Summary of basic XJ (or paramedian) facelift (with links to subsections):
- among least invasive of facelifts (confined to skin and superficial subcutaneous tissues)
- among more extensive of facelifts (frees skin to corner of mouth)
- short scar utilized in all patients (no scar along temple hairline or out from behind ear)
- focus of suspension is jowl and paramedian face (area near nose and mouth)
- vector of soft-tissue suspension: (uniquely) vertical
- delicate suture material for facelift suspension (light-weight / rapidly absorbable) without tension
- avoidance of tension promotes naturalness
- avoidance of tension promotes long-lasting results (in office, many cases reviewed 10-20 years post-op)
- expectation: elimination of jowl and marionette line
- jowl-volume returned to low cheek (fat grafting to cheek and face therefore unnecessary in most)
- facial volume increased in selected patients by structural fat grafting
- widest redraping of skin for improved complexion and skin quality
- jowl lift creates direct action on mouth position (intrinsic)
- expectation: significant improvement to slumped mouth position and bitterness folds
- includes division of depressor anguli oris muscle, with direct suspension of modiolus and corner of mouth
- includes suspension of chin (with associated muscles)
- includes suspension of upper lip (without scar across lip)
- includes tasteful restoration of lip volumes by structural fat grafting
- includes restoration of neck (without scar under chin)
- includes restoration of hollow upper and lower lids (without surgery or eyelid scars in most)
- includes conservative laser resurfacing of lids (in most)
Dr. Little’s basic rejuvenation techniques have been undergoing a gradual evolution and development over the past twenty years, with something worthwhile added or modified at least every year. Thus the results of his surgeries proved better (more exciting in a natural way) last year than two years before, which–in turn–were better than four years ago, and so on. This is the place on the website where some of these more recent trends and directions can be capsulized and reiterated.
- lower eyelid aging in the younger patient:
Increasingly, Dr. Little finds he can address tired lower lids in the younger patient with structural fat grafting and conservative laser resurfacing alone, without the need for direct surgery of any kind.
- restoration of the aging neck without under-the-chin scar:
If the vector for suspension of the fallen neck muscle (platysma) is re-directed vertically (like those for the jowl and corner of the mouth), the central scar under the chin can usually be eliminated, even when the entire sweep of the muscle must be divided.
- modiolus hitch and sub-alar hitch:
These most recent additions for further suspensory effort to the mouth have brought particular promise.