By John Casey
Reviewed By Charlotte Grayson
Deciding to have a traditional facelift is hard enough: After all, it's expensive, invasive surgery on the most noticeable part of your body. Now the decision may become even more difficult. Some plastic surgeons are promoting a controversial procedure called the "mid-facelift," which can be done by itself or can be done along with a traditional facelift.
The incisions made in the mid-facelift are just the same as those made in the traditional facelift, but the surgeon cuts much more deeply into the muscle tissue of the face in the newer procedure. This allows the surgeon to pull the muscles around the nose and in the cheeks up. The surgeon then stitches these tissues into the structures below the eye sockets.
By adding this extra step to the facelift, the midportion of the face, which normally isn't much changed by the facelift, is moved and secured higher in the face. Some say this gives a more natural appearance. Others say it is an added step that offers little long-term change to the patient's face.
"There are a number of doctors doing the mid-facelift, but it is a technically delicate operation. And since you have to be very aware of the anatomy and be prepared to deal with things that may go wrong, some doctors are criticizing the procedure," says Elliot Jacobs, MD, a plastic surgeon at Beth Israel Hospital in New York. "Some say it's too prone to complications, but it's not, if you know what you're doing."
Many people considering a facelift might find that to be too big an "if." Nonetheless, the procedure is growing in popularity, as facelift patients and cosmetic surgeons alike look for ways to make traditional facelifts look more natural.
"The mid-facelift is a very new treatment," says Jacobs. "It is totally revolutionary; and it allows me to do things that I would never be able to do with any other procedure. Many of my mid facelift patients are younger -- in their 30s and 40s -- and they don't want a full lift, just a younger look."
Most surgeons would rank a facelift as a major operative procedure, says H. George Brennan, MD, a cosmetic surgeon in Newport Beach, Calif., and a spokesman for the American Academy of Cosmetic Surgeons.
"This is a complex surgery," says Brennan. "Not only do you want to consult with a board-certified plastic surgeon, but you have to get a doctor who has extensive experience in this mid-facelift itself. People sometimes get the idea that a facelift is not real surgery, but it is very real surgery. It comes with its own risks, and the best way to approach those risks is to go with highly qualified experts in this particular procedure."
According to Shan Baker, MD, president of the American Academy of Facial, Plastic and Reconstructive Surgery and director of the Center for Facial Cosmetic Surgery at the University of Michigan in Ann Arbor, "The facelift has changed radically in the last 15 years." Doctors, he says, are now performing surgery under the deep facial muscle tissues to achieve "a more natural, less operated-on look."
The new operation is becoming more common "because of the feeling that there was an imbalance in the upper face and lower face in traditional facelifts," Baker explains. "[The mid-facelift] was supposed to give a flatter, more youthful look at the fold from the lower eyelids along the sides of the nose and down." But, he says, that claim is debatable.
Does It Work?
The surgery itself takes about 60-90 minutes. According to Jacobs, it begins with the same lower eyelid incision, just under the eyelashes, that starts a traditional facelift. Working through that incision, he says "I like to go all the way down, past all the tissues to the corner of the mouth. And this is where the mid-facelift differs: I lift up the entire cheek and put the stitches on the inside and attach them to the bone around the eyelid socket area, all on the inside."
Why do it this way? "This procedure allows me to clean up the eyes and clean up the fold and lift up that cheek tissue that tends to descend as time goes on," Jacobs explains. By comparison, he says, "The classic facelift involves incisions around the ear and back into the hair and does very little on the fold of the midface around the nose."
Once these procedures are complete, Baker adds, the doctor will usually remove any fat bags near the eyes and trim any extra skin to remove lines and wrinkles.
But according to Baker, there's not much evidence that the mid-facelift produces the kinds of improvement that some doctors claim. "The theory is that you're left with a very smooth lower eyelid, which flows right into the cheek, and a softer, more natural-looking nasolabial fold," he says. "But that is a point that is debated; and many doctors feel that the complexity of the procedure is not worth the benefits, which many see as negligible."
Jacob disagrees: "A good way to think about this operation is kind of like an introductory way into plastic surgery to deal with the first signs of aging."
Since it's a cosmetic procedure, the mid-facelift isn't covered by health plans: It costs around $7,500, depending on where you have it done.
The side effects are the same as those of a traditional facelift -- swelling, bruising, inflammation, and pain. In rare cases, there might also be nerve damage, and sometimes a second procedure may be needed to make corrections to treated areas. In general, Jacobs says, "People go back to work within a week."
Reviewed by Charlotte E. Grayson, MD, May 14, 2002
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