Carmel Mini Lift Monterey
The Carmel Mini Lift
Everyone wants to look their best. It is part of human nature. Over the years I have been in practice I have heard a lot of women and some men come into my office who want an improved appearance, they want to look more youthful and vibrant, but they feel they are not ready for the so-called “complete facelift.”
Often times people will want something to improve their looks that is not so dramatic, they might prefer a more subtle or moderate change, they don’t want a lot of downtime, they might not want a deep general anesthetic and prefer the office setting to have a procedure, and they may want an option that is more affordable that still gives them a noticeable improvement. And still to some people, a complete facelift, whatever that means, still has a bad connotation, or a stigma, and they would prefer something more simple, a procedure that does not take a long time in the operating room, and that leaves shorter or fewer scars.
Maintaining Your Youthful Beauty Without Totally Changing Your Look
There are a lot of younger people requesting such a similar procedure. For many different reasons even a younger person with only subtle or early signs of aging will want to improve their looks without doing something dramatic, they want something that will not totally change their looks or be so obvious to their friends and coworkers. Too often they know of someone in their neighborhood, or even a celebrity that had a so-called complete facelift that has dramatically changed the way they look and is so obvious to everyone. today’s workplace is still very competitive, in the social and dating scene appearance is still so important, and a person’s level of self confidence can dramatically influence their path to success in many different areas of life.
Is a “Complete Facelift” My Only Choice?
For many people the so-called complete facelift is not what they need, nor what they want. I see a lot of patients in my office that want to look their best, they do not want to take a lot of time away from their fitness routines, they want to get back to work and the social scene more quickly, and they feel uncomfortable with the idea of that type of dramatic change.
Over the years after seeing so many people expressing similar concerns and desires, I became more interested in the many different approaches to less dramatic ways to lift and elevate the face and to potentially restore volume loss. Over the years there have been many procedures described in the plastic surgery literature such as the so-called short scar face lift, a light lift, the S lift, the MACS lift and on and on.
Advancing the Facelift
Plastic surgeons, like many other surgical subspecialists have been trying to do more through smaller incisions. New technology helps us accomplish this. I now commonly use quite powerful loupe magnification while operating, fiber optic lighting that weighs just a few ounces mounted right to my head, and sometimes endoscopes and other fiber optic technology to be able to accomplish more surgery, and more desirable change and effects through shorter incisions.
There are a couple of artistic professors of Plastic Surgery in Belgium who have explored these newer approaches – Patrick Tonnard and Alex Verpaile. I have traveled and taken their course; I incorporated many of their techniques in the Carmel mini lift. I also traveled to observe Larry Nichter and Jed Horowitz in Orange County use some of the short scar lifting techniques. They were both instructors at USC when I was Chief Resident there, and Dr Nichter and I have operated on children overseas. In New York both Dan Baker and Sherrell Aston have employed shorter scar approaches to face rejuvenation.
In Plastic Surgery, there is of course a great deal of artistry and improvisation – we borrow from each other and develop our own techniques and approaches.
In my practice I am committed to the concept of a customized individual approach. Of course there are still many women and men who might be the ideal candidate for a more extensive facelift, they are willing to block out their calendar for a somewhat longer recovery time, they do not object to a longer procedure, and they would expect more dramatic improvement. Others of course might be the ideal candidate for the so called mini lift. I am committed to the concept that everyone’s face is different, their goals and desires are all different, and a custom designed approach has served my patients well over the years.
Choosing the Right Procedure
As I have emphasized, it is important to match the right procedure with the right patient at the correct time in their life. The short scar face lift is not for everyone; there are some limitations to all of these different short scar approaches including the Carmel Mini Lift. The change or improvement is not as dramatic as with a more extensive procedure. In general if someone needs a lot of skin removed a longer incision is recommended.
The Benefits of the Carmel Mini Lift
With the Carmel Mini Lift there are still shorter scars because short incisions must be made to achieve access to tissue that must be lifted. If someone is considering a procedure in the office they must be able to relax in such a setting, and any medical problems they may have must be under meticulous excellent control. And of course a custom designed approach includes a choice of anesthesia as well. Some people will elect to have a short scar mini lift and still prefer heavy sedation or even a general anesthetic for their procedure. I am a big advocate of accommodating different desires and comfort levels for anesthesia as well as for the surgical procedure.
The incisions for the Carmel Mini Lift begin with a sort of W plasty approach in the hair of the sideburns, or what we call the temporal tuft of hair in a woman. The incision then curves up toward the top of the ear, downward toward the ear lobe, under and around the ear lobe to the crease in the back of the ear.There are many different options and choices for that incision between the top of the ear and the ear lobe.
Many people even in their youth have a crease in front of the ear which serves as an almost ideal place for the incision and the resulting scar, others will like the incision placed at the edge of the cartilage called the tragus, which is the button like protuberance in front of the ear canal, and for others i custom design a hybrid approach.
Men should keep in mind as we are designing this incision that their facial hair and beard growth may influence their choice, and both men and women should remember that normal recess or slight concavity in front of the tragus may be modified if they select the incision to be made at the edge of the cartilage or even in back of it. Again, a custom designed approach for every patient over the years has served my practice and my patients well.
Through this S shaped incision around the ears I can gain access to the side of the neck, the jowls, the cheeks and gain limited access to the malar areas, the so-called cheekbones. I am able to lift and firm and tighten the lateral or side of the platysma muscle, the fascia called the SMAS, thereby giving a longer lasting, more effective, more natural look following this procedure. By tightening and firming the SMAS this also allows us to take tension off the skin which typically results in less visible scars.
After consulting with Dr. Morwood we decided on a lower face mini-lift and that I also transfer fat from my own abdomen to my cheeks to restore lost volume. I now feel like my face matches my youthful attitude and lifestyle. I have the volume in my face I had in my twenties, I have a beautiful neckline again and the lines around my mouth are nonexistent!
A really good plastic surgeon such as Dr. Morwood knows how to restore your beauty without people knowing what you have done to have found the fountain of youth again.
There is a healing process that you need to respect and be patient with as the weeks go by. Following your doctor’s orders are imperative. And most importantly, enjoy the youth that you have received back! Thank you so much Dr. Morwood and your fabulous team!
by Cheryl K.
Revolumizing the Face with a Carmel Mini Lift
During the same procedure, prior to completing the operation, it is possible with a Mini Lift to perform some re-volumization of the face for someone if needed. You may be familiar with my concept of the triangle of facial rejuvenation. As we mature we tend to lose fat in the face and in the hands and gain that fat in the trunk.
There are a few different ways to restore lost volume in the face; one way is with fat grafting. We are able to perform a conservative amount of liposuction, typically from the abdomen or the flanks, centrifuge or decant the fat, maintain sterility, and graft it to where there is volume loss such as the cheekbones, the nasolabial folds, the posterior mandibular angles, or even the temples.
During the Carmel Mini Lift the third angle of the triangle of facial restoration can be considered which is skin resurfacing. A TCA or other peel can be accomplished during the same setting for the patient who needs improvement in their complexion.
Anesthesia and Facility choices for the Carmel Mini Lift
In summary there are three anesthetic choices while having the Carmel Mini Lift:
- Oral sedation with local anesthesia – This is typically done in the office for a person who is capable of relaxing, who is overall healthy, is able to lay down and cooperate for a few hours and has no uncontrolled medical problems like high blood pressure or diabetes or a history of heart and lung problems. After taking and ensuring vital signs are normal, a person will take pills by mouth and with time will become very relaxed. After a suitable delay for the oral sedation to take effect, we then inject local anesthesia into the skin. That stings because we inject with a needle. After a further monitoring period delay we numb the deeper tissues with a solution called Hunstead’s formula, which is the same fluid we use to numb up an area for liposuction. After waiting for that to take effect a patient is very relaxed, numb, but awake.
- IV anesthesia at the surgery center – The nurse will start an IV, an anesthesiologist will be present, and those same medicines that we give by mouth in the office are now given directly into the vein. The patient can tell the anesthesiologist and nurse “how deep” he or she would like to go. This ranges from twilight to daydream to a light general anesthetic to a deeper general anesthetic. For this approach I still infuse local anesthetic and make the deeper tissues numb. This insures a comfort level during the procedure and also almost eliminates the possibility of any sort of “subconscious pain.” Following the procedure a person is generally monitored in the recovery room for about an hour and then goes home. A person if desired may have the option of staying for less than 24 hours afterwards overnight in the surgery center if this is arranged ahead of time.
- General anesthetic performed at the outpatient surgery center – This is a great choice for people who are older, who would like other doctors and nurses around, and for people who have medical problems. Again, I still administer a local anesthetic and a solution to numb the deeper tissues to people selecting this option. A patient has an option of going home after one or two hours of being monitored in the recovery room, or they may elect to be monitored in the hospital overnight, or in some cases longer if they so desire.
Postoperative rest and recovery
All of my patients understand that if there is a problem or question following a procedure my practice offers 24/7/365 coverage. I have an on-call group of plastic surgeons and we provide 24 hour coverage service to our patients.
Regardless of the location and anesthetic choice I routinely talk to my patients the same night after surgery. If there is a problem or question I will see the patient either in my office, or at the hospital, or make a hotel or house call
I always see my Carmel Mini Lift patients the very next day in the office. The bandages are changed, rarely drains are used after this procedure; if they are my assistant and I remove them after about 24 hours or until there is minimal drainage. My patients can shower, use shampoo, soap, and water running on their face and the incisions 24 hours after the procedure. If a patient would like assistance during this first shower and shampoo we can usually offer a medical assistant or an aid.
I emphasize to my patients that three days and three nights of rest, taking it easy at home and keeping their head up is vital. We do not at all encourage them to lay in bed; short walks are encouraged, but overall rest, take it easy at home, and keep the head up.
On day four we encourage more activity but discourage elevating the blood pressure. Short walks are encouraged, i.e. easy elliptical striders, easy stationary bikes are all acceptable and encouraged, however no racing, running hard, working out with weights or exerting oneself Is allowed. Makeup is allowed on day 4 on the face, but the incisions must be avoided with anything such as makeup or moisturizer or sunblock.
Depending upon personal preference we have a lot of people who on day #4 will go into work and sit at their desk and do paperwork and take phone calls, however no physical labor is allowed. For people who would like to go back to work on day #4 we emphasize the need to continue to avoid blood pressure elevation, and most of those patients do not interact closely with clients or customers for a few more days.
On day #11 we encourage getting back to regular life slowly. This means a slow return to regular exercise regimens, returning to a more normal life at home as well as a slow resumption of workplace activities.
All the skin sutures are melting or dissolving. My medical assistant and I help with suture and incision care during frequent visits to the office during that initial 10 days. I sometimes use staples in the hair bearing skin of the temples as at times this gives the best closure and resulting scar with the fewest hair follicles injured.
Schedule a Consultation for Your Carmel Mini Lift
These few paragraphs of course are just a summary of the key points regarding the procedure. All patients are seen by me in initial consultation in my office, they meet my staff, and anyone having an operation or procedure with me must read, understand and sign the American Society for Plastic Surgery consent forms.
For the healthy active person who desires a more youthful, vibrant, attractive look, who prefers a shorter rest and recovery, and who does not expect, want or need a dramatic change the Carmel Mini Lift may be the perfect choice for that woman or man. Contact our office today to schedule a consultation.
brought to you by the Carmel Plastic Surgery Education Center CPSEC