Dr. Little’s Philosophies
Tension in Facial Rejuvenation
Most accomplished facelift surgeons utilize the tension of a heavier pull when they lift the tissues of the face; they want an effective result for their patients that lasts a decent interval.
Good Surgeons Use Tension
Therefore, they prefer heavier sutures of a long-lasting or permanent nature, securing them to rigid zones of the face, often near bone. The word itself–tension–evokes images of stretched, overdone results in facelift. Such undesirable outcomes, however, are produced not by tension itself, but rather by tension in the wrong place or in the wrong direction. Skilled plastic surgeons, of course, avoid such results; yet most use tension. Dr. Little does also, at least to a degree, when he elevates the relaxed portion of the neck muscle below the earlobe.
But Tenson Can Be Avoided in the Face
But he avoids tension altogether within the face itself. The sutures he has used for nearly two decades to elevate the soft tissues of the jowl complex are both delicate and short-lived (dissolving in a matter of months), and they engage no deep, rigid structures…bringing together instead the same mobile superficial subcutaneous (fat) tissues above and below. Many patients (and some plastic surgeons) have therefore asked how the tissues can remain corrected beyond the early postoperative period: why doesn’t the jowl drop back into its earlier position when the sutures dissolve? Because Dr. Little avoids the traditional tightening effects of tension when lifting the jowl tissues, the patient’s normal wound-healing ability is sufficient to hold the tissues in their new position. Newton’s Third Law of Motion tells us that for “every action there is an opposite and equal reaction.” When tension is minimized, the “reaction” part is also minimized; the only force pulling down on the elevated jowl is gravity, a lesser force that required 40 years or more to pull the jowl down in the first place. To reassure patients during the consultation on this matter of long term stability, Dr. Little reviews multiple results ten to twenty years after facelift that confirm lasting correction of the jowl and associated structures with delicate, absorbable sutures placed without tension.
Illustration: detail from Leonardo da Vinci, “Graphic procedure for studying tractive effort,” Codex Atlanticus, fol. 211r-a, Biblioteca Ambrosiana, Milan