Long Incision Facelift
Video transcript: Earlier we discussed some of the other types of facelift surgeries. The last step in the step wise approach is a long incision facelift and this is for situations where people not only need elevation of the facial skin along the jaw line, but substantial tightening in the neck. With a long incision facelift we almost always perform a platysmaplasty as well. So, the platysmaplasty allows us to tighten the neck in the midline and then all that extra skin that accumulates can be pulled posteriorly and trimmed.
So the risk reward trade off for long incision facelift are such that the skin flap we elevate is bigger, so there’s going to be more swelling, more bruising. The risk of hematoma is probably larger again because the skin is elevated. This is what’s going to increase the risks of this procedure in comparison to an S Lift or a Short Scar Lift. Hematomas are a complication of facelift surgery and are not dangerous unless untreated.
The benefits however are pretty substantial. So in patients who have a very lax neck this really the gold(or goal?) standard for rejuvenating significant laxity of the lax skin. In addition to the platysmaplasty that we perform in the midline this skin elevation posteriorly that we do in the occipital hairline allows us to have substantial removal of excess skin. I think it’s a great procedure in people who need that.
I think one of the biggest differences in a short incision lift and a long incision lift is the extension of the incision back in the occipital hairline. In patients who want to wear a ponytail, I think sometimes the incision that goes back into the hair can be visible when wearing a ponytail, it’s a trade off. If a patient’s priority is to tighten the neck and if they have substantial looseness of the neck skin and the muscles of the neck, I think a full long incision face lift is appropriate. If they really can’t tolerate they’re going to have a scar there and they really want to wear a ponytail, then they can elect to have a short incision lift.
As long as they’re aware it probably won’t tighten in the neck as much.
So, who’s a candidate for a Long Incision Facelift?
As I mentioned before, someone with very prominent jowls, laxity of the jaw line, marionette lines, and a very poor neck angle because of substantial loose skin. I think in those patients the results are best if we can really pull that extra skin backwards into the hairline.
So here’s an example of a Long Incision Facelift in terms of the incisions and the flaps. So the incisions are very similar to the short incision lift except that we’re going to extend the incision into the occipital hairline. This allows for elevation of skin all the way down here and then all the way in front of the neck. So it also gives us a little bit more access to the SMAS layer so we can pull more of the SMAS posteriorly and superiorly and this is that incision line here that of course in a patient who is wearing a ponytail, they might be able to see that.
So the steps in the Long Incision Facelift are marking and making of the incisions. I will always perform a platysmaplasty with this type of surgery to really tighten the neck and the midline before I pull it laterally. The skin is elevated so I can access the SMAS. The SMAS is either removed partially or folded onto itself depending whether a patient has a full face or a thinning face and once that’s done the skin is re draped and trimmed so the extra skin is removed and then the skin is closed with staples and sutures.
Once the long incision facelift flap has been elevated it exposes the SMAS layer. So the SMAS is again in yellow and that’s marked, sometimes it’s cut and sometimes it’s folded onto itself. When it is cut, that section of SMAS is removed and then the anterior portion of the incision is pulled backwards and upwards to close that defect and subsequently pull the jowl and the neck, so that’s pulled in an upward direction and sutured into place.
So the risks and recovery with Long Incision Facelift, again probably the risks are slightly increased, bleeding and infection as well as poor wound healing, risk of hematoma is elevated with a longer incision. The more skin you elevate the better the results but the higher chance of things like hematomas or significant bruising.
The recovery time from long scar facelift again depends on the person but because there is more skin elevated there is more platysma tightened, usually the recovery is longer.
I often tell people they should take 2 or 3 weeks off after a surgical procedure like this.
When talking about the Risk Reward Trade Off with a long incision facelift again the risk are increased bruising and swelling, the recovery period is longer, the rate of hematoma is slightly higher. In terms of improvement, this is the procedure that gives the most substantial improvement to the neck line and the jaw line. And, in patients who are requesting substantial removal of skin or substantial tightening along the jaw and neck this is usually the procedure of choice.