The mini lift is a surgical procedure that improves the appearance of the lower face and upper neck. This procedure has recently become more popular because it is less invasive than a traditional face lift, yet has comparable results. Advantages of the mini-lift include shorter, less noticeable incisions, quicker recovery and less chance for complications such as noticeable scars or hairline irregularities. More importantly, the mini lift can look less “plastic” or “pulled” as compared to the traditional facelift. Most patients prefer results that make one look “refreshed” or “rejuvenated” as opposed to appearing “done”.
So what exactly is the mini lift? In order to answer this in an understandable way for the non-surgeon, let’s address the three most important aspects of any lifting procedure, whether a mini-lift or traditional face lift: 1) the design of the incision; 2) the extent of work that is done underneath the skin; 3) the work that is done for the neck. While it is the design of the incision that makes the scar discreet, the work underneath the skin for the cheeks, jawline and neck is what truly effects the improvement and longevity.
The major difference between the incisions for the mini lift and the face lift is the length. The mini-lift incision is approximately 1/2 to 2/3 the length of the face lift incision. This shorter incision starts within the sideburn hair, curves down following the contour of the ear, extends just inside the ear canal, curves around the earlobe and ends either at the attachment of the earlobe on the cheek or within the crease behind the ear. In contrast, the face lift incision includes all of that and then continues up the back of the ear, takes a right angle backward to reach the hairline behind the ear and extends on for another 3-4 inches within the hair of the neck. This longer incision can lead to more noticeable scars, loss of hair along the back of the neck or simply an unnatural looking hairline. These undesirable results can make it difficult for a woman to wear her hair pulled back or for a man to wear his hair short. The mini-lift incision is therefore much less likely to be noticeable. A number of mini-lift incision designs have been promoted as unique such as the S-lift or J-lift. In essence, these are just mini-lift procedures with slightly different designs for the incision.
Having discussed the incision, let’s address what is of greatest importance for the patient’s outcome.
After the incision has been made, what does your surgeon plan to do under the skin to improve both the lower face and the neck?
In 1976, Drs. Mitz and Peyronie described a layer of tissue under the skin of the cheek that they called the superficial musculo-aponeurotic sheath (SMAS). This report changed the way face lifting procedures would be performed from that time forward. Before their report, face lifts were performed by lifting the skin only, pulling tightly on just the skin and then removing the extra skin. This “skin lift” provided results that did not last for years and often looked “pulled”. Currently, the SMAS layer is often referred to as the “muscle” layer when the surgeon communicates with the patient.
Lifting techniques changed quickly to incorporate the SMAS layer for several reasons. By lifting the SMAS layer, the jowls and lower facial volume can be repositioned and lifted more effectively. In addition, the results of the procedure will last longer if the SMAS layer is lifted also, and not just the skin layer. Finally, the result will look more natural and less “plastic”, if the SMAS layer is used.
There are many different techniques for manipulating the SMAS layer. Some surgeons choose the cut through the SMAS, lift underneath it for a certain distance, and then pull it vertically and secure it with sutures. Others remove a section of the SMAS, do not lift it and then reattach the cut edges. Some use multiple “plication” sutures to fold the SMAS on itself and effectively lift the jowls. Finally, some will use a “purse string” suture technique to tighten the SMAS in a concentric pattern. Ultimately, the success of the procedure depends on how well the surgeon uses his or her preferred technique to achieve the best result for the patient.
When there is a minimal to moderate amount of loose neck skin, short vertical “turkey” bands and a small amount of neck fat, a Minilift with limited liposuction under the chin will suffice. If more extensive work is necessary, wherein there is a lot of extra neck skin and fat and the vertical bands extend down most of the front of the neck, then a concomitant neck lifting procedure is warranted.
Improvement of the neck with a Minilift is achieved primarily through a combination of neck liposuction through a small incision under the chin and by pulling on the muscle layer in the neck known as the platysma. The platysma is a sheet of muscle beneath the fatty layer under the skin that resides on each side of the neck and is the cause of “turkey” bands. It also happens to connect on the same plane with the SMAS layer in the cheek. During the Minilift, the surgeon may choose to use a suturing technique to pull on the upper/outer corner of the platysma, just below the angle of the jaw and lift upward. This pulling has the effect of improving the neck angle as seen from the side view and tightening the tissue of the upper neck and under the chin.
As in all plastic surgery procedures, the judgment, experience and technical skills of the surgeon are of utmost importance. Whether he or she recommends a traditional face lift, or a mini lift, or a mini lift with neck lift depends on the patient’s reasonable expectations and clinical needs. A mini lift is a very appropriate option for improving the appearance of the lower face and neck with potentially less recovery and potential for complications.
The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Mitz V, Peyronie M. Plast Reconstr Surg. 1976 Jul;58(1):80-8.
Minimal access cranial suspension lift: a modified S-lift. Tonnard P, Verpaele A, et al. Plast Reconstr Surg. 2002 May;109(6):2074-86
Lateral SMASectomy, plication and short scar facelifts: indications and techniques. Baker DC. Clin Plast Surg. 2008 Oct;35(4):533-50, vi