Short Incision Facelift Surgery
Video transcript: The next step in our step wise approach to the lower face would be the short incision facelift. What this entails is an incision similar to the S Lift, but the amount of skin that is elevated anteriorly is substantially more.
With this procedure, we want to perform skin elevation to allow access to the SMAS layer quite far forward in the face so that SMAS layer can be elevated in a powerful fashion to really correct the jaw line and the neck substantially.
The main risk of that is of course when we are lifting a larger skin flap to access the SMAS layer, there’s generally more bruising and swelling so the recovery time tends to be longer than a s lift.
The benefit however, is because we have such substantial access to the SMAS layer we can do a very powerful elevation of the jaw line and neck.
Who is a candidate for a Short Incision Facelift?
Patients who have early jowl formation or laxity around the jaw line, as well as patients with marionette lines or some laxity to their mento-cervical angle or obtuse neck angle.
Patients who are not a candidate for the Short Incision Lift are people with very poor neck angle. So even with the significant access to the SMAS layer with the short scar incision, we can’t necessarily pull the skin as tight as we might want to and in that case we might want to chose a different procedure.
This is a diagram of how a Short Scar Facelift would work.
So we have similar incision to the S Lift although we sometimes will extend it behind the ear a little bit more. That will allow for me to under mind the skin quite far forward and that is going to allow access to the SMAS layer so it can be suspended from quite far down. And this is a much closer location to the jaw, jowl, and neck line than with the S Lift, so you can get a much more powerful elevation as a result.
The steps to this procedure are of course, marking the incisions and making the incisions, elevating the skin flap forward towards the marionette line, exposing the SMAS layer and then tightening that substantially. And the tightening is done is a superior posterior direction so that not only is it pulling it backwards, but it’s also elevating it up and once that’s done, the skin is re draped and the excess skin that accumulates is removed, subsequent to that the skin is closed with dissolvable stitches and staples.
How is the SMAS layer tightened?
First of all it needs to be exposed through either a short incision or a long incision. We elevate the skin so we can see the SMAS layer which is here in yellow. The SMAS is then pulled upwards with stitches and now someone with a full face, what we will often do is actually excise some of the SMAS, take the layer that’s in front and pull it backwards.
In patients who have a thin face or have lost some of their facial fat will actually overlap the SMAS onto itself. So we’ll actually take the SMAS anteriorly and will fold it posteriorly and suture it in place. That not only tightens the jaw line and neck but also adds volume to the cheek area.
This is how the SMAS Ectomy works and this is when we remove the SMAS. So this yellow layer is the SMAS layer, that tissue is removed and once its removed we want to mobilize the SMAS layer anteriorly and bring it upwards in the direction that the arrow is pointing. So this front edge is pulled back to the posterior edge. In that way, the SMAS layer is not overlapped on itself so patients with a fuller face, we’re actually not adding extra volume by pulling that SMAS layer onto itself. How it’s done is it’s retracted upward and sutured into place.
So the risks of the surgery include bleeding, and infection, sometimes the wounds may not heal as quickly as we might like, occasionally blood can accumulate underneath the skin that needs be drained after the surgery. That is called a hematoma, fairly rare but that can occur.
We always ask that people take it fairly easy after the surgery, no heavy physical activity for at least 2 weeks. Most people can go out and do day to day activities after 3 or 4 days like shopping or going to a movie, but they will have to camouflage the surgery site by using a scarf or a hoody.
So we always want to think about the Risk Reward Trade Off and with this surgery I think the main risk is that we’re elevating a bigger skin flap, so more swelling and bruising, probably a slightly higher risk for hematoma and also the recovery period is going to be longer.
The big reward however is that we can substantially improve the jaw line and neck line through a short incision because of the substantial elevation of the SMAS layer.