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.