Endoscopically assisted limited-incision rhytidectomy: a 10-year prospective study.
ABSTRACT The ability to bring aesthetic harmony back into the ageing face requires the blending of surgical technique, anatomic knowledge and artistic sensitivity to individualise the surgical approach for each given patient. Since the advent of endoscopic techniques for facial rejuvenation, there has been an increase in the number of patients who seek alternative facial procedures, refusing a conventional face-lift. Limited-scar rhytidectomies offer patients with mild-to-moderate facial ageing an alternative to traditional face-lift surgery. The authors present a prospective study using the endoscopically assisted limited-incision face-lifting technique. Indications for using this technique include young patients with a relatively small amount of skin excess, older patients with thick skin and minimal skin redundancy, smokers and bald people. A set of incisions in the forehead, pre-auricular area, ear lobe and post-auricular area are done. Frontal and temporal endoscopic lifting is performed, followed by middle third and cervical undermining and transposition of a 2×5.5 cm rectangular pre-auricular superficial musculo-aponeurotic system (SMAS) flap. Overall satisfaction with the facial appearance after this procedure was rated on a scale of 1 to 5. A total of 54 patients were operated upon during January 1997 and January 2007, which represents 13% of the total number of face-lifting procedures performed during that period. Their age ranged from 28 to 55 years old (mean 38 years), and 35% of them were men. There were two cases of haematoma formation (1%) and four patients (2%) required further liposuction of the submental region. There were no cases of nerve injury or infection. Six patients (3%) requested revision surgery after 2-4 years after the first procedure (median 3.5 years). They underwent a secondary round of face-lifting. The mean follow-up period has been 5.5 years (range 1-9 years). Sixty-nine percent reported that their appearance after limited-incision rhytidectomy was 'very good' to 'excellent' and 22% responded that their appearance was 'good'. Only 9% of patients thought their appearance was less than good. This is not a mini-lift technique but rather a full face-lift performed through minimal incisions and assisted by the use of the endoscope. Although the endoscopically assisted limited-incision rhytidoplasty is reserved for a specific category of patients and requires a learning curve, it appears to be a procedure with a low rate of complications and a high patient satisfaction.