Facelift/Mini-Incision Facelift

A facelift can elevate and smooth the jowls and reverse the early changes of lower facial and upper neck aging. As a restorative surgery, however, a facelift does not change your fundamental skin appearance and cannot stop the aging process. A facelift performed surgically will last longer and have a fuller result, whereas non-surgical rejuvenation treatments (laser resurfacing, radiofrequency FaceTite-Accutite, thread (Silhouette InstaLift) cannot quite achieve surgical results, but they can help delay the time at which a facelift becomes appropriate or beneficially complement the results of surgery to provide the most complete and naturally appearing lift possible while minimizing downtime. Many choose non-surgical techniques as they don’t have any downtime or just don’t wish to undergo surgery at a particular time in life.  Age-related descent of the lower face causes the youthful triangle formed by the chin and jaw to revert to a more squared or upside-down triangle configuration formed by the jowls.

Other rejuvenative procedures can be performed at the same time to include: dermal fillers/volumizers/fat grafts for facial folds, thread lifting, laser/radiofrequency/plasma skin resurfacing, chemical peeling for superficial skin related pigment issues and fine wrinkles, wrinkle blocker (neuromodulator botulinums), and other eyelid/forehead procedures.  Dr. Burroughs often performs Accutite and FaceTite to further improve nasolabial folds, fatty jowls, midface descent, sagging brows, and lower eyelid fat bags.  Fillers and fat transfer have become extremely popular as they can often provide improvements to areas better than surgery (e.g., nasolabial folds and marionette lines around the mouth). Fat grafts also bring beneficial growth factors that can improve skin quality.  Fillers (hyaluronic acid, Sculptra, Radiesse) also can help restore volume to facial areas that have become deflated with age (e.g., the cheek fat pads). Dr. Burroughs utilizes many techniques and is as an extensively experienced oculofacial plastic surgeon helping him improve the eyelid, forehead, mid-face, lower face, and neck in a “wholistic” manner so that results are excellent, natural, and can be long-lasting.

Dr. Burroughs mostly performs a mini-incision facelift (short-scar facelift) whereby patients actually often recover more rapidly than from cosmetic eyelid, forehead, or other facial surgeries. This has made Dr. Burroughs a sought-after cosmetic surgeon as his techniques offer excellent results and quick recovery. It is important to realize that a “mini-incision lift” doesn’t have to mean a “mini” or short result. The surgery can be customized to not only address the lower face jowls but also neck related sagging. More extensive neck sagging can be further improved by slightly extending incision a little into the front hairline area and/or just behind the ear if needed to enhance the result and avoid pleating/folding of the skin anterior, under, or behind the ear. Very tiny incisions can also be made higher up into the hair above the ear to further smooth and improve the outer cheek or extensive wrinkles/folds lateral to the eyes. Suture suspension techniques in the neck have also come a long way providing amazing results with a minimally invasive approach. The mini-incision facelift won’t address a neck with significant fatty tissue, heavy bands, or severe skin sagging but for many patients, an outstanding and natural result is achieved. If these other neck concerns co-exist, then Dr. Burroughs will recommend adjunctive procedures or surgeries to also address these concerns. Neck liposuction with radiofrequency tightening (external Morpheus, internal RFAL NeckTite) can often rejuvenate the neck along with a mini-incision facelift with rapid, restorative results with minimal downtime. Some patients rarely return to work or feel comfortable to go back out in public within just a few days.

There are several reasons that include the effects of gravity and weakening of the facial support tissues over time. The structures that attach the skin to the bony skull elongate, causing skin to sag. The orbital bones also elongate and inferiorly become more depressed causing weakened support for the overlying fat pads and skin. Additionally, the loss of skin elasticity causes sagging, and we lose the beneficial supportive fat volume in critical areas of our face. As our faces lose volume this worsens wrinkle formation and facial descent. An analogy is a balloon. If a round balloon is fully inflated, it will be perfectly round and without lines on the surface. When the air is let out, it will no longer be round and lines (“wrinkles”) develop on the surface. Also similar to an inflated parachute that is smooth and full until it reaches the ground whereupon it collapses and folds (wrinkles) upon itself.

The primary reason is to regain a more youthful and rested look. As we age, our facial tissues sag downward, causing soft tissue to droop below the jaw line (jowls). Younger patients have a well-defined and rounded jaw line, whereas older patients with jowls have a more squared configuration with loose tissue hanging below the bony jaw line. A mini-incision facelift elevates these jowl areas and restores the youthful, rounder contour. For very fatty jowls, Accutite or FaceTite RF skin tightening can improve and be done with or without surgical facelifting and re-volumizing procedures of the face (e.g., dermal fillers, fat grafting).

This varies from person to person. It is time for surgery when the amount of improvement desired or longevity wished for has moved from subtle bothersome findings to more significant sagging. Surgery gives quick to immediate results and lasts longer than energy-based treatments, which can take months to begin to be noticed and don’t peak until 6-12 months post treatment. We don’t all age the same and we don’t all inherit features from our parents that we wish to keep. Some can begin to see jowling in their 20s and double-chins even younger. The time is when you choose that the desired improvements can be likely be achieved and understand the risks, benefits, and alternatives. Dr. Burroughs sometimes talks patients out of facelift surgery depending upon the degree of improvement needed to reach the desired goals. Alternatively, some patients are recommended facelift surgery younger than they would have guessed as the best result and longevity can be achieved through surgery and enjoyed now and not waiting for displeasing aging changes to worsen. Many patients regret not having done surgery sooner, and many are very relieved to find their goals can be achieved through non-invasive or minimally invasive approaches and they don’t need surgery yet.

Aging causes both loss of volume (“deflation”) and drooping of the cheeks and lower face, so patients benefit from addressing both. Dr. Burroughs often performs mid facelift surgery, mini-incision facelift surgery, and dermal fillers and fat transfer for volume restoration. Restoring facial volume often improves the overall result and recovery by addressing focal areas that are not as well or naturally addressed by surgery and by often lessening the amount or extensiveness of surgery that would have been needed otherwise. Surgery can Redrape the tissues, but it doesn’t restore volume or improve skin quality that are critical for ideal cosmetic improvement and maintenance of results that are both natural and beautiful. Fat grafting not only provides a long-lasting improvement, but it brings helpful growth factors that benefit the locations they are injected into. Further, platelet rich plasma treatments can also boost healing and results of both surgery and filler injections.

Generally, the surgery is not painful at all, and Dr. Burroughs most commonly performs this procedure in an office surgical room just using just oral/IV sedation, local anesthesia, and Pro-Nox nitrous oxide (laughing gas). The office setting often provides a more relaxed environment that reduces anxiety, allows for patients to eat a light meal before surgery, avoids general anesthesia effects, and reduces the cost for the procedure substantially. Mini-incision facelift surgery is often more comfortable and less stressful than eyelid surgery. Recovery time is very fast with minimal swelling. There can be tightness for a while, but actual pain from the surgery is quite minimal and many just take Tylenol for discomfort following surgery.

The incisions are placed primarily right in front of the ears with slight extension behind the bottom of the ears and sometimes there is some posterior or hairline extension. The skin sutures are removed between 7-14 days after the surgery. Some absorbable sutures are left behind the ear lobe for up to a couple weeks to avoid a pixie-ear deformity whereupon the ear lobe is fused to the neck/jawline skin, which is a tell-tell visible sign of having had a facelift. Some surgeons advocate putting the incision behind the tragus on the front part of the ear to hide the scar, this often leads to a displeasing and overly tightened look from the faces skin directly fusing as it intersects at the ear tissue as compared to having the normal slight depression (dimple) of cheek skin just before it intersects with the ear tragus. Dr. Burroughs’s incisions are designed to provide a normal and pleasing slight depression just in front of the ear and avoid the pixie-ear deformity he often sees in many patients of his that had prior facelifting surgery done elsewhere.

Most patients have very little swelling and bruising as the skin is thicker than eyelid and forehead skin and thereby hides these issues better. When bruising does occur, it is usually resolved by a couple weeks after the surgery and can be even quicker with IPL treatments. Focal intense pulse light (IPL) treatments, offered in the Springs Aesthetics medspa, are complementary following cosmetic facial surgery and procedures and improve bruising resolution speed 3-4x and can help with incision redness. They break apart the pigment in a bruise so it can be dissolved/reabsorbed more quickly. Springs Aesthetics also offers LED light treatments that can improve redness and healing that are often included with your facelift surgery on an as needed basis. Dr. Burroughs also utilizes TXA (tranexamic acid solution) through various means and this has decreased bleeding, rebleeding, hematomas, and bruising and swelling. Dr. Burroughs was amongst the first in Colorado to utilize this medication to improve recovery and safety with cosmetic eyelid and facial surgery and reported his findings at one of his national meetings. The more extensive the surgery or additional treatments performed (e.g., Facetite, or CO2 laser) the risk of increased bruising or swelling can occur, but these adjunctive treatments enhance and add to results that surgery alone could not provide. Dr. Burroughs does not advise taking oral arnica or bromelain to reduce bruising before surgery as they can increase bleeding, which can lead to more bruising and even certain complications. However, oral bromelain, arnica (oral/gel/cream) can be helpful following surgery.

The surgery technique used by Dr. Burroughs has little effect on the hairline or sideburns. In fact, the sideburns or longer hair in front of the ears can help camouflage the incisions during healing. In men, a facelift surgery requires them to shave more closely to the ear as it shifts the hair-bearing cheek skin towards the ear as it involves the removal of skin. Extended incision facelift surgery can alter the hair slightly depending upon their locations, but Dr. Burroughs is mindful of this and discusses this during consultation or can answer your specific questions at your preop or by a telephone call or second consult. Dr. Burroughs prefers his patients be very well informed and he and his staff spend considerable time going over the planned procedures and surgery beforehand to foster a smooth experience.

Yes, it has become very possible within the last 6 years to perform non-surgical face lifting with non-invasive and minimally invasive technologies. Dr. Burroughs was among the first to obtain radiofrequency skin tightening and lifting using the Inmode platform back in 2016. The under-skin probes for the FaceTite and AcccuTite are placed into well-concealed needle holes and can in some patients provide up to a 30+% improvement of the sagging when done in conjunction with external radiofrequency needle tightening. As this technology has improved and become well accepted, it is critical to have an experienced oculofacial plastic surgeon to perform these procedures as they carry risk to motor nerves face and can unfortunately cause unintentional fat volume loss that can lead to displeasing contour changes in the facial or neck tissues. This fat reduction is helpful in some areas such as prominent fatty jowls or just outside the nasolabial folds, but non-facial plastic surgeon trained providers are typically not trained cosmetic surgeons and do not have as detailed awareness of the pertinent facial anatomy or fully understand the aesthetic contours that are an essential sign of beauty. This can lead to poor results or even injury to the motor nerves in the face. Radiofrequency facelifting can last up to 3-4 years. Dr. Burroughs has been performing radiofrequency face tightening procedures, numbering in the thousands, on a weekly basis since 2016. Owing to his experience and proven results, he teaches proper technique and strategies at large cosmetic surgery and procedure meetings.

A primary problem with aging is facial volume loss with little to no sagging of the facial tissues. Cosmetic facial surgeons know this issue best with their understanding of facial anatomy and the changes with age. These patients do well by having volume restored to the needed areas, especially in the mid face and, to a lesser degree, in the lower face. Radiesse is a dermal filler that is an outstanding facial volume restorer and deep fold reducer that lasts between 1-2 years. Sculptra injections can last 2 years or more, and restore volume to large areas of the face providing a more youthful appearance. Bellafil (polymethylmethacrylate) is a unique volumizer that can last up to 5 years in some patients. Some subtle elevation of the mid-face tissues can be achieved by restoring volume in the high cheek areas but, in many circumstances, is best addressed by radiofrequency or surgical approaches. Subtle eyebrow descent can likewise be improved with botulinum toxin injections, suture or thread lifting, or radiofrequency lifting but is more powerfully addressed by a brow or forehead lift (an “upper facelift.”)

They are truly different though having one performed can positively improve the other to a certain extent. If jowl formation is the primary concern, then the mini-incision facelift is the ideal procedure. Some patients, however, also have excess skin in the neck. As long as the neck skin is thin and the amount of sagging is mild to moderate, then the mini incision facelift can provide nice improvement. Thick, heavy, and considerable excess neck skin and banding is better improved by a neck lift particularly if the concern is just under the chin or central neck area. Furthermore, patients with considerable fullness of the neck from excess sagging fat benefit from a dedicated neck lift with skin resection and liposuction. Performing a lower facelift and a neck lift is sometimes called a full facelift, but a neck lift differs from a mini-incision facelift as the incisions extend much further behind the ear and the surgical dissection is often quite extensive. Therefore, some types of surgical neck lifts require surgery under general anesthesia. The neck lift recovery is also longer than a mini-incision facelift. Many patients opt for quicker recovery with the radiofrequency technologies such as NeckTite that reduce fat volume with or without liposuction and provides good skin tightening in suitable candidates obviating the need for more extensive and much larger incisional neck surgery. Neck suture suspensions (e.g., MyEllevate) have been performed by Dr. Burroughs for about 4 years now (since 2020). These can provide fantastic results particularly to the central sub-mental (area below the chin) that can rival lateral approach surgical neck lifts. Some male patients with severe skin ptosis of the central neck do well with a direct excision at the site of concern and can heal well though it can take time for these incision scars to become less noticeable. Most of Dr. Burroughs’ patients that want both significant lower face and neck improvements can have amazing results with a mini-incision facelift that slightly extends behind the ear and a 2-3 cm incision in the submental area under the chin to address prominent bands, heavy neck fat and the placement of a neck suspension suture that acts like a supportive net (hammock) under the chin to lift and contour the neck tissues to an ideal position. It truly it amazing the results that can be achieved with minimal incision techniques these days.

Yes, it can and many patients with thin but minor sagging neck tissue will see substantial improvement. Patients, who will tolerate an extended mini incision, can get a more substantial neck lift. Alternatively, radiofrequency tightening, and suture lifting can also help with minimal invasiveness and are often done with a mini-incision facelift for amazing improvements.

Oftentimes, poor results are caused by too much skin removal, over-pulling, and by not addressing facial volume loss. This causes an unnatural, pulled back, “wind swept” appearance. When needed areas of facial volume loss are addressed simultaneously with a facelift, the amount of skin removal may be lessened and quicker recovery and more naturally appearing results achieved. Prominent fatty jowls should be addressed beyond simply lifting them as sometimes they need to be slimmed and volume added into the prejowl sulcus to provide a smoother jawline and better contour. Allowing the earlobe to fuse to the neck/cheek skin can appear abnormal and a common sign that a facelift was previously performed. Additionally, draping the skin over the tragus at the front of the ear often causes a displeasing and abnormal appearing interface with the ear. Poor results or short duration results can arise from poor quality skin that is not addressed to improve the elasticity and health of the tissues. Skin quality can be improved through radiofrequency, microneedling, and top-grade cosmeceuticals. Significant weight fluctuations and poor nutrition or health can also lead to suboptimal results and longevity.

Yes. All medical procedures have risks associated with them, but the technique(s) Dr. Burroughs utilize for mini-incision facelift surgery is generally very safe and safer than a deep plane facelift and neck lift surgery. You should discuss the risks of facelift surgery with Dr. Burroughs so you can make the best-informed decision. Dr. Burroughs can show reasonably realistic estimates of the results with a hand mirror and has an extensive collection of his before and after facelift patients. He refers and suggests 2nd opinions if he determines this to be in your best interest and goals. The most concerning risks are motor nerve paralysis or skin flap necrosis with potential severe scarring. These are fortunately very rare. Smoking and being a heavy bleeder greatly increase surgical risks of facial surgery. Unfortunately, many herbals, vitamins, and supplements surprisingly increase bleeding and Dr. Burroughs helps guide which you can take and which you should temporarily stop before surgery. The most common risks are swelling, bruising, visible scars, or minor infection. These fortunately improve with time and are readily treatable to speed resolution and improvement.

A mid-facelift surgery addresses the cheeks primarily and helps patients look younger with a happier facial expression. With facial aging, descent or drooping of the cheeks in the mid-face tissues also occurs in addition to the lower facial skin. This causes a facial expression of a greater sad appearance. Cheek descent also contributes to under eye dark circles, increased lower eyelid bags, and to deepening of the folds between the cheek and lips (“nasolabial folds”). Mid-face lifting of the cheeks can improve the dark circles, the nasolabial folds, and provide a more cheerful facial expression. Surgical techniques for the midface vary greatly amongst surgeons. Improvements to the midface tissues often can be achieved without surgery utilizing volumization enhancements/restoration (fillers/fat grafting), thread lifting, and radiofrequency treatments.

Mid-facelift surgery is most commonly and often best performed at the same time as eyelid surgery. Some mid-face elevation (lift) can also be achieved from a temporal pre-hairline or endo (under the skin) approach. These can be minimally invasive or extensively invasive with retaining ligament release and skin resection. Bruising and swelling usually resolves within a few weeks. An upper facelift (forehead lift) surgery can improve the midface when adjunctive retaining ligament release and suture mobilization to lift is performed. This can provide a very nice improvement in many patients with incisions predominantly behind the hairline especially if done with upper eyelid surgery.

Generally, patients see results last up to 5-10+ years, but this can vary from patient to patient and how aggressive the surgery is performed. Dr. Burroughs always strives for a natural and safe result. Very aggressive surgery (think celebrities) may last longer, but for years the results can look overdone, too tight, and unusual. A best and preferred result is typically obtained by achieving an appreciation by others that you looked more refreshed, happy, and youthful but an unawareness to others that surgery has even been performed. Most patients want to look on the outside how they feel on the inside. Medical grade skin care not only helps with healing, but helps protect the investment of facial surgery. Non-invasive volume replacement and skin treatments helps complement and prolong the results. Good genetics, sun protection, and maintaining good health and a stable weight are also important for better and longer results. You can’t change your genetics, but most variables can be controlled by your own decisions and determination.

Avoiding blood thinners and even alcoholic beverages will help, and be discussed preoperatively. Alastin is a medical-grade cosmeceutical that prepares and aides skin healing and reduces bruising by increasing arnica levels in the skin by up to 50%. This is more than any other off the shelf topical arnica. Compliant wear of a provided face/neck wrap helps for the first 48 hours and some will wear it nightly for about 2 months. Avoiding strenuous exercise for a week after surgery is beneficial, and avoiding nicotine and smoking for a month prior to surgery. If the incision become red or raised they can be improved dramatically with intense pulse light treatments that are complimentary with your surgical fee and are best performed beginning at the first month after surgery. This is a benefit of having surgery with Dr. Burroughs at Springs Aesthetics as he and his team uniquely care before surgery about preparing the skin, education for what to avoid, having cutting edge intraoperative treatments to reduce bleeding (tranexamic acid), medical spa treatments that work postoperatively to hasten healing, and post surgical skin care to maintain results and improve overall skin health and vitality.