One-stitch Facelift

Here's a little not-so-secret. A lot of women in "glamour" professions, such as acting or TV news, have had "a little work done" to extend their longevity in jobs that value "youth." In recent years, more men have undergone cosmetic procedures, too.

The latest "wrinkle" (so to speak) is something called the "one-stitch facelift." Less invasive, less expensive, faster healing time.

At the Cleveland Clinic (www.clevelandclinic.org), plastic surgeons refer to it as a "cheek" lift. In a recent article, "Cheek-lift is Pre-emptive Strike Against Aging Face," the clinic says the traditional facelift is not very effective at resolving one fundamental attribute of the aging face - drooping cheeks that create a hollow look around the eyes and prominent lines around the nose and mouth.

Several years ago, according to the clinic, a technique called the mid-face lift helped resolve the problem, although it proved to be an involved surgical procedure and wasn't always practical.

Today, a new mid-face lift technique has evolved that is not only effective, it also can be performed using a minimally invasive approach - very small incisions and no cutting of tissue or muscle.

The cheek lift was originally intended to resolve sagging lower eyelids and had been proposed in 1997 by an ophthalmologist. A clinic cosmetic surgeon, Dr. Daniel Alam, modified it for use in facelift surgery.

The cheek lift relieved sagging skin below the eyes and diminished lines around the mouth and nose, taking years off a face. Now, it stands alone as a rejuvenation option - and is increasingly popular with middle-aged adults who want a minimally invasive procedure that is affordable and produces results that last.

Here's how the Cleveland Clinic says it works:

The mid face owes its form in part to malar fat pads that rest beneath the cheeks and on top of the cheekbones. Over time, gravity forces the pads to gradually descend from their normal positions, causing hollowing around the eyes and at the upper cheeks and droopiness in the lower cheeks. As the cheek skin droops, it causes deepening of the nasolabial folds, the slight creases that run from the lower portion of the nostrils and down around the corners of the mouth. All of these changes contribute mightily to that slightly saggy, tired expression that in many people characterizes the onset of middle age.

To counteract these effects, the surgeon repositions the fat pad using a simple suspension system placed discreetly underneath the skin. A small incision on the side of the head - between the ear and the forehead - and two tiny punctures on the cheek provide access for needles that are used to thread very fine sutures under the skin and through the top of the fat pad. The sutures - two for each pad - are gently tightened until the fat pad is properly repositioned; then it is secured at the incision site on the side of the head, to a tough tissue plane called the temporal fascia. "This tissue is strong, so by securing the sutures to it, we can minimize further sagging of the fat pads," the clinic quotes Dr. Alam.

Repositioning the fat pad lifts the mid-face up and out, softens the nasolabial folds, lifts and contours the jaw line and smooths wrinkles in the upper lip. The procedure also softens laugh lines and diminishes hollowing under the eyes. In fact, the cheek lift produces such dramatic improvement around the eyes that Dr. Alam says many of his patients are asked whether they've undergone eyelid surgery (blepharoplasty).

Mid-face rejuvenation does not require general anesthesia or hospitalization and costs about one-third of the price of a traditional facelift, the clinic says. Patients are given sedating medication before the procedure to help them relax. The surgery lasts approximately 20 to 30 minutes. Recuperation usually lasts about a week,

"The real key to a quick recovery is ice, ice, ice and more ice," says Dr. Alam. Patients can resume normal household daily activities immediately after surgery, but should hold off on exercise or strenuous activity for one week.

If a patient is not satisfied with the results, the suspension system can be adjusted to raise or lower the fat pad. "I just have to cut one stitch to affect a change, so making adjustments is quite easy," says Dr. Alam. "By opening the incision in the hairline, I have complete access to the suture. Then I can easily use it to manipulate the position of the fat pad. I'll move the pad to different positions while the patient and I watch the results," he says. "Once we agree on the optimal position, the suture is re-secured."

Dr. Alam says that his patients are both men and women in a wide age range, from late 30s to early 50s. "Everyone's face ages at different rates and in different ways," he says, "so the age range can be broad." Some want to look better for themselves; others believe looking younger gives them an advantage in the workplace. Any person who has sagging malar fat pads is a candidate for the procedure. There are no age or other restrictions.

Cheek lifts can also be combined with other cosmetic surgeries, such as traditional facelifts or neck lifts, to give optimal results in the mid-face. All patients who opt for a traditional facelift get the cheek lift as well, says Dr. Alam. Even patients who have already had a facelift can undergo a cheek lift to achieve increased smoothing of the nasolabial folds.

According to the National Institutes of Health (www.nih.gov), face lift risks include:

Risks for any anesthesia are:

• reactions to medications
• problems breathing

Risks for any surgery are:

• bleeding
• infection

Additional risks include:

• a pocket of blood under the skin (hematoma) that may require drainage
• injury to nerves that control facial muscles (usually temporary)

The NIH cautions, after a facelift, limit exposure to the sun.

Cleveland Clinic Tips on Choosing a Physician

• Verify that the surgeon is a member of at least one of three medical boards:

American Board of Facial Plastic and Reconstructive Surgery: (www.abfprs.org)

American Board of Plastic Surgery: (www.abms.org)

American Society of Cosmetic Surgeons: (www.plasticsurgery.org)

• Make sure the surgeon clearly explains what's involved before, during and after surgery and what results can be expected.
• Ask to see "before" and "after" shots of patients the surgeon has treated.
• Be sure the physician can document background and training.
• Ask the surgeon where he/she did medical residency and how long he/she has been performing the procedure you're interested in.