To create a natural result, all tightening of the SMAS and platysma is performed in a vertical vector, Dr. Morganroth explained. No horizontal vectors are used, in contrast to the traditional facelift, he added. Dr. Morganroth uses a Mohs’ surgeon’s approach to the closure of the incision of the Facial Lipo-Lift, using multi-layered closures to repair the incisions. This technique avoids tension on the incision, subsequent spreading of the scar, and the need for subsequent scar revision or camouflage by a change in hair style, he explained.
Explore This IssueJuly 2006
The traditional facelift is commonly performed with only superficial sutures and staples for the skin closure and has a higher risk of incision spreading, causing widened scars and inferior displacement of the earlobe, known as a ‘pixie-ear deformity.’ I prevent this by anchoring the skin flap to mastoid fascia behind the ear and cartilage and carotid fascia in front of the ear with buried sutures, he explained.
The type of liposuction he uses is called tumescent liposuction; a diluted lidocaine and epinephrine solution (0.1% to 0.3%) infiltrates the skin and is used for local anesthesia. This numbs the skin, plumps it up by expanding the adipose compartment, and constricts the blood vessels. The patient is totally awake during the procedure and may have a sensation of pressure, much the way they would experience a dentist’s drill under local anesthesia. There is no pain, and patients can ambulate on their own afterwards, he said.
Both procedures are done at Dr. Morganroth’s office, which has a Medicare-approved operating room. Because neither general anesthesia nor an anesthesiologist is needed, the Extended Facial Lipo-Lift is less expensive, safer, and has less downtime than a traditional facelift. There is no need for drains, because there is little or no bleeding. Recovery is faster. Patients can take care of themselves and perform activities of daily living on day 1, go out for lunch on day 4 or 5, and have the sutures out on day 7.
Patients have to take a week off of work to have the Extended Facial Lipo-Lift, Dr. Morganroth said.
Other advantages of the Extended Facial Lipo-Lift over a traditional Webster-style facelift include minimal post-operative pain, minimal bleeding and bruising, and low risk of nerve injury due to expansion of the adipose layer, he said.
Candidates for Lipo-Lifts
Candidates for the Facial Lipo-Lift include people with mild facial ptosis and jowling, but good skin elasticity and minimal to no banding of the neck muscles. These are usually women in their 40s and 50s, Dr. Morganroth explained.