Mini facelift (short-incision facelift)

What is a short-incision facelift?

What is often called a mini facelift refers to methods that use a shorter incision than a standard facelift and reduce the extent of dissection beneath the skin. However, even under the same name, which layers are treated and to what extent can differ from one method to another.

A typical example, the MACS lift (minimal access cranial suspension lift), is presented as a minimally invasive face and neck lift designed on the basis of an understanding of the anatomical changes that come with facial aging ^[1]. It uses a short incision and limited dissection under the skin, and it resuspends the soft tissues of the neck and midcheek by placing purse-string loop sutures through the SMAS and platysma muscle and anchoring them to the deep temporal fascia (the firm tissue layer over the temple muscle) ^[1].

Who is it considered for?

The results of short-incision methods depend heavily on patient selection. The MACS lift was reported to be effective in appropriately selected patients, with high satisfaction among both surgeons and patients ^[1]. This does not mean that the same result can be expected for every kind of sagging.

For some patients whose problem is almost entirely limited to the contour of the neck, a short-scar neck lift performed through an incision under the chin alone has been described ^[4]. This method improves the neck contour by changing the deeper structures without removing skin, and the remaining skin is left to redrape over the wider surface of the neck ^[4]. The literature notes that in appropriately selected patients, the overall look of the face can improve noticeably ^[4].

How the SMAS is handled

Apart from the length of the incision, how the SMAS layer beneath the skin is handled also affects the result. Lateral SMASectomy is a method that removes part of the SMAS where the mobile SMAS meets the fixed SMAS and pulls it tight ^[3]. The authors who introduced it explained that it produces cosmetic results similar to a traditional SMAS flap while avoiding the additional risk of nerve injury that comes with dissecting a flap, and that the direction of pull can be adjusted to suit various facial features ^[3].

The MACS lift handles the SMAS with sutures, and lateral SMASectomy handles it by partial removal; both differ from methods that lift a wide SMAS flap ^{[1, 3]}. When sagging is severe or there is a lot of loose skin, it needs to be judged separately whether these methods alone are enough.

The neck needs its own diagnosis

The literature explains that the success of a neck lift depends on diagnosing the underlying problems and making a logical surgical plan ^[5]. Although liposuction under the chin and skin tightening are often recommended, it has been pointed out that in most patients they alone are not enough ^[5].

The same review stressed that removing fat under the skin and tightening the skin does not correct the anatomical problems beneath, so each possible problem should be checked one by one when making the surgical plan ^[5]. When considering a short-incision method, it is also important to first identify what problems are present in the neck.

Anesthesia and recovery

A review of facelifts under local anesthesia considered the short-scar anterior facelift suitable for local anesthesia because it involves limited deep-plane dissection and a short operating time ^[2]. It stated that a careful medical history is important in selecting patients, and that people who have had no problems with dental treatment and have no history of severe anxiety are better candidates ^[2].

The same review explained that the local anesthetic mixture should be kept simple and used at a diluted concentration to reduce the risk of dosing errors and local anesthetic toxicity, and that when sedation is added, oxygen saturation, heart rhythm (ECG), and blood pressure should be monitored ^[2]. Local anesthesia does not make the risks disappear, so it is best to check the type of anesthesia and the safety measures in advance.

The length of recovery and the amount of swelling and bruising vary with the extent of surgery and from person to person. The research summaries reviewed for this article do not include data comparing the recovery time or how long the results of short-incision methods last in numbers.

Risks and precautions

A short-incision method is still surgery, so it carries risks such as bleeding and a collection of blood under the skin (hematoma), infection, scarring, changes in sensation, asymmetry, and nerve injury. Even with a short incision, a scar remains, so the location and shape of the scar should be checked during your consultation.

What to check during your consultation

The reported benefits were seen in appropriately selected patients ^[1]. It is important to have an examination to check how much sagging you have and the condition of your skin, and whether you fall into that group.

• Which layers are treated, and how, under the name of mini facelift
• Where the incision will be and how long it will be
• Whether the degree of your sagging suits a short-incision method
• Whether your neck has anatomical problems other than fat
• The type of anesthesia and the safety measures