In the past, facelifts were only skin lifts. It consisted in peeling off the skin with very large incisions that started in the temporal region, went down in front of the ear and then behind, up to the nape of the neck. All the skin was then peeled off and tractioned. However, with this lifting technique, large hematomas were produced and, in addition, when the skin was stretched, the sideburn was lost at the upper and posterior levels, and steps were created in the scalp that became very visible.
Large scars, the big problem with facelifts
Incisions were then made right at the hairline. The problem with this technique is that the scalp is much thicker than the skin of the face and, therefore, the scars that remained were very visible. In the nape of the neck, a broken scar was made and, in order to hide it in the hair area, zigzag scars were made when the skin was pulled forward. With these facelifts the sideburn was also lost and very large scars were made. It produced alopecia and the skin was very tractioned and unsightly and, in the long run, due to this traction of the skin, the ear was tilted forward. In addition, all the structures that were sagging, such as the platysma, the masseter or the facial muscles, after 2-3 years and due to the flaccidity of the skin, returned to the way they were before, but the scars did not disappear.
To palliate all this, the skin was also lifted, with wide scars, dissecting the SMAS (Superficial Musculo-Aparotic System). In this way, one centimeter below the zygomatic arch, the SMAS was detached from the whole cheek, tractioning it and doing the same with the skin, a posteriori. However, with this technique the scars are just as large, losing also sideburns and with the appearance of steps in the nape of the neck, with the advantage that the soft tissues are tractioned by the SMAS and, therefore, they are much more durable facelifts. The platysma is tractioned and the masseter as well. The problem with this technique is that the SMAS is an avascular tissue, resulting in artificial and very rigid lifts.
Minimally invasive facelifts, the current solution: without scars and with long-lasting results.
The third group, to which I belong, are minimally invasive facelifts. Within this type of liftings there are some that make loops in the cheek and neck (Tonnard technique), but has the defect that these loops have a traction, they are released and stop tightening.
My personal plastic surgery technique consists of making an inverted U flap over the parotid, so that, since the facial nerve is covered by the parotid, there is no risk of injuring it. When SMAS is performed, as described above, there is a great risk of facial nerve injury. In contrast, if the inverted U-shaped flap of the SMAS above the parotid is made, there is no risk of facial nerve injury. This exits from the stylo-mastoid orifice and passes under the parotid, branching to the forehead and to the orbicularis oculi and vacinator, as well as to the orbicularis labii and to the platysma.
Performing the inverted U technique in this SMAS, a single incision is made, detaching the skin only above the parotid. This inverted U is rotated and sutured behind the ear, at the mastoid, tracting the platysma. A small submental incision of 2 cm is also made, which is not visible because it is just at the ridge of the chin crease. It is then when the platysma bands are sutured in the middle part, and the lateral part is tractioned, which makes a hammock shape and the neck is completely at a right angle, keeping the submaxillary gland that sometimes is a little fallen. Subsequently, the area in front of the flap is sutured, thus tractioning the SMAS, correcting the nasolabial fold and the mandibular ridge. Finally the skin is tractioned, eliminating the excess skin but without reaching the sideburn or the scalp of the nape of the neck, leaving the scar imperceptible because it coincides with the incision of the ear with the face.
With this technique, when the central part of the face has been detached, fat can be injected by means of lipofilling, achieving an improvement in the quality of the skin, in addition to reconstructing the facial oval and filling the nasolabial fold. With lipofilling with stem cells a great repair is achieved, something that we explain in the book “Atlas Minimal Invasive Facelift”. The fat is obtained with a 10cm syringe and, with a couni cannula, small lipomas of 0.5mm are obtained, something called microfat. This is what is injected in the cheekbone to reconstruct the facial oval. This microfat is also transferred from one syringe to another 40 times to make the emulsion that is injected into the dermis to achieve a perfect mesotherapy, greatly rejuvenating the skin. In addition, the emulsion is passed through a filter that does not allow adipocytes to pass but stem cells, which are injected in the periorbital area to change the color.
With the minimally invasive lifting by tractioning the SMAS at the level of the parotid, suturing the platysma in the central submental part and the inverted U flap, a very good remodeling of the neck is achieved forever. If, in addition, we enrich the face with stem cells obtained from adipose tissue, we obtain a lifting with integral rejuvenation of between 10 and 15 years of duration.