With the large number of minimally invasive facelift techniques currently being offered by aesthetic practitioners, it is difficult to determine which techniques are fads and which ones offer the best results with minimal downtime. PSP tapped Howard A. Tobin, MD, FACS, a cosmetic surgeon at the Facial Plastic & Cosmetic Surgical Center in Abilene, Tex, to help distinguish the differences between the procedures and give the inside scoop as to whether they actually work.
PSP: How many years of experience do you have performing facelifts? How have the techniques changed over the years?
Tobin: I have been in practice since 1969 and have been exclusively practicing cosmetic surgery since the late seventies. I have been performing facelifts since 1972. Over the years, we have seen a great deal of change in our facelift technique. Initially, we carried out very simple skin flap facelifts. From there, we advanced to musculofacial plication.
About 20 years ago, we extended our technique to begin elevating the deeper planes, initially addressing the lower platysma muscle and, later, the upper musculofacial tissues of the midface. For the past 15 years, our standard technique has been to perform a biplane facelift unless patients undergo concomitant laser resurfacing, in which case we would perform a deep-plane facelift with much less superficial undermining.
PSP: What is the reason for more aggressive approaches to facelifts?
Tobin: We [physicians] are—and our patients are—relatively dissatisfied with the results of the more conservative techniques. I feel very strongly that the most substantial lift we can accomplish comes from mobilizing and repositioning and fixing the deeper tissues. I feel that any type of technique that depends primarily on simple plication or skin stretching results in a much more temporary improvement.
In essence, there is very little place for the minimally invasive techniques, at least in my practice. An exception to this is our recommendation for a mini-lift as a “secondary tuck” procedure.
We find that if patients come back about 2 years after their original facelift and undergo a very minimal skin-tightening procedure, there is a significant benefit. The reason this works so well is because there is an underlying network of scar tissue that has been developed by the initial operation. So we are tightening a firmer tissue than just the skin. I learned this technique from Frank Kamer, MD, many years ago, although my recollection was that he used it mainly as an early “boost” for patients who were not happy with the initial results.
PSP: What are some of the most popular minimally invasive or “lunchtime facelifts” that patients are seeking? How do they compare to one another?
Tobin: I certainly don’t claim to be an authority on the minimally invasive operations. In essence, they all represent a regression to the very early and, in my opinion, rather primitive, techniques of facelift.
The variations include a simple skin tightening combined with various types of either imbrication or plication. Over the years, these techniques have come and gone. And while many of them are touted as unique, they’re all techniques that have been practiced repeatedly over the years.
PSP: There is so much hype about these types of facelifts. Do they actually work?
Tobin: As to whether they work, the answer is yes, in the short term, but probably not in the long term.
Let’s face it: Anytime we perform a facelift, we are fighting the aging process. All of the techniques that we have today still leave something to be desired. All of the mini-facelifts that are being offered today suffer from the same problems that early skin-tightening facelifts suffered from years ago. They depend largely on the simple skin stretching. When we do our biplane facelift, all of the tightening comes from the deeper layers and the skin is merely redraped without any stretch. We seem to get longer-lasting results from this procedure.
PSP: What types of “corrections” can be made by performing minimally invasive facelifts?
Tobin: The mini-lifts do tighten the skin and do provide some minimal support through plication or imbrication of the deeper musculofacial tissue. However, what they lack is a mobilization, repositioning, and firm fixation of the deeper tissue, which is essential for the best possible long-term result.
PSP: Which of the minimally invasive facelifts return the best results?
Tobin: I doubt that any of them are much different from the other. They all are pretty much minimal approaches with minimal undermining, minimal deep mobilization, and simple tightening through stretching.
PSP: What is the estimated downtime with these types of facelifts?
Tobin: The touted benefit of the mini-lifts is quick recovery. However, with modern techniques of tumescent infiltration combined with careful dissection largely assisted by laser and electrosurgery, our patients undergoing a major biplane facelift usually are recovered to the point where they are comfortably able to go out into the public within 1 week. I doubt that the recovery is significantly shorter with these mini-lifts.
PSP: Why have these procedures become so popular among patients?
Tobin: I think they have become very popular largely because of massive advertising and marketing.
Many of these procedures are carried out through franchise agreements where relatively inexperienced surgeons are taught to do these limited techniques. In my practice, I have seen many patients who have been dissatisfied with the results of these operations.
This opinion is supported by some of the general Web sites that also report a high degree of dissatisfaction with these procedures. In particular, the lifestyle lift received so many adverse reports from one of the Web sites that one of the lifestyle-lift companies attempted to [sue] the Web site [to prevent it from] reporting its data.
If you Google “lifestyle lift lawsuit,” you will find numerous references to this. One site, realself.com, in 159 patient reviews reported that 60% were dissatisfied with the lifestyle lift. It was not worth it. I don’t think that many reputable cosmetic surgeons would stay in practice long if 60% of their patients were unhappy with the results.
PSP: What are the advantages and disadvantages of these procedures?
Tobin: They do not provide as long a lasting result as a real facelift. Presumably, they would cost less, but it seems that many doctors are charging as much for these mini-lifts as most cosmetic surgeons charge for a full facelift.
PSP: What types of patients are good candidates for these procedures?
Tobin: A good candidate for a mini-lift is someone who needs to get ready for a function in 1 week or so and is afraid of the recovery period that would be required from a full facelift.
In my practice, other than our recommendation for the secondary tuck, we do not recommend mini-lifts. Mini-lifts give “mini results,” and I always recommend that patients delay surgery until they feel they are ready for a real facelift.
I’m frankly disturbed by the degree of marketing that tries to encourage patients to have early facelift surgery. I feel that, in many cases, this is simply a marketing ploy. The concept of recommending a facelift at an early stage stating that it delays aging, in my opinion, is not based on any scientific evidence. It simply represents an effort to encourage patients to have surgery before they need it.
Rima Bedevian is a contributing writer for PSP. She can be reached at [email protected]