Short scar facelift

The skin of the face and neck changes for two common reasons. Volume in the face is often lost. Elasticity in the skin declines as well — more markedly with sun damage and smoking, but also as a natural course. The ligamentous structures themselves are stable. The laxity develops between them.

In youth the face has a smoother shape, because there is more elasticity throughout the structural support. Later, the points that have stronger support keep their position, and the soft tissue between them tends to glide down. The contour becomes more uneven. A facelift is, in that sense, predominantly a stabiliser. Once the tissues are settled in a new position, the shape remains more stable, and closer to the face you see when you lie down and look in a mirror — when gravity is not exploiting that difference in mobility.

The short scar operation relies on the same aggregate displacement of the cheek SMAS and the skin that defines the deep plane facelift. They move together. That is why the effect is stronger along the jaw and the labio-mandibular (marionette) lines, and why the mid-face can look fuller without being filled. The nasolabial lines often improve as well, though more discreetly. The same movement produces a more vertical vector, which is particularly helpful when there is more sun damage and the skin has lost elasticity. The skin is not asked to hold the result by tension; it follows the SMAS.

The difference between a short scar facelift and the more extensive deep plane facelift is not the plane of dissection. It is the amount of laxity that has to be managed, and whether the neck needs its own contouring work at the same sitting.

The short scar facelift requires release of the cervical-facial retaining ligaments, in the same way as the deep plane facelift. That release is what allows the SMAS and the skin to be moved as a unit, and what produces the change around the mouth, the lower face and the jawline.

There is still a short scar behind the ear. It is simply not as extensive as the scar used when a neck lift is combined with facelift surgery. If the SMAS displacement would leave a significant amount of spare skin, or if the neck needs formal contouring for volume, platysma bands or marked laxity, the short scar is no longer the honest operation. The plan then moves to a deep plane facelift, a deep contouring neck lift, or both.

The procedure is eminently suitable for patients who tend to have a relatively good neck contour — perhaps with a degree of skin laxity, rather than hyperactive platysma bands — because that skin laxity can be helped. Hyperactive platysma bands are a different problem. They belong with platysmaplasty and the deeper neck work, not with a short scar facelift on its own.

Neck skin laxity can also be helped to a degree by the facelift itself, through the intermediary of the vertical lift. The vertical lift works on the laxity in the lower face, and it reaches out to the underside of the chin through the intermediary of the lateral platysma suspension. That suspension is feasible through the short scar access used for the facelift.

That reach has a limit. It can tidy a modest amount of spare skin under the chin and along the jawline. It does not reduce deep volume below the platysma, and it does not treat established platysma bands. When those are the problem, the conversation is a deep contouring neck lift — or, if only volume is present and the skin and platysma are quiet, an anterior neck lift.

Because the skin travels with the SMAS, the vertical vector of the lift pushes tissue up towards the temple. That excess has to go somewhere. In the short scar setting it is often absorbed by combining the facelift with a brow lift. The brow lift takes up some of the skin generated in the temple region and, at the same time, operates on the position of the eyebrows and on the outer contours of the eyelids.

The other way to manage temple excess, used more often when the scar is already being extended, is to carry the incision along the edge of the hairline in the temple. That is a judgement made against the hairline, the amount of spare skin, and whether the brow itself needs to change.

A facelift does not, on its own, lift a heavy brow or refine the texture of the skin. The eyelids still need their own assessment. Sometimes they are included; sometimes they are left for another time; sometimes they are the better first step.

The procedure can be carried out under general anaesthesia or under local anaesthesia with intravenous sedation, on its own. It takes approximately 2.5 hours. It can be a day-case intervention or an overnight stay in hospital, depending on the patient’s preference and on what else is being done at the same sitting.

During the surgery it is common in our practice to use fibrin glue. It is applied in the area of the surgery — so not on the skin — to help seal the layers together and to reduce the tendency to swelling and bruising.

A compression garment is frequently useful for the first week after the surgery, to help the swelling decrease at a faster pace and to assist recovery.

We use 2D and 3D evaluation of facial shape where it helps the discussion. The images are a planning tool. They make it easier to look at the jawline, the corner of the mouth, the mid-face and the way the lower face meets the neck, and to see how a vertical vector would sit on that particular face.

A simulation is not the outcome. The computer can suggest a direction of change; it cannot predict swelling, the way a particular skin will drape, or how the temple excess will be absorbed. That distinction is part of the consultation, not a footnote after it.

Shape and surface are different problems. The short scar facelift changes the position of the deeper layer and the skin that travels with it. It helps texture only to the degree that spare skin is redistributed. Fine surface change — sun damage, crepe quality, pigmentation — is a mixed surgical and non-surgical conversation, and often continues after the swelling has settled.

Naturally there will be questions, and you will want to meet the surgeon who would operate. Trust in that relationship is not a small part of the decision. Surgery is unique to each person; a detailed discussion and assessment are what allow advice to be personal rather than general.

We look at your medical history, medicines, previous facial or neck procedures and history of smoking. We look at the face and neck in motion as well as at rest. The neck examination matters here as much as the jawline: a relatively good contour with some skin laxity is a different plan from bands, deep volume or marked spare skin.

Two points need particular weight when facelift surgery is being considered. Blood thinners increase the risk of bleeding and have to be managed specifically around the operation. Raised blood pressure also increases the risk of bleeding, and needs the same special attention. Neither is a footnote to the medical history; both influence whether surgery can be planned safely, and how it is planned.

If a short scar facelift is not the better course — because the neck needs its own contouring, because the SMAS displacement would leave too much spare skin, because the brow or the eyelids are the real issue, or because the safer option is to wait — that should be said directly.

No operation is planned from a website enquiry. Surgery requires assessment and discussion in person, often more than once. The written information after the consultation allows you to consider it in detail. Fees depend on the combination of procedures and the setting in which they are carried out; they are confirmed in writing for the plan that has actually been agreed.

Post-operative care is crucial for a safe and more comfortable recovery. In our practice we provide manual lymphatic drainage to help the early swelling settle. The first days are the most restricted: tightness, bruising and a face that is not yet your own are expected. Help at home is wise.

As a working guide, expect about two weeks before a return to office work, and usually one week for a return to work from home. Return to exercise is at three weeks. These are typical figures, not a promise; bruising and swelling vary, and they vary more if a brow lift or eyelid surgery is included.

A compression garment is frequently used for the first week. Hyperbaric oxygen therapy, as an adjunct to the recovery, is associated in our experience with a faster decrease in facial swelling and generally a quicker return to activity.

The contour continues to settle for months. Early photographs are not the result. Some firmness around the ears and some unevenness of swelling are part of that course and usually soften.

Every operation carries risk. For facelift surgery the discussion includes bleeding and haematoma, infection, delayed healing, numbness or altered sensation, asymmetry, an unsatisfactory scar, and injury to the facial nerve — usually temporary when it occurs. Swelling and bruising are expected; they are not complications, but they are part of the recovery that has to be lived through.

Blood thinners and raised blood pressure both increase the risk of bleeding. They are managed in the plan; they are not left as incidental details on a form. Smoking impairs healing and is relevant to whether surgery should go ahead at the time proposed.

The written information after consultation sets these points out for the operation that has actually been discussed, rather than for facelift surgery in the abstract.