MA Before and After Mini-Facelift, midface lift<br />

Practicing in Worcester and Boston for over 28 years, Dr. Bentkover performs a number of different types of minilifts.

Depending on your age, your degree of facial volume loss with againg, sun damage and some genetic factors, a minilift may be all you need. Today we can offer you a number of different minilift procedures. They are less surgery than the traditional full lower deep plane facelift. They achieve more limited or perhaps more focused results, results aimed at improving just one part of the face. With less down time and quicker healing, minilifts have become some of our most popular procedures; but there are not shortcuts to quality.

Often people think a minilift is just an operation that tightens the cheek through a smaller incision than a full facelift. While that may have been true a number of years ago, now there are several types of minilifts. It may involve just tightening the tissues of the outer cheek & jawline, midface, neck or temple individually. It is also sometimes used as a touch up procedure a few years after a full facelift. Many surgeons call many different procedures a minilift. At your consulstation always besure to ask enough questions so that you know exactly what is planned.

Here are examples of the minilifts that Dr. Bentkover performs:

A submental platysmaplasty (30 – 60 minutes) is a minilift of the area of the neck just under the chin (the submental triangle). It is done through about a 1-1.5 inch incision in the crease just under your chin. It tightens the muscle in this area (the platysma) and is frequently combined with liposuction to the area and a chin or pre-jowl implant. No skin is removed, so this procedure is usually performed on patients under 45. Over 45 you may need to have some skin removed; you may need a complete necklift.

A necklift (2-3 hours) is a minilift that combines the submental platysmaplasty (above) with further tightening of the entire neck through an incision hidden in the creases around the ear. The platysma muscle is tightened in two areas, near the ear and under the chin. Excess skin is trimmed, and liposuction is used to further sculpt the neck if needed.

A cheeklift (1.5 – 2 hours) is a minilift that lifts the tissues of the cheeks in a vertical direction to tighten the outer cheek, jaw line, and jowls. The original minilifts were really cheeklifts. In this procedure the SMAS tissue (subcutaneous muscular aponeurotic system) is usually cut and trimmed in such a way as to be able lift a portion of it and place it in a higher position. This what lifts the cheek and outer face. The SMAS is the most important layer in tightening your face. Dr. Bentkover does what is called a deep plane sub-SMAS flap procedure. The SMAS tissue that is elevated and repositioned is called a flap. Common types of cheeklifts include the S lift and J lift. so-called for the shape of the incisions placed in the SMAS tissue and skin. These are different ways of achieving a similar outcome. Excess skin is also carefully tirmmed.

Properly performed minilifts designed for the best possible longevity and most natural look are careful and delicate operations best performed with general anesthesia or intravenous sedation. While the iidea is appealing, procedures performed with only local anesthesia and oral sedation do not repostion and tighten the SMAS as effectively as those with more appropirate anesthesia. Cutting corners, so to speak, is not in your best interest. Besides, wouldn’t you rather be comfortable during your procedure?

A midface lift (1-2 hours) is a minilift that lifts the area below your eyes and the area over your cheek bones. As you age, the middle of your face generally descends at about a 45 degree angle and often flattens, creating hollow areas below your eyelids and in the lower cheeks. A midface lift elevates the upper cheek in such a way as to correct the hollows and washed out appearance that can develop in the middle portion of your face. Part of the procedure is performed under the periosteum, the fibrous coating over the bone. Elevating below this layer facilitates the movement of the midface and the longevity of the lift.

The traditional full facelift today is more properly called a full lower facelift. It treats the neck and lower third of the face.


Full Lower Facelift = Cheeklift + Necklift

When adding a midface lift to a full lower facelift, it becomes a so-called triplane facelift, because the operation involves elevation of three separate types (or planes) of tissue, skin, muscle and the coating over the bone (periosteum).

Information rules! But information must often be put in perspective. That is the role of the consultation. Dr. Bentkover will spend an hour with you going over all your options in an effort to see which minilift or variation of a full facelift best meets your goals. Take your time to think about your options. Don’t just jump at the first procedure that sounds easy. You should want real and lasting results.


Before Surgery

Dr. Bentkover will carefully evaluate your face and discuss with you how your face can look and what you might expect from surgery. If a minilift will achieve your goals, he will recommend the appropriate type of minilift. If he thinks you need a full facelift instead of a minilift, he will tell you so. His objective is to create a natural appearance. Using digital some photos of you he can simulate different types of minilifts with our imaging software. Our aesthetic nurse will give you instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and medications. If you smoke, he will ask you to quit for at least 1 month before and after your surgery, since smoking can ruin good surgery. It can cause more swelling and lead to loss of skin! You must stop anticoagulant medications or herbal preparations such as aspirin, ibuprofen, vitamin E, gingko, garlic, St. John’s Wart, or ginseng 2 weeks prior to surgery. You may be required to take antibiotics to prevent infection. You should shampoo your hair the night before surgery. We often use Arnica and pineapple juice (for its Bromelein content) to help decrease swelling and bruising.

The Procedure

Minilifts may be performed in conjunction with a blepharoplasty (eyelid surgery), forehead lift, chin augmentation, resurfacing, and/or liposuction to create an overall rejuvenation of the face. A procedure may need to be repeated a number of years later, since the effects of aging and gravity continue. You will be the judge of when or if you need further surgery.
Minilifts are most commonly performed in the Same Day Surgery Unit of Saint Vincent Hospital at the Worcester Medical Center. General anesthesia or local anesthesia with intravenous sedation is required. Dr. Bentkover also operates at the Massachusetts Eye and Ear Infirmary. The placement of incisions depends on the type of minilift being performed. These incisions are placed in such a manner that they generally hide very nicely and are as small as possible.. Most women can wear their hair up in a few months without worry of unsightly incisions. Minilifts take less time that a full facelift, and often multiple types of minilifts can be performed at one time. For example, a cheek lift is often combined with a mid facelift or a submental platysmaplasty.

Recovery: What to Expect

You will be given pre- and post-operative instructions. By following these instructions you will minimize potential problems. It is necessary to have someone drive you home and stay with you for the first 24 hours. The type of dressing depends on the type of minilift and often includes some type of face wrap. Stitches around the ears will be removed in a few days. Many of the sutures will dissolve on their own. Scalp sutures/staples will be removed in 7-10 days.

Generally scars fade satisfactorily over a number of weeks, but maximal fading may take a few months. Most swelling and discoloration generally decreases within two weeks, but some areas may take months to subside. If a midface lift is performed, the swelling will persist a bit longer. Tightness in your face or neck will be present for several weeks, and there may be slight changes in your hair pattern around the incision. Dr. Bentkover will discuss all these details with you and show you the location of the incisions. If you have had a facelift previously, your hairline may be a bit high at the sideburn area. Dr. Bentkover may alter the incision to prevent further elevation of you sideburn.

We recommend that you avoid the sun after surgery. In order to preserve the results of your surgery and prevent unwanted thick scars, we actively discourage excessive sun exposure and encourage high SPF sun protection (45-75).

Complications following minilifts are very rare. These may include bleeding, infection, loss of skin near the ears, facial nerve injury, discoloration of the skin, numbness, asymmetry and excessive scarring. Infection is rare due to the large blood supply to the face. The risk of bleeding is greater if you take aspirin or blood thinners within 10 days of the surgery. The risk of wound complications is higher in smokers, diabetics, persons with a history of radiation and autoimmune or collagen diseases.

The healing process is gradual, so you may look good in a couple weeks but look better in 3-4 months. A minilift may not last as long as a full lower facelift. Most patients do not have another lift later in life, but the number of patients having second lifts is definitely growing. Most patients who have had minilifts are pleased with their new, more youthful appearance.

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