Will facelifts become obsolete?

New York - Facelifts are rapidly becoming obsolete, according to Mitchel Goldman, M.D.

"You don't need a facelift anymore to get that young-looking appearance back in your face," Dr. Goldman says. "You can do more minimal things and get just as good a result, with far less recovery time."

Dr. Goldman, associate clinical professor of dermatology, University of California, San Diego, discussed alternatives to facelifts during his seminar, "Minimally Invasive Facial Surgery," at the American Academy of Dermatology's Academy '04 here.

"We are using fat transfers now to put bulk back in, not take it out as facelifts do," he adds.

Dr. Goldman discussed three major categories of minimally invasive facial surgery: plumping (or the surgical correction of soft-tissue defects), aptos intradermal suspension (AIS) and subcision.

Plumping Dr. Goldman explains that there are two basic techniques for plumping: autologous fat transfer FAMI and vein transfer.

"The fat transfer involves harvesting fat with tumescent liposculpture technique, using a sterile syringe at very low pressure," he says. "The extracted fatty tissue is lightly centrifuged for one or two minutes at 10,000 RPM to remove blood and fluid, then is injected with a blunt cannula as close to the muscle as possible, or within the muscle, in the desired facial area. This microlipoinjection technique restores volume that, in most cases, lasts years."

Autologous vein/collagen transplantation is a technique used in the correction of dermal atrophic conditions. The excised leg vein is similar to a Gore-Tex implant and can be used just like one would use this type of implant.

"This procedure is basically the transplantation of a leg vein to an area in need of filling out," he says. "Leg veins are 50 percent collagen and also contain muscle and elastic tissue."

AIS Aptos intradermal suspension, or AIS, is a procedure for anchoring transplanted tissue in the desired area. Dr. Goldman focuses on the use of the aptos intradermal suspension thread.

"This is also known as Russian thread, and literally means 'barbed thread,' " he says. "The skin and fat are one cosmetic unit that can be modified without affecting the muscle or fascia. Sliding of this unit produces redundancy and sagging, so it has to be anchored - and with the aptos thread technique, anchoring doesn't have to be to bone or muscle."

Dr. Goldman explains that the aptos thread attaches to the dermis as a gathering stitch and works like Velcro.

"The advantages of this technique are many," he says. "First, there is no major trauma; most patients can return to work immediately or, at most, within a few days. There are no major scars left afterwards, mostly because the threads are often inserted through puncture wounds. From the physician's perspective, the procedure is relatively easy to learn and do, and in most cases the procedure takes less than an hour."

He adds that AIS can be used in virtually all typical facial procedures, such as eyebrow, forehead and cheek lifts; cheek augmentation; filling of nasolabial and nasolacrimal folds; neck rejuvenation; correction of mid-face sagging; and for minimizing jowls and correcting the loss of mandibular rim.

Subscision As for subcision, Dr. Goldman describes this technique as the aggressive undermining of dermal scars and the physical freeing of scars. He says subcision is especially effective for acne scars and depressed traumatic or surgical scars.

"Usually one to five treatments are needed with this technique," he says.