Minimal Access Cranial Suspension Lift: A Modified S-Lift

Abstract

There is a strong trend at hand toward less dramatic facial rejuvenation surgery. Most of the authors' patients want a cosmetic improvement but not at the cost of prolonged disfigurement or a high risk of complications. In 1999, a very simple but effective rhytidectomy technique, termed an S-lift, was described in the literature and was adopted by the authors. Its basic principle is the suspension of sagging facial features by a strong, permanent purse-string suture. The procedure is performed with the patient under local anesthesia. Significant modifications were applied to the incision, to the purse-string suture anchoring site, and to the direction and shape of the skin excision. The authors named the modified procedure the minimal access cranial suspension lift to specifically describe the concept of the technique. Through an inverted L-shaped preauricular incision with extension below the sideburn, a limited skin undermining is performed. Two strong, permanent purse-string sutures are woven into the superficial musculoaponeurotic system tissues in a vertical U and an oblique O shape, initiating from a strong anchorage in the deep temporal fascia at the level of the helical crus. Tying these sutures produces a very powerful vertical correction of descended facial features that acts mainly on the jowls and the upper neck. The procedure can be extended by continuing the dissection over the malar fat pad, placing a third vertical purse-string suture with strong action on the nasolabial groove, and vertically repositioning the midfacial volumes. During 20 months, pleasing results and a very low complication rate were obtained in 88 consecutive patients with a mean age of 551/2 years. In this article, the authors provide a detailed description of the anesthetic and surgical technique, a demonstration of the results in different patient age categories, and a discussion comparing the minimal access cranial suspension lift with other types of facial rejuvenation procedures.

Recent Advances in Face Lift to Achieve Facial Balance

“…Its concept was initially described by Passot [24] in 1919. In the 1990s Saylon and later Fulton described the S lift [25]. The preauricular skin is excised in a S shape followed by purse string suture plication of the mobile SMAS and the extended supra platysmal plane (ESP) which is fixed to the periosteum/fascia of the zygomatic arch.…”

Short-Scar Facelift without Temporal Flap: A 10-year Experience

“…At the same time they want natural long lasting results without any stigmas. There have been several surgeons that have proposed less invasive techniques (20,12).…”

“…In our technique, the length of the incision was decreased in 45% by avoiding the intracapilar posauricular and temporal incisions. We consider that the intracapilar incision does not provide any advantages in the cervical treatment but only allows skin placement, concept that we share with Tonnard and Verpaele (20,21). The excess skin can be situated in the retroauricular sulcus.…”

Retightening Revision of a Previous MACS-Lift Meloplasty

“…We encountered the same situation when revising one of our earlier MACS-lift patients from before 2002. In that case, we indeed used Prolene 2-0 in loop sutures [1]. We also were tempted to retighten the original suture but were disappointed in the effect we obtained in the neck.…”