Scarless Facelift

Richard D. Anderson, M.D.

Are you looking for a scarless facelift? Well, if you are, one doesn't exist. But what about a facelift that uses hidden, nearly invisible scars that are placed in the hairline? Scars that no one can see.

There has been a large amount of media rage about the so-called "thread lift" and "barbed suture" techniques of facelifting. Unfortunately, these two sensationalistic procedures do not provide long-lasting and beautiful results. In a word, they have not been proven to stand the test of time, years out.

The signs of facial again are well-known to Board Certified plastic surgeons and to their patients. Unfortunately, we can't beat gravity. As we age, the cheek tissues fall and pull away from the lower eyelid areas. The falling of this soft tissue causes and aged, hollowed-out appearance to develop below the eyes. This is often referred to as the tear trough deformity.

Other signs of facial aging include the deepening of the cheek folds. The cheek folds are diagonally oriented from the side of the nose down to the corners of the mouth. Shadows that start at the side of the nose and cheek area only serve to accentuate an aged look. These shadows are more marked unfortunately when light illuminates the face from above.

In addition, thanks to gravity, the corners of the mouth and the outer edges of the eyebrows sag. When the corners of the mouth sag, it can create a sad look. When the cor- ners of the brows sag, it can create a mean or sad look.

Other changes that patients complain about include the presence of jowls that develop along the jaw line. They complain that they can no longer see the bony edges of their jaws. Deep "marionette" lines can also run down from the corners of the mouth and the corners of the mouth themselves can turn downward. When these Charlie McCarthy-like folds develop at the corners of the mouth, they are usually present in from of the jowls. All of these changes create a tired, sad and aged appearance.

I developed this endoscopic facelift to lift and reposition the sagging facial tissues; to counteract the forces of gravity and to create a more youthful result. By lifting the upper face and the midface tissues to a higher position, the hollowing at the cheeks and below the eyes can be addressed surgically. Even the outer brows can be lifted with this endoscopic lift. The cheek folds and jowls can be suspended and reduced (but not completely removed) in appearance.

This "minimally invasive" surgical procedure is per- formed with an endoscope (a small pencil-shaped camera and light system) that is introduced in order to aid with visualization and dissection. The use of endoscopic equip- ment allows for smaller incisions. The greater the amount of surgical experience the plastic surgeon has with endoscopic surgery, the less the postoperative swelling and downtime.

The day of surgery, the patient is marked preopera- tively with respect to certain importants anatomic nerve landmarks. In my practice, the procedure is performed un- der local anesthetic with intravenous sedation at an ac- credited outpatient surgery center.

The surgical release of the soft tissues (tissue located below the skin) is performed. This soft tissue is then lifted with suture placement and suspension. The procedure is performed as the plastic surgeon views a clear and mag- nified image on a TV monitor. There is a learning curve associated with performing endoscopic surgery. In fact, this specialized type of surgery has been compared to using small "chopstick-like" instruments through tiny incisions. The technique is very safe and can create less trauma to the surrounding tissues depending on the experience of the surgeon with the endoscopic technique. Less trauma translates into less swelling after surgery.

After a complete soft tissue release of the sagging tissues is performed, suspension sutures are surgically placed on each side. These sutures are then secured to the deep tissues lo- cated at the temple areas, hidden in the hair line. The sus- pension of the soft tissues (aka suture suspension) achieves the desired elevation of the soft tissue with a simultaneous restoration of a more youthful look. The suspension sutures are accomplished with a single, tiny hidden scalp incision on each side. Absolutely no hair is removed, shaved or cut. At the completion of the procedure, the hairline is not changed or pulled up. The mall incisions are virtually invisible after they heal. Ideally, hair grows through the small incisions.

The endoscopic facelift procedure is done in an ac- credited oupatent surgery facility with intravenous "twi- light" anesthesia. Inpatient hospitalization is not needed. Our patients are very comfortable and sleepy during the surgery and post operative discomfort is minimal as well.

After the two small scalp incisions are closed and light dressings are placed, the patient is monitored in the re- covery room prior to going home. Most patients are back to light activity in a few days. They are back to normal activity, including work, within two weeks. In fact, some patients have returned to work within one week!

The suture suspension face lift can be safely combined with other cosmetic procedures such as upper or lower eyelid tucks (aka blepharoplasties), a neck lift, chin en- hancement, and laser wrinkle reduction, as long as these procedures are indicated.


In my practice experience, no cases of hematoma (abnormal collection of blood) and infection have occurred. Slight, tem- porary weakness of minute branches of the facial nerve have occurred in less that 5% of the cases. All nerve branches "woke up" after overcoming the fact that surgery was performed adja- cent to their vicinities. In all cases, sensation returned to being completely normal.

What about the so called thread lift, feather lift, and "barbed suture" techniques which are currently being hyped by the media? Do they provide the same type of facial improvement?

Unfortunately, they do not. the overall improvement achieved is much less impressive with these simple thread lifts. The pa- tients aren't pleased. The plastic surgeons who perform the sim- ple thread lifts are disappointed with the short duration of the minimal improvement achieved. The temporary improvement often lasts less than a few months,. In contrast, patients who un- dergo endoscopic soft tissue release and suture soft tissue suspen- sion have seen persistent and long-lasting facial rejuvenation for up to 8 years and even longer. Out patients have ranged from 37 to 72 years of age. In patient surveys, our patients have answered positively with respect to their being pleased with their results in over 90% of the cases performed.

Having performed well over 1000 endoscopic face lifts, I have found the procedure to be very safe. The procedure also gives my patients an impressive improvement which lasts for years instead of temporarily lasting just a few months (like with the simple thread lifts). I expect that the endoscopic technique that I have perfected (and have taught to fellow plastic sur- geons) will continue to increase in popularity in view of these many advantages which include: better visualization of im- portant structures; a more complete soft tissue release; smaller incisions; virtually invisible scars; less postoperative swelling; long-lasting facial rejuvenation; less downtime. Some of the disadvantages include the need for proficiency in endoscopic surgical skills on behalf of the surgeon.

I believe that this minimally invasive, endoscopic facelift in- volves less downtime and can provide a youthful, refreshed and rested appearance that will stand the test of time.

I pioneered and have perfected the endoscopic suspension facelift. Over the past ten years, I have taught this technique to hundreds of plastic surgeons worldwide. Additionally, I feel that I have helped hundreds of my own patients change their tired, sad and aged-appearing faces into new younger, rested, refreshed and natural-appearing faces. And the best part is that there are no vis- ible scars (since they are hidden in the hairline); patients experi- ence a faster recovery and enjoy long-lasting improvements.

Breast Augmentation and Plastic Surgery Articles

Breast Implants USA features articles from our own writers, our sponsoring Board Certified Plastic Surgeons and other sources with something to say about any aspect of Breast Augmentation and Plastic Surgery.

Breast Augmentation Blog

Our Breast Augmentation Blog is updated several times per week with news about Plastic Surgeons, Plastic Surgery, Breast Augmentation, Breast Implants and more! Be sure to check out the latest from our writers.