18 November 2015 (online)
Among the current topics, one that is more commonly discussed is that of the mini-invasive or “soft” techniques that seem to attract doctors and patients more than real surgery. We instead propose a relatively aggressive technique that can really rejuvenate the faces and necks of our patients. Are we not in step with the times? The problem is, unfortunately, that until now there is nothing that, without anesthesia, swelling, bruising, and so forth, can magically bring about the result of a well-done facelift. There are no “thread lifts” or fillings or endopeels or weird devices using radiofrequency, ultrasound, or shock waves—the list could go on forever—that can compare with a properly performed facelift. But how should a good facelift be done? For many years, we have been using the protocol described in this article, and the request for facelifts has not dropped, despite never having used advertising in our practice. We want to give our patients natural and long-lasting results, and for this purpose we must use an effective and individualized technique, even if it implies a relatively long down time. In this article, we describe the technical choices that we have made based on a long clinical experience and on detailed anatomical studies. Most difficulties that are encountered with this type of surgery concern finding the proper dissection plane and the proper amount of traction to be applied to the different tissue layers. It is indeed not at all easy, especially for a beginner, to be sure that one has reached the proper depth of dissection, which will allow the elevation of the superficial musculo-aponeurotic system (SMAS) in a risk-free manner even in the area which is medial to the anterior border of the parotid gland where the facial nerve is no longer protected by the gland itself. We will nevertheless try to provide precise indications concerning every important detail needed to perform the operation safely.