Commentary

The demand for facial rejuvenation surgery is growing rapidly. This demand by perspective patients is largely affected by increasing social pressures to maintain a youthful appearance. These pressures are primarily a by-product of media and internet advertising. As the media has given increased exposure to cosmetic surgery, public acceptance for surgical procedures has grown, and the healing process for these procedures has often become trivialized.

As demand for cosmetic surgery has increased, surgeons have developed more types of procedures, more names for these procedures, and of course, more advertising. Patients are affected by: (1) media pressure to maintain a youthful appearance, (2) fear of looking unnatural after surgery, (3) desire to produce change with minimal cost and downtime, and (4) advertising blitz by medical device companies trying to capitalize on this increased demand (e.g., companies producing sutures or threads extolling the virtues of cable lifts).

The variation of the mini-face-lift performed in many locations termed the Lifestyle Lift™ is not new. However, the mass marketing and attempt at general acceptance of the concept are novel. The popularity of the short incision, minimal flap face-lift is a result of massive advertising and of the patient's desire for minimally invasive surgery with decreased cost and downtime versus traditional techniques.

The potential problems with any mini-face-lift are not the procedures themselves but the manner in which the procedures are marketed. Although patients are concerned with cost and downtime, their overriding concern is typically related to how good their result is and how long the result lasts. The mini-face-lift produces less complete results that are shorter-lasting. For this reason, the mini-face-lift is usually indicated for younger patients with less extensive aging changes.

The general concept of asking for a procedure (e.g., mini-face-lift)-rather than telling the surgeon what they want to improve and subsequently discussing options-often leads to patient dissatisfaction. Additionally, bypassing the typical process of evaluation and diagnosis first, followed by a complete discussion of options and then treatment can contribute to misdiagnosis and communication failure. Even in cosmetic surgery, a diagnosis-oriented treatment tends to get better results than does a procedure-oriented one.

When a patient presents asking for and determined to receive a given procedure, they must be made aware of the procedure's complications and limitations. It is important that the physician's staff does not push “procedures.” Instead, a thorough doctor-patient consultation should be advised. This consultation should not be outsourced to office staff members. It is during the consultation that the diagnosis is made, the procedure decided upon, and the relative risks and limitations discussed.

It is also advisable that physicians performing mini-face-lifts have knowledge of and experience in other types of face-lifts, including superficial musculoaponeurotic system-flap lifts, and deep plane lifts. This will allow the surgeon to prescribe different procedures for different facial types and different facial diagnoses. Additionally, the surgeon will avoid advising only procedures with which they are comfortable. This is particularly important with mini-face-lifts, which do not work well for all facial types (e.g., very aged or very heavy faces).

The short flap, minimal incision face-lift is a safe, consistent procedure that has been well described in the facial plastic surgery literature. The procedure should be a part of a battery of procedures used by astute surgeons to rejuvenate the face. Both the patient and surgeon should understand the limitations of the procedure-the surgeon to carefully advise the patient and the patient to make an informed decision on procedure choice.