind the ear.

"When that technique is combined with a submental incision and tightening of the platysma muscles through there, we can sometimes spare that behind-the-ear incision," he says.

"A lot of women still don't want the behind-the-ear incision because it shows up when they wear a ponytail or they wear their hair back, so often even older women will opt for this less-invasive technique even though they know that the neck tightening will be more modest than if they had a traditional full facelift," Dr. Moy says.

For additional rejuvenation, Dr. Moy adds laser resurfacing to the mini facelift.

"Originally we didn't think that that was safe, but we have found that conservative laser resurfacing works well, because you can improve the perioral and periocular wrinkles with a very natural-looking result," he says.

Combining the mini-facelift with laser resurfacing and then adding volume with fat injections or malar implants provides the total package to patients who are in the market for minimally invasive surgery with maximal results, according to Dr. Moy.

"You can use other dermal fillers to sculpt the cheeks, but we often do it with fat, because I think fat works well in this situation," he says.

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