Mini face lift vs. standard face lift: First consider the indications

Patients should understand that there are specific indications for both a mini and standard facelifts. When surgeons attempt to sell patients on maximal results with fewer or shorter scars, it is the patient that ultimately is left dissatisfied.

When patients do elect for a mini-facelift, it is my recommendation that they complement the surgical procedure by having less invasive and complimentary procedures performed at the same time, i.e. Botox, Radiesse, Juvederm, fat grafting, or laser skin resurfacing. We are now seeing a plethora of surgeons offering volume-only restoration to the face. While these can produce wonderful, albeit temporary results, I found the best solution is usually a combination.

One concept the patient should not overlook in deciding between a lesser or more extensive facelift procedure is the issue of “facial harmony.” By improving and rejuvenating only the midface, and not addressing the brow and the neck (because of the limitations of a mini-facelift), this will often accomplish an artificial or incomplete surgical appearance. Only your surgeon will be able to dictate whether your specific aesthetic goals can be addressed through such a lesser procedure. The advantages are intuitive, but if only done for the right indication.

It is always my recommendation that patients spend enough quality time with their surgeon reviewing example pre- and post-operative photographs.

In my opinion, the approach to facelifts are dramatically different than for example, a breast augmentation. There is no one solution or technique that should be applied to every patient.

In a young patient with minimal skin looseness, a mini lift may be just the right thing.

In older patients or patients with significant jowl and neck looseness, the mini lift simply won't have the degree of pull necessary to tighten up the jawline and smooth the neck. It may be necessary to augment lost volume, tighten and restructure loose deep tissues and perform other small procedures if the patient is to have a harmonious result.

Many patients are disappointed to find out that their "mini-lift" had the same incisions as a full facelift, but only half the result, since no deep restructuring was done. And if the incisions were closed unskillfully, the scars for many mini-lifts can be horrific.

Far, far more important than what technique you choose is the judgment of an experienced facelift surgeon which procedure will get you the best results.

The mini-facelift is an old concept really - an idea that will always sound good, except that, unfortunately, it does not result in superior, or even good, lasting results.

The procedure differs from a traditional SMAS or deep-plane facelift in the following ways:

• It is performed under local anesthesia, usually with oral sedation
• The dissection (the 'lift' part of the procedure) is superficial, usually below the skin only
• Surgeons performing mini-facelifts usually have not undergone the training required to perform more complex facelift procedures
• Note, however, that the length and position of the resulting scar is actually nearly identical to a traditional facelift!

Patients should be aware that dermatologists, ophthalmologists, oral surgeons, and "cosmetic surgeons" (this is not even a recognized specialty by the American College of Graduate Medical Education [ACGME]) may not have the extensive training required to safely or properly perform a traditional facelift.

Back to why I do not recommend or perform mini-facelifts; most patients who are good candidates for a facelift need significant skin and underlying soft tissue repositioning. The superficial nature of the mini-facelift dissection places significant tension on the skin, rather than on the stronger underlying fascial layer as in a traditional facelift, and the skin rapidly stretches and sags back to its original state.

I strongly advise patients who are uncomfortable with the idea of a traditional surgical facelift to consider a series of skin rejuvenation prodecures (light chemical peels with microdermabrasion) in combination with injectables, such as Botox, Juvederm, and Radiesse. These procedures are truly minimally invasive and can deliver fantastic, albeit temporary, results.

A mini-facelift or short-scar facelift is an appropriate facelift for the patient with minimal signs of facial aging, minimal skin laxity, minimal jowling and minimal looseness in the neck.

A full facelift is more appropriate for patients with greater signs of aging including greater facial skin laxity, worse jowling and more neck skin excess and looseness. The scars should be minimally noticeable with either technique as long as too much tension is not placed on the skin.

Nomenclature for procedures are not specific. One surgeon's mini may not be the same as another's. The procedure should match your anatomy and your goals. Whatever it takes to get you what you want is what will need to be done. You can call it whatever you want and the surgeon can charge whatever he wants. The important thing is to determine what is going to make you happy. Ask your surgeon to describe what that would require. You can modify the surgery and the subsequent cost to fit your situation. One surgeon's "minilift" may be more expensive than another surgeon's"full lift". Doing a less expensive surgery that doesn't get you what you want will cost you more in the long run and won't make you happy. Tailor your surgery to your anatomy and desires.

The debate over minifacelift vs full facelift is often discussed.  The most important word in your question is "jowls". The jowl is one of the hardest areas of the face to correct in a significant way and the best way to do this is with a vertical facelift. This requires a skin elevation to the region near the mouth. The vertical facelift can be done through a short scar or traditional scar (the difference is negligable) but the skin elevation from the ear to the mouth region would not be considered a mini facelift in my book.  If there is just a little saggyness to the neck and jawline then a mini facelift or more limited dissection can work very nicely but for more significant aging with jowls and marionette lines the vertical facelift is much more likely to make you happy.

In general, I am not a fan of mini anything.  However, there are some patients that for what ever reason are candidates for watered down versions of certain operations.  The facelift is not a good choice for this sort of thing, but for the right patient, a mini facelift may be adequate. 

The difference between a mini or a full facelift mainly has to do with the condition of the neck. Usually someone in their 40's may well just have a slight sagging of their jowls. Their neck may still be in good tight condition. A minilift would then be advisable because it tightens the face from just above the ear to about the top inch or so of your neck. Many patients still have good necks well into their 50's or even 60's.

A full facelift pulls the entire neck up without causing a swept-up look. The incision begin just above the ears, follows the natural curve in front of the ear, around the earlobe, up behind the ear and into the hairline about 2 inches. The muscle, fascia, and tissues are all elevated, trimmed and repositioned to give a natural refreshed look, taking one back to where they were before gravity took its toll.

The Wonderlift is another alternative for someone who isn't ready for a full facelift. In other words their neck only needs lifting about midway down the neck. The lower half of the neck is still in good condition. Incisions are the same for a full facelift but eliminate the incision into the the hairline behind the ear.

Evaluation by a surgeon who only works in the head and neck areas, that is a Board Certified Facial Plastic surgeon, is your best resource for helping make an educated, well informed decision.