The facelift operation as practiced by Board Certified Plastic Surgeons continues to relentlessly evolve as surgical science and cell biology uncover new applications which can be utilized to improve our already outstanding results. Responding to the wishes of our patients, operations have tended to become less invasive and shorter in duration with less swelling, bruising, and a much shorter down-time. The short scar facelift has seen a resurgence with new and original methods of dealing with the SMAS, such as our progressive, multiple vector SMAS plication. The blending of the improved mid-facelift with the lower eyelids and less invasive neck surgery when possible had been our idea of a modern facelift. Due to the teachings of Sydney Coleman in New York City, we added structured fat grafting to our lips much improving the perioral area and enhancing the cheeks and what has been architecturally described as the facial “ogee.” I believe fat grafting as now practiced was a huge step forward in facial rejuvenation completely replacing foreign body fillers such a Juvederm® and Restylane®. In some circles, the efficacy of fat grafting is still questioned even as the evidence of graft takes in the 80-95% range are routinely described. Over the last couple of years, the basic science of cell biology has given us new information on adipose biology and the nature of adult adipose derived stem cells. The term “stem cell” occupies front page position in almost every modern women magazines. Until recently, it has been unclear how this new information could be applied to Plastic Surgical science.
The evolution of stem cell biology including the fact that we could isolate stem cells from our own body fat seemed almost too good to be true. Rather than throwing away the fat we obtain with liposuction, we can now take this fat, process it in the office, obtain stem cells, and then utilize the stem cells for improving fat graft take even further as well as adding growth factors to the fat grafts that have a beneficial effect on aging skin. Body contouring with liposuction complimenting facial rejuvenation is truly a “scots” efficiency as Dr. Ralph Millard would say. The beneficial effect of growth factors on healing and facial skin aging has been known for several years, but exactly how to utilize this knowledge never progressed after the discovery of its use as “fibrin glue.” More recently, we have added platelet rich plasma (PRP) obtained by drawing blood at the onset of the surgical procedure, processing the blood to get PRP which adds large quantities of growth factors when added to fat and fat stem cells used for facial contouring and rejuvenation. All of these biologic enhancements to fat grafting are obtained from the patient and therefore are autologous with no problem with rejection such as that which occurs with foreign body fillers.
To summarize our current facelift techniques, incisions are of the “short scar” variety, the SMAS is handled with progressive tension suturing in multiple vectors, micro-drains are used for 24 hours to reduce bruising, the glabella, cheeks, lips, chin, and perioral areas are enhanced by fat grafting augmented with stem cells and PRP. Cost controls include doing the procedure in the office with local anesthetics and mild sedation. The sum of these procedures we like to call the “Howard Lift” for lack of a more descriptive term.
Read more about top facelift surgeon Dr. Paul Howard in Birmingham, Alabama.
The Smartlift™ facial surgery procedure is the latest trademarked surgery marketed directly to the patient as an answer to facial aging problems. The Smartlift™ procedure differs significantly from the copyrighted or trademarked procedures in that the so-called Lifestyle Lift® is based on the aggressive marketing of a procedure (the Lifestyle Lift®) which only distinguishes itself by its simplicity leading to certain claims of reduced recovery and reduced operative times leading in some way to superior results. The Smartlift™ is different in that the sales pitch has to do with technology rather than the marketing of a procedure. The Smartlift™ is the facial rejuvenation procedure performed with the Cynosure® laser used for the laser assisted Smartlipo® procedure. While the use of the Cynosure MPX® laser is accepted for liposuction, it is less accepted in the face and may be contra indicated when used to liquefy facial fat.
The Smartlift™ is the use of a laser underneath the surface of the skin (internally) as opposed to other laser platforms used on the surface of the skin (externally) resurfacing for fine lines and wrinkles. The premise behind using a laser as an adjunct for facial rejuvenation is that due to the heat generated by the laser, facial skin contracts causing some small amount of skin tightening. At the same time, the skin is heated and the laser emulsifies the facial fatty tissue violating the premise that you shouldn’t remove fat from the aging cheek. The Smartlift™ is the procedure using the laser as described above to effect facial skin tightening with no actual surgical lifting performed. Even with the addition of CO₂ fractionated laser to the external surface of the skin, the actual skin tightening is minimal. With the aggressive attempt to tighten the facial skin by internal heating one runs the very real risk of removing facial fat excessively leading to a fairly dramatic skin laxity and worsening of the facial aging signs as well as severe skin contour deformities.
The patient above is a 65-year-old woman 11 months after having the so-called Smartlift™ facial procedure on her sagging neck and aged jaw-line. Additionally, she had upper and lower blepharoplasty. She related her request for improvement in her aging face, neck, and eyelids after the Smartlift™ laser procedure.
The first challenge was to re-drape the skin of the neck which was no small feat due to effects of the laser on the submental fat and skin. The jaw-line, cheeks, marionette lines, and nasolabial folds were addressed with a midface lift. The cheeks were blended with the lower lids and the upper lids re-done. Fat was liposuctioned from her abdomen, processed and enhanced with her stem cells to be injected in her nasolabial folds, lips, chin, and marionette lines. Her neck continues to be a problem and has required several steroid injections to help soften the scarring caused by the Smartlift™ lift. It has come to my attention that the Cynosure Corporation through its marketing people are now touting several other procedures based on the Smartlipo® laser with the addition of incisions in the mini-lift pattern as well as the full facelift incision pattern. Succumbing to the philosophy that all of these procedures deserve a trademarked name, i.e. the mini-lift plus laser is the “Ultra mini-lift™,” the full facelift plus laser is the “Laser Smartlift™.” I was surprised that the “Ultra Mini Smartlift” was kept out of the marketing “lift” bonanza.
Read more about Dr. Paul Howard and his popular Howard Lift Facelift in Birmingham, Alabama.