ACELIFT: A Minimally Invasive Alternative to a Facelift
September 2014 | Volume 13 | Issue 9 | Original Article | 1038 | Copyright © 2014
Deborah S. Sarnoff MD FAAD FACPa,b and Robert H. Gotkin MD FACSb,c
aDepartment of Dermatology, NYU School of Medicine, New York, NY
bCosmetique Dermatology, Laser & Plastic Surgery, LLP, New York, NY
cDivision of Plastic Surgery, Department of Surgery, North Shore/Long Island Jewish Lenox Hill Hospital
and Manhattan Eye, Ear & Throat Hospital, New York, NY
BACKGROUND: Cervicofacial aging is often characterized by a combination of skin and subcutaneous tissue laxity, midfacial deflation, an accumulation of excess submental fat, an obtuse cervicomental angle, jowls, and rhytides of the face and neck. Traditional treatment, and the “gold standard” against which other treatments are compared, is a facelift.
OBJECTIVE: To demonstrate that a combination technique called ACELIFT – an acronym for the Augmentation of Collagen and Elastin using Lasers, Injectable neurotoxins, Fillers, and Topicals – in selected patients, is a viable, safe, and effective alternative to a facelift.
METHODS: Ten healthy women, ages 50 to 62 (mean age = 58), with cervical and facial stigmata of aging were enrolled in a prospective study conducted in the authors’ private practice. Patients underwent a two-step procedure; the first step was laser lipolysis of the submental and anterior cervical areas with a pulsed 1440nm Nd:YAG laser with a side-firing fiber (PrecisionTx, Cynosure, Westford, MA). Three months later, the patients were treated in a single session that combined injectable neurotoxin, fillers, and fractional (Fx) CO2 laser resurfacing delivered in a novel “hammock” distribution. After two weeks, following complete re-epithelialization, the patients were started on a topical regimen that included daily use of sunscreen and antioxidants and nightly use of retinoids and peptides. This regimen was continued for a period of six months when all patients returned for final evaluation.
RESULTS: Nine months following the initiation of treatment, all patients were evaluated by the following: Global Aesthetic Improvement Scale, cervicomental angle scale, physician, and subject evaluation. Clinical improvement was evident, and often marked, for all subjects. Both physician and subject satisfaction scores were high, indicating overall satisfaction with the procedure and the outcomes. Side-effects were mild and transient; there were no incidents of adverse scarring, thermal injuries, permanent nerve injury, or dyschromia, hematomas, seromas, or infection. Subjects were likely to recommend the procedure to a friend.
CONCLUSIONS: In properly selected patients, the ACELIFT proved to be a safe and effective, minimally invasive alternative to a facelift. There was little downtime and high patient satisfaction.
J Drugs Dermatol. 2014;13(9):1038-1046.
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Cervicofacial aging is a pervasive cosmetic problem in our society. Typical components of facial aging include laxity and descent of the facial skin and underlying soft tissues, midfacial volume loss, anterior cervical skin laxity, an accumulation of excess fat in the submental area resulting in an obtuse cervicomental angle, jowls, and a loss of jawline definition, cutaneous photodamage, and rhytides of the face and neck. While this entire constellation of findings does not exist in all individuals, procedural plans must be flexible enough to address all that do occur.
Women over 50 years of age complain about looking old, looking tired, “seeing my mother in the mirror,” and feeling badly about the appearance of their necks.1 As the face and neck age, one of the changes commonly seen is a blunting of the cervicomental angle – the angle formed by the more horizontal submental area and the more vertical portion of the neck. The “ideal” cervicomental angle is 105°.2 As aging progresses, the cervicomental angle becomes more obtuse.
Since more women are living longer, and societal pressures to look more youthful abound, there is a need to address facial aging in this population. But many women do not want invasive surgery. Some have a fear of the surgery itself – untoward cosmetic results, visible scars, looking “fake” or unnatural, no longer looking like themselves – or the complications that may arise afterwards – hematoma, seroma, or facial nerve damage. Others have a fear of anesthesia and anesthetic-related complications and even death. Still others are wary of the downtime associated with a facelift – time lost from work, social functions, and activities of daily living.
What is a facelift and what does it address? Rhytidectomy, rhytidoplasty, meloplasty, facelift, neck lift – all are common names for a surgical procedure that addresses cervicofacial aging by re-positioning subcutaneous soft tissues and elevating and re-draping sagging, ptotic skin of the face and neck. There are incisions beginning in the temporal scalp and extending along the preauricular crease, around the earlobe, up the back of the