Short-Scar Face Lift (eBook)

This second volume on short-scar face lifting comes just 3 years after the publication of our debut volume on the MACS-lift short-scar rhytidectomy. In that short interval, the interest in less-invasive approaches to facial rejuvenation has grown exponentially with many new and exciting developments being reported by expert surgeons throughout the world. This new book seeks to build on that interest and to capture the contributions of other surgeons who share our belief in short-scar face lifting.

Thus this volume may be viewed as a companion to the first. It has its own unique characteristics and advances the concepts and techniques discussed earlier to a new level of understanding. What has become clear in writing this book is that the MACS-lift technique remains as beneficial and relevant as it was when we first described it in 2002, and we continue to fully endorse all of the principles developed in the first volume. Additionally, thanks to interaction with colleagues worldwide during many international meetings, we have come to recognize that many surgeons’ ideas about the concept of facial rejuvenation and the ways to achieve it tend to converge. The trends in face lifting seem to focus on volume restoration, vertical vectors, limiting complications and face-lift stigmata, shortening downtime, and optimizing the risk/benefit ratio. Furthermore, it has become evident that the combination of different simple and effective surgical and nonsurgical approaches seems to work synergistically to deliver a result that is more than the sum of the contributing factors.

We remain convinced of the necessity of a patient-oriented approach to facial rejuvenation, paying close attention to the patient’s individual needs and aging patterns. We must move away from a reliance on a standard recipe for facial rejuvenation. We now have tools that allow us to “treat” patients from age 30 to over 80 with more subtlety and flexibility rather than relying on the traditional reflex of “face-lift plus upper blepharoplasty.” Botulinum toxin, fillers, nonablative photorejuvenation, radiofrequency, and other nonsurgical techniques offer interesting options for refining our approach to facial aging. Although all of these techniques have temporary and limited results, they are enormously appealing to the public because of their minimal downtime with reduced complications. It is therefore imperative for us to limit the downside of operative procedures while preserving their validity through effective and long-standing results. Obviously, the outcome of a rejuvenating treatment is not solely technique dependent. Correct preoperative aesthetic analysis is the key to determining the best techniques for achieving the desired result.

We believe that these two volumes contain valuable information for any surgeon involved in facial rejuvenation. Short-scar face lifting is a concept that is rapidly gaining popularity among facial aesthetic surgeons, and which is in need of in-depth analysis and detailed teaching. Hopefully these books will help to lower the threshold for performing minimally invasive face-lift surgery for young, inexperienced surgeons while providing technical pearls and insights to experienced surgeons who are accustomed to their established techniques. Correspondence from our colleagues reports shortened downtimes, improved natural results, and enhanced pleasure in operating after adopting some or all of the concepts of the MACS-lift and other short-scar face-lift techniques. It is our hope to convey some of this enthusiasm to our readers.

Volume II is a multiauthor work with contributions from eminent plastic surgeons dedicated to this field of work. The time was ripe for bringing together the ideas of different experts who, although they have various viewpoints and approaches, are all thinking in the same direction.

The book is divided into two parts. In the first part, the subject of short-scar face lifting is approached from different angles. We begin with a chapter on the power of short-scar face lifting in which we make the case for this approach to facial rejuvenation and explain the rationale behind the short-scar face lift—why this is not merely a face lift with a short scar. Next Dr. Foad Nahai provides his perspective and approach to the short-scar face lift. Drawing on his long-standing experience with a variety of techniques for facial rejuvenation, he identifies specific situations in which a minimally invasive approach is appropriate and effective.

The next three chapters focus on the MACS-lift technique. In Chapter 3, Dr. Joseph Hunstad relays his personal experience with the MACS-lift operation and explains how short-scar rhytidectomy can expand one’s face-lift practice while improving patient satisfaction. In Chapter 4, we review the important lessons learned during 7 years of MACS-lifting, including an update on complications, problems, limitations, and technical tips and tricks. The biomechanics of the MACS-lift technique is addressed in Chapter 5by Dr. Mark Jewell who compares suture suspension techniques with SMAS flap elevation approaches. This chapter provides the reader with valuable tips on how to succeed with the MACS-lift technique. Dr. Daniel Baker, a pioneer in short-scar face lifting for the last two decades, describes his personal technique of SMASectomy in Chapter 6, balancing it with other comparable and convergent techniques. One of his key messages is that suture techniques applied for sculpturing subcutaneous tissues are as effective as traditional SMAS flap undermining techniques.

Part II focuses on the various synergistic procedures that combine to produce exceptional results. It begins with the work of Drs. Daniel Labbé and Julien Nicolas in the anatomy lab that interestingly reveals the anatomic basis of minimally invasive neck correction by platysma suspension, based on the theory of gliding planes in the aging of the neck. The dissections are extensively described, and the important clinical implications are pointed out.

Next Dr. Alain Fogli describes his simple and safe technique for temporal lifting by fasciapexy. His technique is a welcome addition to the MACS-lift, completing the facial rejuvenation in the superior third of the face, which we personally apply in a slightly modified version. Our personal experience with the short-scar temporal lift is described in Chapter 9. The book concludes with a chapter by Dr. Thomas Roberts III and colleagues who discuss how facial rejuvenation results can be optimized when specific procedures, such as facial sculpting with microfat grafting, facial liposuction, laser resurfacing, lateral canthal suspension, and subnasal lip lift, are used synergistically with classical or short-scar face-lifting techniques. The authors base their treatment on a detailed analysis of facial beauty and facial aging.

Similar to the first volume, this work is conceived as a technical guide of practical value—this time based on the experience of different experts. Although we have attempted to provide a consistent format throughout the book, we were careful to respect the individual styles of our contributors to enable them to deliver their messages freely. Each chapter contains a list of surgical pearls that point out in a concise, powerful manner the essence of each author’s contribution. Ample clinical examples are included throughout to illustrate the clinical value of the work presented.

Our first volume, The MACS-Lift Short-Scar Rhytidectomy, was conceived as a clinical atlas, guiding the reader through the basics of the technique, and trying to provide a comprehensive understanding of the MACS-lift concept. This second volume is the natural evolution of the first, and is meant to bring the reader who has embraced this concept to the next level of understanding. It will also provide any surgeon involved in facial rejuvenation with an unprecedented wealth of “backstage” tips and tricks, as all the contributing authors have given the best of themselves to assist the reader in his or her quest for superior results and greater patient satisfaction. Although each volume can stand alone, they are planned to work hand-in-hand, and on several occasions there are references from the second volume to the first. To complement the material presented in this volume, we have included a video demonstrating operative technique as well as the expert anatomic dissections of Dr. Labbé.

This second volume, similar to the first, was conceived from the perceived necessity for natural, safe, uncomplicated, and reproducible facial rejuvenation techniques and the lack of structured teaching in this matter. It is our profound hope and desire that this work will continue to stimulate thinking about facial aging and its treatment in an open-minded way, and that our patients will be the ultimate beneficiaries of this dialogue.

Acknowledgments

Writing a book is a collaborative effort, with numerous people contributing to the final result. Thus we have many individuals to thank who have assisted us in making this second volume a reality. First, we would like to express our appreciation to all of the authors who have contributed to this work. We asked them because of their expertise in short-scar face lifting, recognizing that these were individuals whose schedules were already full with lecturing about their technique and publishing their ideas. We know that our request to contribute to this book with the short deadlines imposed was an extra burden laid on their shoulders. Each of their contributions is unique and will be extremely valuable to the reader of this second...