What is a mini-facelift ?
A mini-facelift is a surgical procedure which improves the jawline and loose skin the cheek area. It is a procedure which has a shorter scar compared to a standard facelift. The surgical technique involves a reduced elevation of the skin compared to a standard facelift and therefore has an improved recovery time. Various terms have been applied to this operation such as ‘mini-facelift’ , ‘MACS’ lift or ‘short scar’ facelift. Essentially these are simply minor modifications of the exact technical way in which stitches are placed and no studies have shown that any technique is better than the other. The most important factor is that the procedure is appropriately tailored to suit the requirements of the patient.
What does a mini-facelift achieve ?
A mini-facelift is a facial rejuvenation procedure which only addresses the jowl area, loose skin along the jawline and in the cheek. It does not address the laxity of skin and muscles in the neck. Furthermore, if the laxity is very severe in the jowls and the jawline a mini-facelift may not be appropriate.
Who is suitable for a mini-facelift ?
A mini-facelift is only useful for younger patients in whom the ageing changes predominantly affect the face and jawline but have not yet caused any issues in the neck. This means the average age of patients suitable for this surgery is in their 40s but very occasionally someone in their early 50s can sometimes benefit . After this age the laxity of the skin and muscles in the neck becomes more noticeable and a standard facelift combined with some form of necklift is usually required.
The risks of this operation are higher in smokers and if you smoke it is important to completely stop at least two weeks prior to surgery. If you are a heavy smoker and you cannot stop smoking you will be unsuitable for surgery.
What happens during the mini facelift operation ?
In a mini-facelift the skin is elevated using an incision which is hidden in the natural curves in front of the ear but occasionally may have to extend for a short distance in the groove behind the ear. The skin is elevated in the cheek and along the jawline. The deeper tissues are then elevated using stitches to reposition the facial tissues into a higher and more youthful position. The exact manner in which this is achieved will vary. The ‘MACS’ lift uses long loops of stitches to suspend the tissues from anchor points in front of the ear. Other more standard ‘short scar’ techniques use individual stitches to produce the elevation. The exact technique is not important since the crucial determinant is to tailor the surgery individually in each patient. This may also involve other minor procedures such as a small amount of liposuction under the chin which enhances the neck and jawline contour.
After the elevation of the deeper tissues the excess loose skin is trimmed away and the skin is sutured very carefully around the ear with delicate stitches. A dressing will be applied to produce some gentle compression in the few hours after surgery.
What anaesthetic is required ?
A mini-facelift can be performed under local anaesthetic combined with sedation. However, since this surgery can take approximately 2 hours most patients find it more comfortable to be completely asleep. The fact that a local anaesthetic procedure is possible means that many patients are attracted to this possibility. However, the level of sedation is quite heavy and this means that there is really not much difference in whether you are asleep in a ‘twighlight’ anaesthesia under heavy sedation or whether you are completely asleep. The exact form of anaesthetic will be carefully discussed with you during the consultation. In reality, quite a few patients have other small additional surgery such as eyelid surgery, liposuction under the chin or some fat transfer all of which enhances the results of facial rejuvenation. Therefore, the majority of patients will need a general anaesthetic.
What is the recovery ?
It is advisable to stay the night in hospital. A dressing which is applied around the face is removed the next morning. Your hair will then be carefully washed by the nurses. When you return home it is important to sleep upright for the first few days and to be careful not to lift heavy objects and to avoid stooping. Taking it gently will reduce the swelling and bruising. The degree of bruising is variable but tends to be minimal with a mini-facelift. Any visible bruising subsides by two weeks. You can cover with make up provided you keep away from the stitches around the ear.
The stitches are removed at 5 – 7 days after which you should feel generally quite comfortable. Some patients experience a tight feeling but usually there is very little discomfort from this operation.
After 2 weeks it is acceptable to return to work but there will still be some very minor swelling which takes another 3 to 4 weeks to completely settle. However, during this stage it should not be overtly visible that you have had surgery. It is best to refrain from heavy exercise for approximately one month post surgery.
The best results are seen at approximately 3 months by which time the tissues have settled. However, the cheek area can feel somewhat numb and it can take a few months for the full sensation to return.
What do the scars look like ?
The scars from a mini-facelift are quite inconspicuous and very well hidden in the curves in front of the ear. There may be an early phase where the scars are a little pink in discolouration which is normal but they will then continue to mature. After a few months they will fade but it can take up to one year before they have matured completely.
What are the risks with a mini facelift surgery?
There is generally a low incidence of risks following a mini-facelift procedure.
Infection is a risk but you will be given prophylactic antibiotics which means that this situation is very rare.
Bleeding is a risk which can result in a situation called a haematoma . This is a swelling under the skin which will mean a return to the operating room to remove the swelling and stop any bleeding point. It is not life threatening and will not compromise the result of the surgery. However, there can be a little more bruising during the recovery phase. This situation occurs in about 2 – 3% pf patients and if it occurs it will be identified during the first night in hospital.
The skin of the cheek will lose its sensation but this gradually returns over a period of a few months. During this recovery phase there may be some minor symptoms like pins and needles or some itching. This is nothing to be worried about and is part of the normal recovery.
Delayed healing of the skin can occur adjacent to the scars. This results in a thick leathery scab which will take some time to separate and heal. It can mean the scar may be thicker than usual and may need further minor intervention to improve the quality of scar. This is more common in smokers and therefore it is imperative you do not smoke prior to surgery.
Damage to the facial nerve is rare during facelift surgery but in particular this is exceedingly rare during a mini-facelift.