Mini-Facelift--Quick, Inexpensive, No Complications

These days, advertising your facelift is definitely not in. A team of facial plastic surgeons from Harvard Medical School have found that in the last 20 years, patients seeking facial rejuvenation surgery have new desires and expectations in their outcomes. Today's patients are looking for a natural result, attempting to avoid the "operated" look. In the era of minimal-invasive surgical techniques, aesthetic patients embrace smaller and less conspicuous incisions and expect procedures that are virtually absent from risk with short recovery periods. Additionally, patients may demand that aesthetic procedures be moved out of the operating room and into the office, thereby avoiding general anesthesia. An example of this new wave is the exploding popularity of local botulinum toxin injections for a temporary and subtle improvement of facial wrinkles.

To meet this demand, plastic surgeons have been zealously searching for new operative techniques in facial rejuvenation. In order to achieve a long-lasting result, more extended and aggressive facelift techniques were developed, namely deep-plane, composite and subperiosteal rhytidectomies (removing of wrinkles by excising skin). On the other hand, less invasive facelift operations promising a "quick fix" with an easier and shorter recovery gained popularity, a trend illustrated by procedures like the purse string plication of the superficial musculoaponeurotic system (SMAS), the mini-rhytidectomy and the percutaneous elevation of the malar fat pad.

The authors of a new study recently introduced minimal-dissection facelift techniques ("mini-facelifts") to their patients. The anterior mini-facelift, primarily designed to address the midface and jowl region, uses small incisions in the preauricular and temporal area. After elevation of subcutaneous skin flaps, the SMAS of the malar region is suture-suspended to the superficial temporal fascia. For patients with complaints about aging--predominantly in the neck area, the posterior facelift is offered which involves limited postauricular incisions with extensions into the occipital hairline. After flap elevation, the platysma was plicated to the mastoid region. Both of these mini-facelift procedures can be performed in an office setting under local anesthesia with minimal patient discomfort.

Success in aesthetic facial plastic surgery is determined by the overall satisfaction of the patient. The normal outcomes of patient expectations for head and neck surgery (swallowing, hearing, facial nerve function, voice complications, and overall survival) have little clinical importance for facial cosmetic surgery. Plastic surgery does offer a significant change in one's quality of life; to measure how surgical intervention meet patient expectations, the specialist often employs standardized questionnaires or instruments to evaluate patient outcomes has been accepted by the plastic surgery community. One such instrument, the Facelift Outcomes Evaluation (FOE) is a previously validated, procedure-specific quality of life instrument that rates the quality of life impact of facial rejuvenation surgery in three domains: emotional/mental, social/interpersonal and physical/facial appearance.

The FOE was used in this study to evaluate the outcomes of the mini-facelift procedures. The results identify the motivations and expectations of patients seeking minimal-dissection rhytidectomies in the form of anterior and posterior mini-facelifts. These findings offer an understanding of the goals, preferences and values of patients; the data will help to identify specific priorities associated with facelift procedures, therefore maximizing the quality of care. The authors of "Advantages of the Mini-Facelift from the Patient's Perspective," Frank P. Fechner MD, Babak Azizzadeh MD, Mack L. Cheney MD, and Ramsey Alsarraf MD, MPH, from the Department of Otolaryngology - Head & Neck Surgery; Massachusetts Eye and Ear Infirmary and the Department of Otology & Laryngology, Harvard Medical School, Boston, MA (Dr. Alsarraf is also with the The Newbury Center for Cosmetic Facial Plastic Surgery in Boston) will present their findings at the annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery http://www.facial-plastic-surgery.org/index.asp May 2-3, 2003, at the Gaylord Opryland Hotel, Nashville, TN.

Methodology: Between July 2002 and December 2002, 84 patients undergoing mini-facelift surgery participated in this study. In addition to demographic data, patients were asked how they heard about the mini-facelift procedure, who referred them to the Massachusetts Eye and Ear Infirmary and whether a traditional facelift was a consideration before pursuing the mini-facelift. In addition, the patients reported whether they underwent cosmetic procedures in the past. In particular, the nature of the previous procedure and the year of intervention were reported by the patients. In order to evaluate the mini-facelift's impact on the procedure-specific quality of life, patients completed the FOE during enrollment in the study.

Depending on the facial aging pattern and aesthetic goals, each patient was counseled towards one or both of two procedures: the anterior mini-facelift, designed to address primarily the midface and jowl region of the face, or the posterior lift, designed to address mostly the region of the neck. In addition, the patients were asked to rank the following six potential advantages of the mini-facelift in comparison with traditional facelift surgery according to the importance in their decision making: limited incisions, speedy recovery, decreased cost, fewer risks/side effects, no need for general anesthesia and a more natural result.

Results: Patients' age ranged from 36 to 82 years with a mean of 54 years. Analysis of the data indicated that the two most important positive attributes of the mini facelift were a speedy recovery and fewer risks and side effects (P < 0.0001). The hope for a more natural postoperative result and limited incisions associated with the mini-facelift were less important. Interestingly, the financial savings of the mini-facelift over a full rhytidectomy played the least important role and were important for only 18% of patients. Also, the avoidance of general anesthesia with a mini-facelift appeared to be an insignificant motivator for the patient. Interestingly, 62 perecent of patients did not consider traditional facelift surgery as an option at the time of consultation.

Conclusions: Patients especially liked the notion that mini-facelift surgery can be associated with fewer risks/side effects and that it allows a faster postoperative recovery. This demonstrates that the acceptable margin for complications in cosmetic procedures is extremely small. Also, in light of most patients' busy lifestyle, it is not surprising that a quick recuperation after surgery is of utmost importance. Today's professional lifestyle simply does not allow one to be out of business for multiple weeks in order to recover from aesthetic surgery. Despite the less dramatic improvement and decreased durability of the mini- versus the traditional facelift, many patients are willing to trade these shortcomings with a safer procedure that allows a faster return to an everyday activity level.