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Facial Lipo-Lift Alternative to Traditional Facelift

Posted on: August 3rd, 2004 by California Skin Institute

Stanford, Calif. — The Facial Lipo-Lift is a minimally invasive procedure that can offer an attractive alternative to the traditional facelift for a wide range of patients, says Greg S. Morganroth, M.D., at “The First Step: Mastering Cutaneous Outpatient Procedures,” a continuing education program held at Stanford University.*

The Facial Lipo-Lift extends and combines facial rejuvenation techniques already being performed by dermatologic surgeons.* Done under tumescent anesthesia, it involves a short scar facelift, which is an extension of standard S-Lift incisions in length and breadth, plus extensive neck and facial liposuction. Depending on the patient’s features, an “extended” version can be performed that incorporates a neck lift, submentoplasty, and/or chin implantation.*

The Facial Lipo-Lift is associated with minimal downtime.* Typically, patients can return to work within a week.* Also, it results in a more natural, refreshed appearance, which in appropriately selected candidates approaches the aesthetic outcome of a traditional facelift but without the downsides of that procedure, says Dr. Morganroth, one of the course co-directors and a private practitioner in Mountain View, Calif. Dr. Morganroth also serves on the clinical faculty of the Stanford University Facial Plastic Surgery Fellowship Training Program.*

“Although dermatologic surgeons have been at the forefront of minimally invasive facial rejuvenation techniques in performing neck liposuction and mini-lifts such as the S-Lift and its variations, those procedures are generally limited to younger individuals in their 40s or early 50s presenting with mild aging changes.* The Facial Lipo-Lift targets a much larger and untapped population of patients with more advanced face/neck ptosis who would be candidates for a traditional facelift, but are not willing to undergo that procedure because of concerns about its associated risks, prolonged recovery period and need for general anesthesia,” says Dr. Morganroth.*

Stylistic differences The incision extends from the sideburn, around the ear, and two-thirds up the post-auricular crease.* As a consequence of its longer incision, the short scar facelift offers many advantages compared to the S-Lift, Dr. Morganroth says.*

Wider undermining and increased SMAS tightening can be achieved to address more advanced facial ptosis.* In addition, the postauricular incision enables access to the neck for patients undergoing an extended Facial Lipo-Lift, and allows the redundant tissue to be moved behind the ear so that the dog-ear created in the closure can be hidden in the postauricular crease.*

The short scar facelift also differs from the S-Lift based minilifts in that SMAS tightening is done in a vertical direction by pulling upward in front of the ear rather than in a lateral vector from the cheek towards the ear.* Consequently, laxity of both the neck and cheek are improved relative to the minilifts, but with minimal risk for the overtightened, overstretched appearance that can occur after a traditional facelift.*

Dr. Morganroth notes that he closes the facelift incision using multiple buried 4-0 Vicryl sutures and 5-0 or 6-0 nylon for the skin closure.* That approach is also in contrast to the closure technique used for traditional facelifts, which relies on staples and nylon sutures without many buried sutures.*

“In the absence of buried sutures, there is a greater risk of stretching or widening of the traditional facelift scar.* Using this multi-layered closure technique increases the likelihood that the incision site will remain as a thin line,” Dr. Morganroth says.*

In the liposuction portion of the procedure, the area of fat removal is extended above the mandible into the lower cheek and jowl area, as dictated by the individual’s needs, and occasionally into the nasolabial fold.* The neck liposuction is performed through submental and infra-auricular stab incisions using a 3mm spatula for sculpting.*

Next, the cheek, jowl and nasolabial folds are sculpted with a 16-g cannula, and a 20-g cannula is used for nasolabial fold sculpting.*

“By adding sculpting of the lower face, this extended liposuction procedure improves the jawline contour relative to the outcome of standard neck liposuction, and it reduces the potential for disproportionate jowl fullness that arises with time in some patients after standard neck liposuction,” according to Dr. Morganroth, who is also clinical assistant professor of dermatology, University of California-San Francisco, and a clinical faculty member in the Mittelman Facial Plastic Surgery Fellowship Training Program.*

The Facial Lipo-Lift is done under tumescent anesthesia and involves a short scar facelift, which is an extension of standard S-Lift incisions in length and breadth, plus extensive neck and facial liposuction.* Depending on the patients features, an “extended” version can be performed that incorporates a neck lift, submentoplasty, and/or chin implantation. Photographs courtesy of Greg S. Morganroth, M.D.*

Patients with wrinkled neck skin and platysmal banding additionally undergo a neck lift and submentoplasty.* In this extended procedure, the submentoplasty is done through a submental crease incision after the liposuction.* The short scar facelift design allows for access to the neck in the post-auricular incision for platysma plication and excision of excess neck skin.*

Low morbidity All patients who undergo the Facial Lipo-Lift develop temporary bruising, swelling and fibrosis, but other complications have been rare.* Over the past two years, Dr. Morganroth has performed more than 95 Facial Lipo-Lifts in various iterations without encountering any problems with wound dehiscence, nerve injury, asymmetry, infection, hypertrophic scarring, downward earlobe displacement or an overcorrected appearance.*

The only complications occurring were hematomas in three patients, all of which were successfully managed in the first week post-op, and compression garment-induced neck creasing in two patients.*

In response to those latter cases, Dr. Morganroth introduced a cervical collar into his post-op regimen.* Patients wear the collar for the first three days after surgery to keep the neck straight while the skin reattaches itself.* With use of the collar, no new cases of neck creasing have occurred.*

“The Facial Lipo-Lift is a local anesthesia procedure utilizing the standard surgical skill set of the dermatologic surgeon.*

“With proper training and mentorship, this procedure can be an important addition to the dermatologists’ cosmetic repertoire,” Dr. Morganroth explains.*

by Cheryl Guttman

*Individual results may vary and are not guaranteed.