It seems that a good way to test the success of a facelift procedure is to use each technique on a set of twins and compare the outcome. One such recent report suggested twin # 1 had an outpatient procedure under local anesthesia with a much shorter and easier recovery than her twin sister. Twin # 2, who underwent the procedure under general anesthesia with an overnight stay, had more swelling and bruising with an extended recovery. The postoperative “facelift” pictures of the twins indeed show a “similar result”. The point of the report was to show that a “facelift” performed with local anesthesia gives the same result with less recovery and expense.
What wasn’t appreciated in the report was the twin’s appearance prior to surgery. The “twins” aged very differently. The first was a thin, smoker with minimal neck changes. The second twin was heavier with deeper folds around the mouth and chin, and a thick redundant neck. The second twin’s surgery elevated the deeper structures to their more youthful position and removed unwanted fat in the neck. The less invasive procedure under local anesthesia done on the second twin would not result in the improvement the more extensive procedure gave to this patient. Also doing the more extensive procedure on the first twin would be unnecessary and probably result in an unnatural overly corrected appearance.
Facelift procedures need to be based upon the aging deformities of the individual patient. Some patients seeking rejuvenation require a lesser procedure because they do not show extensive signs of aging. On the other hand, performing a very limited facelift (i.e.; minilift or “LifeStyle Lift”) on a patient with extensive aging will only lead to disappointment.
Using a “cookie cutter” approach to facial rejuvenation is seldom employed by an experienced surgeon. They will fit the procedure to the patient not the patient to the procedure. The experienced surgeon is not committed to a single procedure but is able to perform the procedure the patient requires not the procedure “as advertised”.
Experience allows the surgeon to employ the whole armamentarium of techniques and skills to give each patient the best result which makes for a happy patient.
Thomas J. Francel, M.D.