Mini-facelift vs. full facelift: which surgery is best?

Mini-facelifts are good for patients with minimal laxity.  A full facelift is reserved for patients with laxity that includes significant jowling, cheek fat pad descent, and significant skin laxity in the face and the neck. 

If mini-lifts are offered to patient that require a full facelift, they usually get a "mini" result.  They always are more appealing but not always satisfying for the patient after surgery if used on poor candidates.

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.

Surgical or even non-surgical treatment of facial aging changes must be carefully individualized to match each patient's aesthetic needs and desires. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized plan is then developed which addresses each patient's specific concerns and needs.

A "liquid facelift" is a procedure that is performed using temporary dermal fillers like Juvederm Restylane or Perlane. There is little to no downtime with a liquid facelift. This might be an ideal treatment for some, but the results are temporary and it does not address excess skin.

Structural fat grafting, sometimes referred to as microfat grafting can provide fullness to lips, cheeks, hollowed upper or lower eyelids and can fill lines and wrinkles on the face. Unlike the liquid facelift, the results from structural fat grafting can be permanent

Laser Skin tightening is a non-invasive treatment with little to no downtime. For individuals with early signs of aging, uneven skin tone, scarring or large pores a laser skin tightening procedure can provide dramatic results.

Full Facial rejuvenation or a full facelift may be the answer for some. Some people looking for facial rejuvenation are interested in the lower face, midface and eyes, others are interested in one area only. Surgical treatment of facial aging changes must therefore be carefully individualized to match each patient's aesthetic needs and desires. No two 'facelifts', by necessity, are the same. In helping a patient to make decisions about plastic surgery for facial rejuvenation, I always examine and assess how each aesthetic area or 'unit' of the face contributes to an individual's overall appearance: the brows and eyelids, the cheeks or 'midface', the lower face and chin, and the neck. An individualized surgical plan is then developed which addresses each patient's specific concerns and needs.

Consult with a plastic surgeon who has experience and expertise in both surgical and non-surgical facial rejuvenation to determine the treatment plan that is best for you.
 

Hello Eileen,

This is a great question that both Physicians and Patients alike are asking and debating in offices and conferences across the country.  With the advent of increasing surgical knowledge, so much marketing and consumer friendly terminology the information available to patients has gotten very confusing.

First lets define some basic terms to help answer your question.

Mini-Face Lift: a surgical procedure where extra / sagging skin is removed and the SMAS/muscle layer may or may not be tightened, plicated or cut & sewn.  Typically indicated for early or mild signs of aging in the lower third of the face or for patients who have had a facelift in the past and need only a minor touchup as they age.  Incisions are smaller and may be limited in location.  Recovery is 5-10 days.  May be done with local anesthesia or sedation.

Full Facelift: a surgical procedure where extra / sagging skin is removed and the SMAS/muscle layer is always tightened, plicated, or cut & sewn.  Additionally deep plane lifts involve elevating the entire SMAS/muscle layers in specific areas and repositioning it.  Typically indicated for moderate to deep signs of aging in the lower third of the face or for patients undergoing a primary facelift and looking for longstanding and durable results.  Incisions are larger and usually extend from the front of the ear to the back and may even extend into the hairline.  Recovery is 10 days to 3 weeks.  Depending on the procedure may be done with local anesthesia, sedation or general anesthesia.

Both are good options but it is crucial that you completely and carefully assess your goals before sitting down with a Surgeon.  Once you have done this the next step is to sit down with a qualifed Surgeon and express your goals and to allow them to assess your anatomy and explain what options they are confident & experienced in performing which will help you attain your specific goals given your specific anatomy.

While cost and recovery time should be factored in, please do not allow them to be the main factors in your decision making.  Financing is widely available and by planning ahead for the required recovery time you can focus on the other factors discussed which are utlimately far more impactful on getting the results you are seeking.

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.

A mini facelift (Lifestyle Lift, S Lift etc.) produces a mini result that lasts for a mini length of time but has the maxi of scars.

Don't deceive yourself into hoping you will get the result of a well done facelift from a mini procedure. My best advice is to use skin care, IPL lasers, Botox and dermal fillers until you are ready for the right surgery done by an expert whose results look like what you are hoping for.

A "minilift" is an acceptable alternative if a patient has relatively minimal indications (mild jowling without significant changes in the neck).  However, patients seeking correction of loose skin, moderate to heavy jowling, and/or a heavy neck will be quite underwhelmed with a "minilift" result.

Another risk of "minilift" procedures (when performed for patients with the correct indications) is that if the changes aren't too bad to begin with, the result may not provide enough change or for a long enough time  to make a patient happy. Likewise, if a "minilift" is performed on a patient with true indications for an extended facelift (midface, jowl, neck elevation), the patient is likely to be less than satisfied. 

The problem in SW Florida is that most of my patients have indications that exceed my threshold for performing a "minilift."  In general, most of my patients with "minilift" indications opt to have fillers or Botox, and I think this is a better choice for them.

As others have stated in this forum, there is no standardization of terminology in facelift procedures.  One surgeon's minilift may be entirely different and less substantive than anothers, so buyer beware.

This is a more complicated question than it may seem, because there are so many variations on facelift and mini-facelift techniques, and such a range of conditions needing treatment.

The key is to individualize the treatment to the condition; some may benefit from tightening the neck only, others the midface, and so on.

Another key is to recognize that facial rejuvenation is a 3-dimensional issue, not one simply of skin tightening or wrinkle filling. The general trend is for less invasive procedures that accomplish a lot of what used to be done more invasively, so a "full facelift" may be less of an ordeal than many people imagine, and with very natural-looking results.

I would caution against anything that seems like a cookie-cutter approach, for the above reasons. To find out what is best for you, see a plastic surgeon who is also able to offer a full range of nonsurgical and minimally invasive options.

Not all mini facelifts were born equal.

With current increased popularity of Minimally invasive procedures, a few new names and techniques appeared on the market. For the majority of consumers and very commonly for Plastic Surgeons, including myself, sometimes it is difficult to separate what represents a reasonable procedure with durable and stable result and what is a marketing gimmick and a new trade name.

Over the years, over 200 techniques of facial rejuvenation had been described. From thread lifts and endoscopic laser tightening to multilayered and composite lifts.

Most patients walking into our office do not request a facelift. They usually pull up on the neck and ask me to do as little as possible to get a smoother neck and cheek, as well as a more defined jaw line. Immediately after that they usually state that they do not want a facelift as they have a friend, a neighbor, or a relative who had it and looks just too pulled and un-natural. The name of Kenny Rogers comes up a lot lately in that content.

It appears that the word FACELIFT itself acquired a negative connotation and today equals to unnaturally pulled looking faces.

The goals of a facial rejuvenation are not to look 18 and very tight, but to look more refreshed, more youthful, but still natural. More aggressive facelift techniques can produce excellent results, but some of them take 6-8 hours, 3-4 weeks of recovery, prolonged swelling up to 3-6 month and may cost $12,000 to $50,000 (yes, this is not a typo).

Most of my patients have 1-2 weeks they can take off and $6,000 to $10,000 to spend. In my experience, to achieve a durable, reliable and consistent result, deeper tissues (SMAS) need to be treated.

I am a big supporter of MACS type lifts (Quicklift and so on). It allows excellent deep tissue support, has much lower risk of nerve injury, limits surgery time to 1-2 hours and recovery to 5-14 days (on average 7-10). It can be performed under local anesthesia alone, though for most patients we recommend sedation too.

Skin-only procedures take less time, can be done in under an hour, but they do not provide enough deep tissue support and therefore are less durable. The cost for these procedures is $4,000 to $6,000. There are people who are reasonable candidates for these lifts, but not everyone.

For sake of completeness, I will mention Thread Lifts. I do not believe in them and do not perform them.

In summary, Not all the Mini lifts produce Mini results. Our practice had shifted to Mini Facial rejuvenation surgery. I have been using this technique for the last 5 years with very consistent results and very high patient satisfaction.

The keys to successful facial rejuvenation surgery are to:

• Find an experienced Plastic or Facial Plastic Surgeon - not a casual facelift doc, but someone who does them routinely, in my mind at least 1-2 a week
• Establish a good and open relation with the doctor, so that he or she understands your goals
• Have your procedure customized to your facial features
• Have it done at a safe place; usually it means an in-office accredited surgery suite or ambulatory surgery center
• Ask questions and use common sense

There is not an easy answer for that question.

When considering cosmetic surgery, determine what your goals are. Then seek out an experienced surgeon with a wide range of options to get those desired results.

A "mini-face lift" is a good alternative for some people and all that some people may require. For patients with more drastic aging changes, a mini-lift can be performed, but the results will not be as dramatic or long-lasting as a bigger procedure, such as an extended SMAS or deep plane facelift.

Another problem with this question is that there is no standard terminology when it comes to facelift procedures. One surgeon's mini-lift may be another surgeon's standard facelift because the surgeon's patient populations are different.

As noted by some of the other contributors, there are other non-surgical options for skin rejuvenation available today including injectible fillers, facial resurfacing, and even makeup. A surgeon with a large array of treatment options will be able to tailor your treatment plan to get the best compromise between the results you want and the risk you are willing to take.

Beware of surgeons or other healthcare providers who only have one or two options available - they may try to sell you only what they have available and not what actually is best for you.

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.

Realistic expectations are critical to ensure a favorable surgical experience and postoperative outcome.

• Think of any procedure as a unique tool that has specific applications and indications. No one tool is a panacea and therefore your expectations must be matched appropriately; otherwise, a new “tool” should be selected.
• Also understand that each surgeon has his/her unique twist to the procedure so your surgeon is your best source of information to help guide your decision.

In general minilift procedures are smaller versions of full facelifts. So, you can expect less extensive anesthesia, in general less recovery, and a less aggressive change. The Lifestyle Lift has gained enormous attention and popularity since many people want a faster recovery that allows them to return to their activities sooner than a more extensive full facelift. Again, matching your goals and expectations with what each procedure can deliver will ensure a smooth postoperative course and outcome.

There are many promotions for alternatives to facelift cosmetic surgery: mini lifts, mini tuck facelifts, thread lifts, string lifts, and weekend lifts. While each of these may have a unique approach to lifting sagging skin, the bottom line is that these procedures act as baby steps.

Minimal surgery will give you minimal results.

• Even if a mini-lift won't give you the dramatic results, getting one may be right for you if you're not quite ready for a facelift;
• these facelift alternatives offer a baby toward the full plastic surgery process. 
• You can recovery quickly and it allows you to test the waters and see if you like the difference. 
• Keep in mind, the important thing is the end result, and not whether or not you're going to have two day recovery, or a two week recovery.

But you can't have both, you can't have a two day recovery on a full face and neck lift.

For a full facelift you need a good two weeks of recovery.