TORONTO – There is no “facelift for all seasons,” says Foad Nahai, MD, a professor of plastic surgery at Emory University in Atlanta, at the 45th annual Aesthetic Plastic Surgery Symposium in Toronto.
“Don’t make the same incision on every face,” says Nahai, also the editor-in-chief of Aesthetic Surgery Journal. “The decision is based on the aging of the patient, the morphology of the face, skin quality and quantity, as well as patient expectations and my understanding of what they (patients) are looking for.”
For example, short-scar facelifts are appropriate for patients who have jowls and aging changes, but no excess neck skin. By contrast, full-scar facelifts are appropriate for patients who have aging changes and excess and inelastic lower and posterior neck skin, Nahai says.
When patients have skin redundancy, particularly in the lower neck, an occipital hairline incision is usually appropriate, he says, adding that the length of the scar will be related to how much neck skin requires resection.
“Skin elasticity is just as important as skin excess,” he says. “Inelastic skin will not redrape and redistribute. If a patient has a good-looking neck to begin with, a short-scar (facelift) is suitable.”
Facelifts, if they involve the superficial muscular aponeurotic system (SMAS), will have some effect on the neck and jawline, Nahai says.
The extent to which he manipulates the SMAS will depend on the thinness or fullness of a patient’s face.
“I would not resect the SMAS (in a patient) with a thin face,” Nahai says. “I would still undermine and mobilize the SMAS (in a patient) with a thin face, but I would not resect it.”
The incision around the ear should be placed so it does not leave a visible scar near the earlobe, Nahai says. “You want patients to have a natural-looking earlobe and a natural-looking tragus.”
Buccal fat pads can play a significant role in the aesthetic outcome of a facelift for patients with heavier faces, he adds.
“There is no one incision or technique that suits all, which is why he considers facelifts ‘freestyle’,” says W. Bryan Callaghan, MD, FRCSC, a plastic surgeon based in Ottawa, Ontario, Canada. “He customizes the operation to each patient.”