Short scar facelift

Published on 22/05/2015 by admin

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Last modified 22/05/2015

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CHAPTER 9 Short scar facelift

Daniel C. Baker

History

The short scar facelift with lateral SMASectomy was developed out of a demand from younger female patients (aged mostly in their forties) who sought facial rejuvenation but were adamantly opposed to any scarring behind the ears. These patients objected to the posterior hairline distortion, hypertrophic scars, and hypopigmentation that they often observed in their friends or mothers who had undergone facelifts. They were embarrassed to wear their hair up or in a ponytail.

My first experience with short scar facelift occurred in 1990, when I operated on a young woman who had submental and submandibular fat and early jowling, but good cervical skin elasticity. I performed lipoplasty of the neck and jowls with wide subcutaneous undermining in the face, detaching the malar and masseterocutaneous ligaments. A pure skin lift was done with no retroauricular scars. The result was excellent, and this experience prompted me to adopt this procedure for all my younger patients with similar anatomic features.

In 1992 I began to incorporate the lateral SMASectomy technique to the facelift operation for women in their forties. I noticed that vertical elevation of the face had a beneficial effect on the cervical skin. Lax cervical skin was tightened because the soft tissues of the face and neck are linked anatomically. Between 1990 and 1998 I performed this operation, which had no retroauricular scars, on a total of 204 young female patients. The results were “ponytail friendly” for these young, active women.

Physical evaluation

See Figs 9.1–9.8.

Type I: The ideal candidate for short scar facelift

See Figs 9.1 and 9.2.

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Fig. 9.1 Presentation of a type I patient, an ideal candidate for minimal incision rhytidectomy.

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Fig. 9.2 Type I patient undergoing short scar facelift with plication only. A–C, Preoperative. D–F, 1 year postoperative.

• Age early to late forties, occasional fifties.

• Aging primarily facial.

• Early jowling.

• Slight cervical skin laxity.

• May have submental fat.

• May have microgenia.

• Good cervical skin elasticity.

• Physically active, wears hair up or ponytail.

Type II: The good candidate for short scar facelift

See Figs 9.3 and 9.4.

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Fig. 9.3 Presentation of a type II patient, a good candidate for minimal incision rhytidectomy.

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Fig. 9.4 Type II patient undergoing short scar facelift with plication only. A–C, Preoperative. D–F, 1 year postoperative.

• Age late forties to late fifties.

• Moderate jowls.

• Moderate cervical skin laxity.

• Submental/submandibular fat.

• May have microgenia.

• No active platysma bands.

Type III: The fair candidate for short scar facelift

See Figs 9.5 and 9.6.

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Fig. 9.5 Presentation of a type III patient, a fair candidate for minimal incision rhytidectomy.

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Fig. 9.6 Type III patient undergoing short scar facelift with open submental SAL, liposuction, plastysmaplasty and lateral SMASectomy. A–C, Preoperative. D–F, 1 year postoperative.

• Age late fifties to early seventies.

• Significant jowls.

• Moderate cervical skin laxity.

• Submental/submandibular fat.

• Platysma bands on animation.

• May have microgenia.

• Some secondary rhytidectomy.

Type IV: The poor candidate for short scar facelift

See Figs 9.7 and 9.8.

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Fig. 9.7 Presentation of a type IV patient, a poor candidate for minimal incision rhytidectomy.

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Fig. 9.8 A–F, Although this patient has a nice improvement after undergoing short-scar rhytidectomy, the 1-year postoperative result demonstrates persistent cervical laxity extending to the sternal notch. The patient was not happy and required neck revision with a classic retroauricular incision. This much cervical laxity can only be corrected with wide through-and-through undermining and removal of excess skin via the retroauricular occipital incision.

• Age late sixties and seventies.

• Significant jowls.

• Poor cervical skin elasticity.

• Skin folds below cricoid.

• Submental/submandibular fat.

• Platysma bands on animation.

• Deep cervical creases.

Technical steps

Incisions

When the temporal hairline shift is assessed as minimal, the preferred incision is well within the temporal hair. With this incision, it is often necessary to excise a triangle of skin below the temporal sideburn at the level of the superior root of the helix (Fig. 9.9).

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Fig. 9.9 Preferred and optional incisions for minimal incision rhytidectomy.

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