Facelift bypass offers "less is more" advantages


Minimally invasive procedures offer good results


May 1, 2003, By: Bill Gillette, Cosmetic Surgery Times


Rancho Mirage, Calif.-When it comes to facelift procedures, it's the opinion of Ziya Saylan, M.D., that less is more.


At the American Academy of Cosmetic Surgery Annual Meeting, Saylan, a Dusseldorf, Germany-based cosmetic surgeon, presented evidence that minimally invasive facial-rejuvenation procedures are viable and effective. Among other procedures, his seminar focused on the S-lift and Serial Platysma Notching.


"Instead of a conventional facelift, a surgeon can achieve good results by performing minimal invasive surgeries, which I refer to as facelift bypass," Saylan said.


Revolutionary S-lift


In the S-lift procedure, Saylan said that the SMAS (superficial musculoaponeurotic system) surgery revolutionized facelift techniques. He said his contribution to the procedure is the fixation of the SMAS and the ESP-extension of the supraplatysmal plane-to the zygomatic bone periosteum so as to achieve stable traction and fixation.


"We have achieved excellent stability of the SMAS and a perfect fullness of the cheeks with traction of the platysma by means of 'purse-string' formed collecting and suturing to the zygomatic bone, which will end up giving a younger look to patients," Saylan said.


The improved procedure features a new suturing technique that Saylan developed and calls "U and O" sutures. The U suture picks up the soft neck tissues and the ESP, while the O suture collects and plicates the SMAS, parotid fascia, and the fat pad.


"This fills the cheeks so that patients have a long-lasting enlargement of the cheek bones," Saylan said. "A deep dissection is unnecessary, and the suspension achieved is, in my opinion, more stable compared to some SMASectomy techniques."

Advantages, disadvantages


Saylan listed the advantages to the S-lift procedure:

  • Short operation time, quick recovery time; The U suture achieves a much better neck result than more traditional procedures; Like a purse string, the O suture collects the SMAS and the parotid fascia without major undermining;

  • There is less risk of facial nerve injury due to tightening of the SMAS, achieved by the purse-string formed plication with superficial "bites" and minimal undermining

  • A natural look is achieved by the pull of the aponeurosis vertically;

  • Fixation of the soft tissue to the cheek bones provides extra fullness to the area, which in most cases negates the need for a malar implant;

  • Because of minimal invasiveness, less swelling and bruising occurs.

Saylan said that in his past experience, a traditional platysmaplasty almost always resulted in a "hardening and scarring at the submental region," largely due to having to dissect the platysma muscle with scissors, a scalpel, or electrocautery.


"Since then, I improved my technique," he said. "I mark the platysma bands and, following small incisions, the band is pinched between two fingers and a serial notching is performed with an electrocautery. A skin closure is not always necessary, and this technique causes fewer complications than traditional submental approaches while being more effective. We call this operation 'serial notching of the platysma bands,' and it is performed alone or with a lower facelift, necklift and submental liposuction."


Achieving optimal results


Saylan said markings are made 3 cm to 4 cm apart, and that after washing the skin with Betadine, local anesthesia is injected. (If a liposuction is planned, he said, infiltration with a classical tumescent solution is necessary.) Then, pinching the skin at the marked areas between thumb and forefinger, 1- to 1.5-centimeter incisions are made horizontal to the platysma band. (He noted that multiple incisions are necessary for the best results.) Electrocautery notching is repeated frequently along the muscle.

"Skin suturing is not always necessary following the procedure," Saylan said, "but if a skin laxity of severe degree is present, suturing is advisable. Normally, we close the wounds with sterile plasters, and after five or six days only a redness of the skin is left and the bands are no longer visible."


Saylan said advantages to the procedure include:

  • Quick recovery period of five to seven days, compared with the typical 14 to 21 days with more traditional procedures;

  • Less potential for hemotoma;

  • No large submental incisions are necessary for results;

  • Lower cost than a necklift or lower facelift;

  • Only local anesthesia is used;

  • Procedure time of 20 minutes.

Saylan noted, however, that some disadvantages exist, such as:


  • Possibility of scar tissue at the anterior neck;

  • If fewer incisions are made, the retracted muscle between incisions can be visible as a bulge;

  • In 11 percent of his cases, more than one session was required.


"Serial platysma notching, all in all, is a good adjuvant to a face- or neck-lift and can be performed on older patients as a single treatment," Saylan said.