Facelift Alternative, Facial-Lipo Lift

Posted on: November 4th, 2003 by California Skin Institute

New Orleans — The Facial Lipo-Lift, a new technique combining modifications of facial and neck tumescent liposculpture with a short scar facelift, provides a safe, effective, minimally invasive alternative to a traditional facelift, said Greg S. Morganroth, M.D.*

Presenting clinical outcomes for 40 patients followed over the past 14 months at the American Society for Dermatologic Surgery/American College of Mohs Micrographic Surgery & Cutaneous Oncology meeting held here in October, Dr. Morganroth said the procedure provides rapid recovery and possesses less risk of complications than a traditional facelift.*

“The Facial Lipo-Lift evolved from a combination of dermatologic surgery techniques and facial plastic surgery techniques,” said Dr. Morganroth, a fellowship-trained Mohs and dermatologic surgeon.* “Facial plastic surgeons were using the mini-facelift alone and dermatologists were using liposuction alone, and what I tried to do was to modify and combine the two techniques to achieve maximum benefit.”*

The short scar facelift portion of the procedure was modified from the facial plastic surgeons’ mini-facelift by extending the incision behind the ear.* This extension provides greater undermining and tightening of the skin along the jaw line and superior neck to a similar tension as a traditional facelift.* Instead of undermining the neck and excising skin in a formal facelift, the neck and jowl liposuction removes the fat and allows a natural retraction of the neck skin in patients with good skin elasticity, said Dr. Morganroth, clinical faculty in both the Stanford University Facial Plastic Surgery Fellowship Training Program and Harry Mittelman, M.D.’s Facial Plastic Surgery Fellowship Training Program.* “Based on the mechanics of the procedure, I anticipate a similar duration of benefit to more traditional lifting procedures, about 5 to 10 years,” he said.*

The Facial Lipo-Lift incision extending post-auricular also ensures that scars are hidden behind the ear, not at the base of the earlobe as in the mini-facelift or S-Lift, Dr. Morganroth said.*

When compared to the S-Lift, the short scar facelift procedure provides more pull along the jaw line and the upper neck.* “The advantages of this technique over the S-Lift are that you get greater undermining of the skin, more opportunity for plication of the SMAS both in front and behind the ear creating greater lift on the supportive structures of the face, and the scars resulting from reduction of the redundant tissue are placed in the post auricular crease,” Dr. Morganroth said.*

Clinical StudyOver 14 months, the Facial Lipo-Lift procedure was performed on 40 consecutive patients in a private practice setting in a Medicare-approved surgery center.* Patients ranged in age from 46 to 74 years (average 59 years) and were all female.*

The safety and effectiveness of the procedure were evaluated based on investigator observation and digital images, and patient satisfaction was measured with a questionnaire.*

Patient satisfaction was high with no episodes of infection, dehiscence, hypertrophic scarring, spreading of scars, earlobe alterations, hematoma, or nerve injury, reported Dr. Morganroth.* Patients, averaging 8.6 months after the Facial Lipo-Lift, reported an average of 88 percent (range 45-100 percent) tightening of the skin of the face and jaw line and 80 percent (range 25-100 percent) tightening for the skin of the neck.* Thirty-seven out of 40 patients would be willing to undergo the procedure again in the future.*
“For selected patients, the combination of tumescent liposuction of the face and neck followed by a short scar facelift under local anesthesia is a safe and effective rejuvenation procedure that serves as a minimally invasive alternative to the traditional facelift,” he said.* “Further long-term studies need to be conducted to fully evaluate its longevity compared to the traditional facelift procedure and to identify the best candidates.”*

Differs from a Traditional FaceliftThere are several features that distinguish this procedure from the traditional facelift.* They include: a shorter incision; the role of liposuction in sculpting the nasolabial folds, jowls, and neck instead of extensive undermining; the extensive placement of buried sutures along the entire periauricular incision; the use of local anesthesia with mild oral sedation; less risk; and a shorter recovery.*

The liposuction phase is distinguished from traditional neck liposuction in that sculpting is performed above the jaw line and extends to the mid-cheek and to the nasolabial fold, said Dr. Morganroth, whereas many surgeons stop the neck liposuction at the jaw line.* “Many physicians are sometimes apprehensive to liposuction the jowl area and the cheeks because of the concern for skin irregularity and nerve injury,” Dr. Morganroth said, “but I have found that I can consistently liposuction these areas and not have that problem by using small cannulae and staying within the adipose layer and avoiding rasping against the mandible.*

“In each patient, the ratio of liposuction to undermining is varied based on individual need.* In patients with fat deposits on the neck with good elasticity, liposuction will play the largest role in the procedure because the neck and lower face can be addressed by the less aggressive liposuction option.* In patients with minimal neck fat deposits but loose skin, undermining will play a larger role to achieve the desired outcome.* The Facial Lipo-Lift incision provides flexibility for a broad range of patients,” Dr. Morganroth said.*

Buried Sutures: It is common that cosmetic surgeons place few or no buried sutures in their facelift skin closure, Dr. Morganroth said.* He places 20 to 25 resorbable sutures in each incision to reappose the skin edges before adding sutures in the top layer of skin – using the same technique he uses for a facial reconstruction of a skin cancer defect following Mohs surgery.* “The multi-layer closure allows the scars to have greater strength and prevents dehiscence, delayed spreading of the scar, and hypertrophic scarring, which are possible complications of a lifting procedure,” he added.*

Ability to extend the procedure: “The traditional S-Lift involves an incision in front of the ear where you have already pre-calculated the preauricular skin that you are going to surgically excise,” Dr. Morganroth said.* A major modification of the procedure is required to get additional benefits.*

“The Facial Lipo-Lift incision extends from the sideburn to behind the ear.* The two advantages of this longer incision include: moving the dog ear from the base of the earlobe to behind the ear out of sight; and providing easy access to the neck for undermining to perform a mini-necklift in patients with loose skin, Dr. Morganroth said.* “By using the short scar facelift incision, you end up having a lot of flexibility during the procedure and can modify the procedure based on the individual patients’ needs.”*

Local anesthesia: The procedure is done completely with tumescent anesthesia and oral sedation.* Liposuction of the neck and jowls with local anesthesia is commonplace in many doctor’s offices, Dr. Morganroth said.* “The patients have minimal post-operative pain, minimal risk of bleeding, and do not require drains. Patients are returning to normal activity within a few days.”*

Limitations of the Procedure: The procedure will help the vast majority of patients unless they have excessive facial and neck droop requiring extensive undermining and plication, ptotic submandibular glands, other structural factors related to prior lifting procedures that require extensive undermining and redraping of skin to correct, or have unrealistic expectations for this minimally invasive approach Dr. Morganroth said.* “All Facial Lipo-Lift patients are acutely aware of the fact that this is a minimally-invasive alternative to a traditional facelift, not a replacement for the facelift.”*

This type of rejuvenation surgery is relatively new for dermatologic surgeons, Dr. Morganroth said.* “The strategy for dermatologic surgeons is to learn these techniques in a step-by-step manner under the mentorship of an experienced colleague or through cosmetic surgery courses followed by a mentorship.* The technical aspects of this procedure are contained within the surgical skill set that Mohs and dermatologic surgeons use every day.”*

by Coriene Hannapel

*Individual results may vary and are not guaranteed.