Background:One of the most common and bothersome signs of getting older is the discovery of jowls and loss of the once tight neck. This aging problem is surgically reversed by a facelift procedure. Contrary to the perception of many, a facelift only affects the lower third of the face by smoothing out the jawline and improving the jaw–neck angle.
Facelift surgery has undergone a revolution of sorts in the past decade based on how the procedure is done. Some of these procedures have become associated with catchy names that promise simple procedures and rapid recoveries. These are marketing monikers that describe a scaled down version of the full or traditional facelift. As the age of patients seeking facial aging improvement is getting younger, the amount of jowling and neck sagging is not as severe. As such, the extent of the facelift procedure should be appropriately less.
Despite the various marketing names, they all refer to a limited facelift which differentiates it from a full facelift. The terms limited vs full largely describe how much skin is lifted up and repositioned and removed. It also indirectly refers to the extent of the incisions needed around the ears. With a limited facelift, there is no need to have the incision extend up along the back of the ear and into the occipital hairline. With less of a facelift operation, there is also a more rapid recovery. But this should not be confused with the often marketed concept that there is no recovery at all.
Case Study: This 53 year-old female decided that it was time to do something about her tired appearance. She had noticed the development of jowls along her jawline, loose and droopy skin in the neck, and lines around the corner of her mouth. While she didn’t feel that it was that bad, she wanted to ‘nip the problem early’ so that she would never need a single drastic procedure that would be very noticeable to everyone. She was not concerned about any aging issues around her eyes or other areas at this time.
She underwent a limited facelift under sedation anesthesia. Initially liposuction was performed in the submental area under the chin. Incisions were then made along the front crease of the ear but inside the tragus. The incision extended along the preauricular tuft of hair (sideburn) in a zigzag fashion superiorly and around the earlobe inferiorly along the crease up the back of the ear. Skin flaps were raised down to the jowls and over the jaw angles. The tissue layer under the skin, the SMAS, was tightened by multiple dissolveable sutures to tighten the sagging jowl fat. The loose skin was lifted and raised up along the ears and the excess removed. The skin flaps were closed along the front and back of the ears with dissolveable sutures. Total procedure time was 90 minutes.
She wore a circumferential head/neck dressing for overnite and removed it in the morning. She could shower and wash her hair the next day. No further dressings or wound care was needed. She has some mild swelling and bruising for one week after surgery. Thereafter, while far from being completely healed, she could pass in public without looking like she just had surgery.
The scars from the limited facelift healed well and after three months could barely be detected, even under close scrutiny. The result looked perfectly natural as it is virtually impossible to have an unnatural look from a limited facial rejuvenation procedure.
Case Highlights:
1) The limited facelift, regardless of what marketing name it carries, is a facial rejuvenation procedure that has its primary benefit in elimination of the jowls with moderate improvement in the neck.
2) It has a more rapid recovery because the procedure is less extensive than a traditional facelift. It is still surgery with less dissection and elevation of skin flaps.
3) Any number and variety of other anti-aging procedures can be performed at the same time for a more overall facial rejuvenation effect. (e.g., eyelid tucks, laser resurfacing, etc)
Dr. Barry Eppley
Indianapolis, Indiana