minilifting mini lifting in Spain

The techniques of mini-lifting have been carried out for nearly a century starting in 1919 when Dr. Passot described the first surgical technique.

Since then, the techniques of minilifting or mini-lift have evolved to achieve the maximum results though incisions and minimal detachments, avoiding incisions behind the ears and on the scalp, meaning that the aggression and the risks are minor and the post operatory care and the recuperation time are much shorter.

The simplification of the technique and the skill of the surgeon allow shorter operating times, in a way that in most of the cases, especially in our centre, the mini-lifting is carried out as an out-patient procedure with local anaesthetic and intravenous sedation without the need for general anaesthetic or hospitalization.

What is a minilifting?

The `mini-lift´ is different from the `full-lift ‘or complete lift due to the length and type of incision. Within the mini-lifting category, there is currently a great variety of techniques based on the type of incision, as well as the quantity of dissections or detachments and the type and direction of the vectors which produce the elevation of the subcutaneous tissue.

There exists a great amount of descriptions in scientific literature regarding the great variety of types of incisions including incisions in the form of “U”, “J”, “S”, “S-plus” or “L” (MACS-lift). Once the skin is elevated, the type of repositioning of the underlying musculoaponeurotic tissue can vary depending on the preference of the surgeon and the aesthetic needs of the patient.

Because of this, in the lifting and mini-lifting, the skin of the patient is not “pulled”, what is “pulled” or “sculptured” through sutures is the layer of tissue underneath the skin (fat, muscle, aponeurosis) making the skin simply adjust without tension to the final contour and eliminating the excess.

 

Who is a candidate for a minilifting?

As with any type of surgery, but more so in a mini-lifting, an adequate indication of the technique is fundamental to obtain good results. The mini-lifting does not substitute a complete lifting therefore making every indication, incision and minimal detachment vital to find patients with needs that are also adequate to the potential of the technique. The reason for this is that a minor incision limits the quantity of skin that we can eliminate; the mini-lifting is not indicated for patients with a large amount of sagging.
The patients who are excellent candidates for a mini-lifting are young patients in their 40’s and 50’s with limited skin laxity. This can also be extended to older patients with limited expectations.
Baker carried out a scale of classification to help to identify the patients who are adequate candidates for the lifting techniques with minimal incisions, a useful guide for professionals like us who perform mini-liftings.

 

  1. The “type I” patient is the ideal candidate for the procedure. We find ourselves with a patient in their 40´s with incipient facial ageing.
  2. The “type II” is a good candidate. Patients who are in their late 40´s or early 50´s with minimum double chin and moderate skin laxity.
  3. The “type III” is a fair candidate as generally at this age, the signs of laxity are more evident and widespread.
  4. The “type IV” is a bad candidate due to the great laxity and excess tissue which generally present at this age. They would be a candidate for a full-lift unless the patient has specific desires or cannot undergo large surgeries with general anaesthetic.

 

 

 

Type of Candidate:

 

 

Age

Jowling   

(drooping of the cheeks):

Excess of the skin on the neck

(drooping):

Submental- Submandibular Fat

(double chin)

Microgenia

(small jaw)

Platysmal bands

(muscle bands in the neck)

 I         Ideal

40-50

Incipient

Light

+/-

+/-

 II        Good

50-60

Moderate

Moderate

+

+/-

 III       Fair

60-70

Significant

Moderate

++

+/-

+

 IV       Not a Candidate

>70

Significant

Severe

+++

+/-

++

 

TYPES OF MINI-LIFTS:

1. S-lift y S-Plus lift

Towards the end of the nineties, Saylan introduced the S-lift, a technique which combines the advantages of an incision and limited cutaneous detachment (5-7 cm) with the advantages of elevation and manipulation of the subcutaneous tissue which is suspended with sutures in a U or an O.

 

ADVANTAGES of an S-LIFT against a CLASSIC LIFTING

  • It is carried out with one sole incision, avoiding the typical incisions behind the ear and hair.
  • The uplifting of the tissue is minimal compared to the great dissection of the traditional method.
  • The traction of the tissues in order to reposition them is totally different and much more natural: more vertical vectors.
  • The resection of the skin is much more limited.
  • Less risk of damage and after effects.
  • Less swelling and bruising.
  • Quicker post operatory recuperation
  • Minimally invasive procedure.
  • More natural and satisfactory results.

We are talking about S-lift plus when the incision and dissection is extended along the line of the sideburn to completely approach the mid-face. This technique is indicated in patients with major drooping of the mid-face: malar and submalar.
If the patient also presents settled platysmal bands, the technique of S-lift should be combined with a platysmaplasty through a small incision under the chin.

 

2. Minimal Access Cranial Suspension Lift (MACS-lift), vertical lifting or L-lift.

In 2002, the Belgium surgeon P. Tonnard published a modification of the S-lift which denominates: Minimal Access Cranial Suspension Lift (MACS-lift). The philosophy of this technique lies in young patients (40-50) who are candidates for surgery, requiring vectors of more vertical repositioning against the horizontal ones (more frequent in classic lifting) to obtain more natural results: more voluminous face vs. flatter face. For this reason this type of lifting is known as “vertical lifting”.
In the MACS-lift an incision is carried out in the shape of an inverted L which goes from the ear lobe to the front of the sideburn. A pocket of skin is lifted which is extended 5cm forward and 1 cm upwards above the cheek and the zygomatic arch and repositions vertically, the underlying aponeurotic muscle system with 3 permanent sutures in the shape of a U, O and a tobacco pouch suture to redefine the jaw line, eliminate the nasal furrows and replace the malar or cheek volume.
Once the facial volume has been replaced, the skin will tense vertically; the excess will be eliminated and sutured without tension.

ADVANTAGES OF A FACIAL MINI LIFTING

  • Limited incisions: less wounds
    In most patients the incisions are limited to the pre-auricular skin which also limits the possibility of visible scars and alterations on the hairline.
  • Reduced operating time:
    The complete “full-lift” or classic lifting requires between 4 and 6 hours of surgery whilst a mini-lifting is performed in 1 ½ -3 hours. This implies less time under anaesthesia, less post-operatory time and less economical cost. Additionally, the full-lifting does not allow completion of the treatment with other procedures such as blepharoplasty or mentoplasty if these were indicated to complement the results.
    Pre and retro-auricular incision in the complete or full-lifting.
  • Outpatient surgery: 
    We can safely carry out a mini-lifting under local anaesthetic and sedation monitored by our anaesthetist Dr. Masot. Because of this we do not need to use a general anaesthetic with tracheal intubation which is obligatory when hospitalised.
    The mini-lifting is, in most patients, an outpatient surgery where the patient can return home within 2-3 hours of the surgery.
  • Less risks:
    The minimal incision and dissection reduces the risk of bruises or nervous lesions. It also reduces the risks of the anaesthesia and its side affects: nausea, vomiting, dizziness…
  • Rapid recovery:
    Because of all the aspects which we have previously mentioned, the mini-lifting allows a quicker recuperation and incorporation into social and work life.

 

LIMITATIONS of the FACIAL MINI LIFTING:

Limited access to the neck and mid-section, for this reason it is not a technique indicated for patients with a large amount of drooping in the neck and malar region although, as we have also seen, modifications of the techniques exist to allow us to approach these cases.

RESULTS:

It is similar to what occurs in surgery of the eyelids or blepharoplasty which is the cosmetic surgery technique which is most used around the world as it is quick, safe, outpatient, with favourable immediate effects and quick recuperation with less post-operatory care in our centre, the mini-lifting has converted itself into a regular practice for the following reasons: quick, safe, without admission, immediate results, minimal post-operatory care and quick incorporation to social and work life.

Minilifting in Spain Before and after case 2
Mini lifting surgery in Spain
Minilifting before and after case 1
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