As we age, there are several constants that will occur in everyone’s face. The bottom half of the face gets heavier as jowls appear along a once smooth jawline and the neck angle drops. To counteract these aging concerns, the traditional facelift has been around for nearly a century. One popular trend in facelift surgery over the past decade has been the emergence of smaller variations that employ lesser lengths of incisions and resulting in less scar. These newer limited facelifts have become known by a lot of names due to marketing efforts such as the MACS lift and short scar facelift to name just a few. Most of the catchy names imply a faster procedure that has less recovery. But in the end, they are all part of a larger family of ‘Mini-Facelifts’.

How do these these smaller facelifts manage to remove those jowls and tighten up saggy neck skin with less scar? The reduction in scarring occurs at two specific locations along the temporal and occipital hairlines, allowing no scar to enter either area. What is the relevance of having less scarring around your ears? The avoidance of visible scars is one obvious benefit. But an equally relevant issue is not having hairline displacement which can be just as distracting as that of wide scars. When a facelift incision runs vertically up into temporal hair-bearing skin, skin flap movement will almost always displace the sideburn or preauricular tuft of hair upwards. When the incision behind the ear extends into the occipital hair, an unnatural notch in the hairline may become may be visible in short haircuts or if one wears a pony tail.

In mini-facelift versions, the incision does not go past the top of the ear or much beyond the earlobe at the bottom of the ear. Between these two points, the incision snakes along the line between the front of the ear and the face ducking in behind the tragus (bump of cartilage in front of the ear) along its ways. By keeping the incision limited to these ear points, less scarring is created and the temporal and occipital hairlines are not abnormally displaced. This allows one to wear their hair any way they want without having obvious signs that has had a ‘facelift’.

While the appeal of less scarring and a smaller procedure is significant, a mini-facelift is not for all jowl and neck aging concerns. As people today are seeking improvements at ever increasing younger ages of age 45 or 50, the size of their jowls and how much their neck skin is sagging is less than those age 60 or older. As a result a younger person needs less of a facelift than those that are older. These procedures help create a smoother jawline, soften deepening nasolabial folds and help restore a curved or more inverted triangular facial shape. In greater amounts of facial aging, a mini-facelift is not as good as improving the significantly droopy neck as that of a traditional facelift. This is why older patients with more advanced neck problems have to accept the trade-off of greater scars from more extensive facelifts.

These mini-facelifts can be combined with other limited procedures for improvement in the rest of the face as well. Such procedures as neck fat removal by liposuction, removal of excess upper eyelid skin and lower eyelid bags and skin refreshening through laser or chemical peels, that tired aging look can be reversed in matter of hours.

Dr. Barry Eppley

Indianapolis, Indiana

Background: The signs and progression of facial aging are well known and fairly classic. Due to gravity and the loss of the attachments of the skin to the underlying tissues and bone, the skin of the face descends. With it comes fat which is attached to the undersurface of the skin. This appears early on as a wad of tissue along the jawline, known as jowls. With jowling appears a line or fold in front of them on both sides of the face which comes down from the corner of the mouth, known as marionette lines.

Appearing anytime as early as the mid- to late 40s, jowls are the aging findings on the lower face that many people notice first. Accompanying the jowls may be, and eventually will be, some loose neck skin below the chin. The combination of jowls and neck sagging is the motivation that will drive many people to consider some form of plastic surgery correction.

The plastic surgery procedure to correct jowl and neck aging is a facelift. This is a surprise to many patients as a facelift is usually considered to be a ‘full face’ operation, extending from the scalp down to the bottom of the neck. This is an understandable misconception as the face does extend from the forehead down to the neck. But a facelift operation in the truest sense of the word affects only the lower third of the face, the jowls and the neck.

Case Study: This 62 year-old female from Indianapolis Indiana was bothered by her sagging jowls and dropping neckline. She has undergone in the past year the removal of basal cell carcinomas on one side of her face. These removals left her with some differences in the amount of jowling on the sides of her face with the left side having less jowling than the right side. This jawline asymmetry was also a motivation to have a lower facial correction as well.

Under general anesthesia, she had a lower facelift procedure. Initially liposuction of the neck was done through a small incision under the chin. Then the facelift was performed using an incision in the front of the ears (but behind the tragus) that went around unto the back of the earlobes in the postauricular sulcus. Skin flaps were raised that extended to the nasolabial folds and down into the neck and back to just below the earlobes. The underlying tissue, known as the SMAS was elevated in front of the ear using multiple plication sutures to produce a lifting and tightening effect. The skin was then lifted up in primarily a vertical direction and draped over the ears, trimmed, and then closed with dissolveable sutures. No drains were used and a lightly compressive neck dressing was applied.

She removed the neck dressing the next day and showered and washed her hair. She did have some slight swelling in front of the ears and small bruises along the jawline that resolved completely by ten days after surgery. She returned to work comfortable in her appearance.

While there are many variations of facelift surgery, the most important concern to a patient is to have a procedure that matches their aging problem. In that regard, facelifts can be fundamentally divided into limited vs full varieties. As this patient illustrates, a limited type of facelift is ideal when the jowl and neck concerns are not advanced. This is usually used in younger patients (under 50 years of age) or in those older if their amounts of jowls and neck sagging do not warrant a bigger operation.

Limited facelifts have captured the public’s attention, largely due to how they are marketed and advertised. With numerous marketed names that sound quite catchy, they promise facial improvements with limited downtimes and rapid recoveries. That is true because they are limited facelifts and not extended ones. While there are attempts to differentiate these types of facelifts from each other, and they do have some minor technical differences, the reality is that these surgical maneuver differences have never been proven to make a difference in the outcome of their appearance or in how long the results will last.

Case Highlights:

1) The early signs of facial aging is the appearance of jowls and loose skin in the neck due to descent of tissues due to ligamentous laxity.

2) Limited forms of facelifts are used when jowling is the major facial aging issue to be improved. Some neck benefits are also obtained by the sling effect and with the concomitant use of liposuction.

3) Limited facelifts provide a rapid recovery and can be combined with any other number of other facial procedures such as eyelid and browlifts.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

As the face ages, so does the neck. For some, the neck is often one of the biggest areas of facial aging concern particularly as one gets older. The loss of the once smooth jaw line and a more well-defined neck angle are telltale signs of the effects of gravity and time. By definition, the use of the term ‘turkey neck’, which almost everyone knows what that means (as unflattering as it is), means an older neck problem as it implies a lot of loose hanging skin. This is usually seen in the 50+ age range and much more common in the 60s and 70s.

When the loose skin in the neck area makes up the biggest part of the problem, the options for treatment become surgical and need to be more aggressive to get a satisfactory result. Forget about non-invasive options or ‘lunchtime’ type procedures. These simply will not work no matter how they are marketed. If the neck and jowl problem is mainly fat, as often occurs in the younger patient, then fat removal methods alone will be successful. Whether it is non-surgical lipodissolve or surgical liposuction, good results can be had as the skin has the ability to shrink and tighten up. When the skin is loose and floppy, that is a sign that it has lost any ability to contract and fat removal methods alone with only be met with disappointing results.

With considerable excess neck skin, variations of a facelift procedure are what is needed. Using the term facelift for many patients is confusing as this procedure often conjures up images of extensive facial surgery throughout the whole face. In reality, a facelift only effects the neck and jowl area and will do nothing for the face above the jaw line. It is a poorly named procedure and a facelift should be called a neck-jowl lift. It is really less extensive and easier to go through than most patients actually think. There are many facelift names and procedures today but most of them are just variations on marketing and advertising.

In actuality, there are only two types of facelifts, limited and full. Which one is best for any patient is determined by the amount of loose neck skin that is present. If the loose neck skin is not extensive, a limited facelift may be enough as this lifts the loose jowl skin a lot and the loose neck skin a little. If there is a lot of loose neck skin, then a full facelift is really needed. This is the most powerful neck procedure and can produce some really dramatic results. The differences between the two are how much of an incision is needed around the ear and the number of days of recovery needed. (even though the recovery is really about how you look or a social issue, there is next to pain at all for either. To put a number to that difference, 4″ (limited) vs. 8″ (full) and 5 days (limited) vs. 7 to 10 days (full).

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

The concept of a facelift for many patients, initially, seems extreme. Prospective patients often have a vision of being swollen and bruised for weeks over their entire face. Such thoughts have driven some patients to other less or minimally-invasive procedures which are often inappropriate for their facial aging problem. They may have been less invasive and may have cost less, but the end result may have also been disappointing.

Some potential patients suffer two fundamental misconceptions about facelifts…what they are and what the recovery may be. Over half of the facelifts that I do are done in isolation without any other facial procedures. Some patients are only concerned about the appearance of their neck and are not concerned about their eyes, for example. If that is only what concerns the patient, then that is the only issue that needs to be addressed.

An isolated facelift, or a neck-jowl lift, causes none of the issues that many patients fear. There would be no swelling or bruising around the eyes. The neck and jowl line will have some mild swelling and bruising…but it will be painless as the neck and jowl skin are numb for several months after surgery anyway. The only discomfort will be around the ears where the incisions are placed. The ears will be tender for a week or two as these incisions heal. While I use a head dressing that wraps around the neck for the first night….with surgical drains… all of this gets removed the following morning. In limited facelifts, there is no further dressing needed. In full facelifts, a small neck strap is used for a few more days. Showering and washing one’s hair can be done the next morning. There is no concern about getting the incision lines wet. One can style and blow-dry their hair as they wish. Even with some mild swelling and bruising the neck and jowl already look remarkably improved.

Patient fears about facelift surgery are often unfounded.  As an Indianapolis facelift surgeon, I find taht when it is done as the only facial procedure, a facelift is much easier to go through than most envision. An improved understanding of a facelift and its recovery is helpful for patients to make better decisions and ensure a good return on their investment.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com/

http://www.ologyspa.com/

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

As we age, our face starts to show jowling and loose neck skin. This happens due to the pull of gravity on our facial tissues whose attachments to the underlying bones and tissues gradually loosens. While there are other signs of facial aging, these are often the most bothersome to many people. Most do not notice these facial aging signs that much until they see themselves in pictures from a side or profile view, to which they may be quite surprised that their neck or jowls looked ‘that bad’.

 
All facelifts are not done alike. Simplistically, they fall into two main categories….full and limited. The limited facelift has become quite popular and represents nearly 50% of all facelifts that I do today. The limited facelift goes by a lot of different names such as the LifeStyle Lift, Quick Lift, Swift Lift, S-Lift. to name a few of the most prominent and marketed. There are other names as well and there will be more marketed and practice-branding names in the future. But essentially they are all the same (despite what each may claim) with a few minor variations that quite frankly don’t mean anything to you as a patient nor to the long-term outcome of the procedure. The difference between a full and limited facelift is…..that the limited facelift is to no surprise more limited. Very little work is done in the neck area and the procedure and scar is isolated to in front of the ear. Mechanically, the upward pull of the limited facelift is fairly vertical as opposed to a full facelift which is closer to 45 degrees so that the excess neck tissue can be worked out behind the ear.

 
The result of a limited facelift is obviously less than that of a full facelift but the results in the jowl and upper neck area can still be quite impressive nonetheless. The key to a very satisfied outcome after a limited facelift is in proper selection of the patient. My approach in patient selection is that it is good for two types of patients. The ideal candidate is the ‘younger’ patient who has early onset or only a moderate degree of jowling and loose neck skin. These are the perfect patients for the procedure as they will get an ideal result. Furthermore, their ‘problem’ doesn’t merit a full facelift anyway. The other patients who can benefit are those whose jowl and neck issues are more severe, and they would get a better result from a full facelift, but they desire less of an operation for a a variety of personal reasons. As long as they can accept and have been fully apprised that the result will not be similar to a full facelift, they can get good results also. For these type patients, its all about understanding that the results are effort-driven. The less of a procedure you do, the less of a result you will get.

 
Unlike some advertised plastic surgery procedures, the limited facelift lives up to its hype. It is a 60 to 90 minute outpatient procedure that requires no drains or dressings. A good social recovery (how do I look?) does take only about a week. Other than some mild ear tenderness, there really is no pain. When combined with other facial procedures (which may require a more normal recovery), even more dramatic changes can be achieved.

 
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Besides patient misconceptions about what a facelift really is, patients are also unaware that there are different types of facelift procedures today. As part of a basic concept of ‘matching the solution to the problem’, a facelift procedure should match the degree of anatomic facial aging, age of the patient, what recovery a patient wants to go through, and how much they want to pay for what type of result. All of these considerations go into the decision as to what type of facelift should be done.

Today, facelift operations go by a lot of different names that are primarily marketing in origin. Essentially, facelifts may be dividied into two types, limited and full facelifts. The most popular and marketed facelift today is the limited facelift. It goes by a lot of different names such as short scar facelift, lifestyle lift, MAC lift, quicklift and numerous others, but in the end they are all really the same operation from a patient’s perspective. A limited or ‘mini-facelift’ is a scaled-down modification of a full facelift where the incision (scar) is restricted to in front of the ear only and the amount of skin raised up and ultimately trimmed off is confined to in front of the ear and down into the jowl area only. In many cases, liposuction of the neck is done with the limited facelift. This produces a nice change in the jowl and upper neck area that needs only a very short recovery. (less than a week) It can often be performed under twilight anesthesis as an outpatient procedure. It is best used in two types of patients, younger patients who have early signs of aging with only small amount of neck and jowl issues and the older patient (who really needs a full facelift for the best result) who does not want to go through a full facelift or, for medical reasons can not go through a full facelift…and is willing to accept as a trade-off a result that is less than that of a full facelift. In other words, someone who is willing to accept some modest facial improvement with limited downtime, costs, and risks of complications. When done with other procedures, such as blepharoplasty and chemical or laser skin peels, the results from a limited facelift are even better.

A full facelift still remains as the gold standard to which any lower facial procedure must be judged, whether that be a limited facelift, threadlift, or a non-surgical ‘liquid’ facelift. The best results in the patient with more advanced facial aging will always come from a full facelift. A full facelift is where the incisions (scars) run in front of and behind the ears for a more extensive lifting of the neck area. Once can not expect a limited facelift to produce the same result as a full facelift. Full facelifts, while sounding more ominous and extensive, do not require a significantly prolonged recovery. They add a few days to the social recovery aspect (up to 10 days to look socially good) but do not require weeks of recovery as many patients think.

Both full and limited facelifts are effective operations that have less recovery and discomfort than most patients think. Which facelift type is best for any patient is based on a thorough discussion with a plastic surgeon to balance the issues of how much solution is needed for the magnitude of the  problem.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

The sagging jawline is one of the first signs of sigificant facial aging. Occurring somewhere in the early to late 40s, the development of jowling begins which may be accompanied by looser skin in the neck and loss of the once-sharp neck angle. In seeing a lot of these early aging patients, they often are initially interested in non-surgical procedures such as threadlifts or device skin tightening. Their belief is that these non-invasive procedures will produce a good result but will not involve any ‘downtime’…..and are relatively inexpensive. At the very least, they definitely want to avoid something radical such as a ‘facelift’.
While most of these early facial aging patients don’t need a full facelift, they are completely unaware of the more limited facelifts options and that significant downtime is not needed. I find most patients don’t even have a good concept of what a facelift is and are under the misconception that it is a ‘full face’ procedure going from the top of the head down to the bottom of the neck with a month for recovery. And, they certainly don’t want that ‘operated look’. These patients require a good education as to a facelift, aka neck-jowl lift, is….which makes transitioning the discussion into the limited facelift options more understandable and appealing.

 From both a result and value perspective, limited facelifts are definitely superior to threadlifts or any form of external, non-surgical skin tightening. The limited facelift goes by a lot of different names such as a mini-facelift, S-lift, Quicklift, Swiftlift, EpiLift, etc. Despite the different names, the procedure is largely the same. It consists of neck liposuction in most cases combined with skin excision and tightening in front of the ear and some deeper tissue tightening. Given that the neck is not widely undermined, and often not undermined at all, the procedure is associated with less than one week of swelling and bruising. I find most of my patients truly look good in a week. Close inspection will reveal the incision into and out of the ear but it is not all that easy to see. The procedure does a beautiful job of lifting the jowl area, and when liposuction is done in the neck, some real neck changes can be seen as well. The limited facelift can be combined with many other less invasive procedures such as Botox, injectable fillers, and light laser skin resurfacing to enhance the overall effect. Much is made of being able to do this procedure under local anesthesia, but I prefer to do it under a general anesthesia. That enables the patient to be ideally comfortable and the procedure is done in a time-efficient manner.
The limited facelift was a procedure first introduced in the early 1900s and was used then because it was limited and surgery was very primtive at that time. The limited facelift is used today because it is a perfect match for early facial aging when more extensive procedures are not warranted or desired.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

The Role of the Limited Facelift in the Younger Patient

The last five years has seen the introduction and popularity of numerous non-surgical or minimally invasive techniques for facial rejuvenation. The list includes Botox, injectable fillers, skin tightening devices, and threadlifts. Each one of these techniques has carved out a niche amongst facial improvement methods, some far more effective than others.

From a simplistic standpoint, I like to think of early facial anti-aging procedures as central or lateral, in terms of the areas of the face where they are used. Botox and injectable fillers are widely used, effective and are essentally central facial treatment techniques. Both are used primarily around the eyes and mouth, central treatment areas. Skin tightening devices such as Thermage and threadlifts are used mainly in the neck, jowl, and brow areas, lateral treatment areas. Using this concept, clinical experience has shown that non-surgical methods work well centrally, but are less effective in lateral facial areas.

While I like the concepts of skin tightening and threadlifting, for many patients and their aging issues they don’t produce enough of an effect or last long enough to justify the effort. I have found that more limited types of facelifts, while it is surgery, produce much better results with really minimal recovery. Through limited incisions in the temporal hairline carried in front of and into the ear, the skin can be lifted and the underlying SMAS layer tightened. This produces a nice uplift of the jowl area and jawline and some tightening of the neck. In the younger patient with early signs of jowling and a looser neck, a limited facelift is a much better value than any other lateral non-surgical procedure. It lasts longer and has a more visible and immediate effect. The costs may be higher, but dollar for dollar, it is usually a better investment of your cosmetic resources. The intermittent use of limited facelifts ove the years may eliminate, or at least put off, the need for a more complete and extensive full facelift.

In the central face, however, the use of Botox and injectable fillers is unmatched by any type of more invasive procedure.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indian
Indianapolis