Facelift (Autologous Sculpting Technique)

Recent trends in facelift surgery include short incisions that are limited to the hairline and in front of the ear. Limited incisions create shorter surgical times, abbreviated recovery periods, and reduced potential for complications. It is unclear what happens to facial fat as we age. Does it just disappear or does it descend down the cheek and over the jaw-line onto the neck? (Figure 1). The goal of this technique is to produce a “heart-shaped” face by elevating the skin, underlying tissues, and fat of the mid-face to restore a more youthful appearance. In particular, reversing the mid-face decent with its attendant jowl formation, deepening of the nasal folds, and drooping of the corners of the mouth are all aided by this procedure. Previous techniques, which only stretched the skin, produced a “windswept” appearance that was less aesthetic.

Autologous sculpting techniques includes volumetric placation of the cheek fat and underlying tissues to create a layered lift (Figure 2). Volumetric “stacking” with interlinked sutures and lipofilling facial muscles with injected fat recreates an attractive fullness. At the same time, the neck is tightened with suspension sutures that create vector effacement (Figure 3).

The marriage of these two concepts provides for a more predictable facial rejuvenation that is attractive and sustained. The facial shape changes from an aged square look to one that is youthful and heart-shaped.

The surgical technique has been aided by the incorporation of quill bidirectional barbed sutures which help to create an effective line of elevation across the mid-face. The quills also tighten the anterior neck (Figure 4).

The short scar facelift reduces the field of dissection without compromising the lift and allows access to the lateral brows and mid-cheek areas (Figure 5).

Fig. 1 As we age our facial fat and underlying tissues descend over the jaw-line that is likened to candle wax dripping down.

Fig. 2 Facial sculpting techniques attempt to recreate a youthful visage by lifting the descended fat to a more youthful location.

Fig. 3 Effacing (stretching) the lateral neck skin and, where necessary, adding fat to the mid-face help to create and “S-shaped” ogee curve that completes the rejuvenation.

Fig. 4 Barbed sutures have become a useful adjunct to reinforce tightening of the anterior and lateral neck as well as the cheeks.

Fig. 5 Short incisions provide access to the cheek for volumetric sculpting (green) and to the neck for vector effacement (pink).