Mini or Full Facelift? How Plastic Surgeons Choose What’s Best for Your Face

Monique Ramsey (00:03):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. Now, no matter how fantastic your skincare routine might be or how well you keep up with your Botox or lasers or skincare, there eventually comes a time when it's time for maybe a little more intervention. And so I have Dr. John Smoot here. He's board certified plastic surgeon, does a lot of facial surgery and he's here to talk about what is the difference between a short scar facelift or a mini facelift and a full facelift, and how do you know which you need and when. So welcome back Dr. Smoot.

Dr. Smoot (00:40):
Thank you. I'm glad to be with you, Monique.

Monique Ramsey (00:42):
Let's talk about what is a short scar facelift and would you consider that kind of the same lingo as a mini?

Dr. Smoot (00:50):
Yes, those terms are interchangeable. The history of a short scar or mini facelift goes back probably 20 years ago. It was called the max lift, but it is a way to do a mini facelift, if you want to call it that. I hate to call it a facelift. It's more of a refresher. It's not meant to do what a face and neck lift would do, and it's for the gal who basically says, alright, I want to look a little better, but I don't want to go with expense and cost and major surgery of a full face and neck lift, particularly if they don't need anything done in their neck. But again, there's many names out there. I've heard 'em called everything from a mini lift to a short scar facelift. That's the more common term for it to, I think La Jolla lift, lifestyle lift or all sorts of different fancy names.

Monique Ramsey (01:36):
People come up with names and then they trademark 'em and you're like, what is that? And I think that's why we're here to really kind of break it down for the basics. Let's talk about scar placement. Where is it that they might have incisions and what areas are you really treating?

Dr. Smoot (01:51):
Well, again, I wish I had a diagram I could show you, but I don't have one to show you on this. A short scar, what we call it, it starts from up here either in the hairline or in front of the hairline depending on what your hairline looks like, and it goes down just to the bottom of the ear. Now sometimes a little behind the ear and that's where that determines if that's a good procedure for you. Because when I lift up, if I pull the skin and it pleats here, it won't look good. So that's one of the tests I do to see if it'll work. But that's typically where the incisions sit is in front of the ear, down to the bottom of the ear, and the area is opened up is like this area right here, get stitches put in here to lift this up this way, lift this way, and then one that goes, this helps tighten that.

Monique Ramsey (02:38):
So if you're listening right now, like on Apple Podcast, stop, go over to YouTube and you can see the video or Spotify has the video. So yeah. So from the temple, like you said to the bottom of the ear.

Dr. Smoot (02:50):
That's correct.

Monique Ramsey (02:50):
And working in the cheek area. Now I know with a facelift there's muscle suspension. Does this only do skin or are you also working with muscles?

Dr. Smoot (03:03):
We work with the muscle. All facelifts have to deal with some type of muscle. Now the muscle work is more what we call a plication, a suspension. We don't really cut the muscle. We don't really cut what we call that superficial muscular Api neurosis. We call it a SMAS. That's where the investing, the muscles are covered by that. That's what we use to tighten. The excess skin is removed, but the lift is not in the skin. It's down underneath. So people think it's a skin lift. That's not what it is. You try to lift the skin, it won't last. But we do remove excess skin because when you pull all this up, yes you have excess skin here, it needs to be removed.

Monique Ramsey (03:37):
And how long would you say short scar facelift would last for somebody?

Dr. Smoot (03:42):
This is the type of procedure who says, I don't need much, but I want to do a little bit more often than a whole lot later. So it is a temporizing procedure, meaning that we can stave off the effects of age and poor skin and some of the healing issues. And I put it back a few years now, it could be a couple of years, it could be five, 10 years, but it depends on how you age, the quality of your skin. But again, that's why I tell patients it is just a temporary fix. Now, there's many techniques out there of how we do facelifts in general, and you'll hear all sorts of things like plication, deep plane lift, SMAS lift, the high SMAS lift. They're all sort different names for these things and they're all good procedures, but it all is in the hands of what you do best. So I can't say that one procedure is definitely better than another. The big hot topic right now is the deep plane lift. It's just a twist of how you handle that muscle layer where they're going out and going underneath the muscle and pulling those, tightening up the face. Some think it has a better result. In some people's hands I think it does.

Monique Ramsey (04:45):
If somebody comes in and they want to talk to you about consultation to refresh their face, at what point do you determine you might be pushing the barrier for a short scar facelift and maybe a full is better or is it more based on the patient's goals?

Dr. Smoot (05:02):
Well, both, but mostly I've got to look at what you're trying to accomplish. Now there are gals that come and say, I just want a short scar, a mini lift. No, you've got way too much laxity. It will not look good. That's why I said when I pull the skin up, I want to see what happens around the ear. If it doesn't pleat or bunch up there, then yeah, you can do a mini. If it does, it's not to be a good choice. At least that's how I determine who's a candidate for it.

Monique Ramsey (05:29):
That's a pretty easy test for all of us to be able to do at home too, is just kind of pull up. If you pull by the ear, does it make a pleat below and none of us want that walking around.

Dr. Smoot (05:39):
No, you don't. Now, sometimes I can get around that by extending the incision around behind the ear. It has to be just a minor pleat, minor excess. If there's a lot, it's all you're going to see it. You're not going to look good.

Monique Ramsey (05:51):
Now, if their neck is something that's bothering them, I am guessing maybe a short scar facelift isn't the thing, or can you combine it with some neck lipo or are you ever doing a short scar facelift with something with their neck?

Dr. Smoot (06:08):
Yes. Sometimes I will do a little lipo underneath the chin and neck area, but it's not meant to tighten those muscles up in there. You can go in there and do some tightening, but if you're going to do that, you might as well do the full face and neck lift.

Monique Ramsey (06:22):
Let's talk about a full face and neck lift. Let's talk about where those scars are and what areas that addresses. So let's talk about the scars first. Where do you start?

Dr. Smoot (06:31):
Well, a full face and neck lift, you do the same thing. It starts up in the hairline down in front of the ear, round behind the ear. Then it goes back into the hairline where we hide the scar. Going behind the ear and into the hairline in the back allows us to get into the neck and do the repairs, but that's often combined with an incision under the chin, which allows us to get in here. Sometimes you get these bands here and here that need to be cut or tightened up, or sometimes you have to remove fat underneath the chin. You need to make that incision. It all depends on what you're trying to achieve and what their facial structure is to allow you to do that.

Monique Ramsey (07:07):
So really for simplicity's sake, it's really just that it's a longer scar. It's lifting more. Do you do that submental platysmaplasty, that scar under the chin? Do you do that 90% of the time? A hundred percent of the time?

Dr. Smoot (07:20):
It's probably 70% of the time it's an incision that's just literally like a little cut underneath the chin. It's hard to see. That allows me to access the muscles sometimes the fat it's under the muscles and take out those bands and tighten it and get that nice sculpted look, neckline that most women want and men want.

Monique Ramsey (07:37):
Yeah, no, that's so true. Now, speaking of men, how do you deal with facial hair in that facelift?

Dr. Smoot (07:45):
The beard on a man is different. You've got to place the incision's a little different, particularly in front of the ear because the excess skin in the neck and the lower face is pulled up behind the ear. So I have to tell them, you're going to have to shave behind your ear where the beard is pulled up here.

Monique Ramsey (08:00):
Or you go up to the med spa for a little laser hair removal.

Dr. Smoot (08:02):
Well, that will work too.

Monique Ramsey (08:04):
Yeah. So I'm assuming a mini facelift or a short scar facelift would take less time in the OR?

Dr. Smoot (08:12):
That's correct.

Monique Ramsey (08:13):
Okay.

Dr. Smoot (08:13):
It takes me about two hours to do, and a regular facelift takes me three to four hours.

Monique Ramsey (08:19):
Okay, and are you ever combining it with, let's say there an eyelid lift?

Dr. Smoot (08:25):
Oh yeah. All the time. Now there's a lot of different ancillary procedure you can do in a face. You can do the brow, you can do the upper and lower lids, you can do fat transfers, you can do laser, you can lift the face, you can do liposuction. I mean, it's what you're trying to achieve here. There's no one key fits every lock here.

Monique Ramsey (08:43):
So you can kind of customize it really for that patient, her goals or his goals. Most of us, I think we all know what bothers us and maybe we're motivated by an event, a wedding, or we've got a graduation or some life event, or you're just fed up with hiding the neck or hiding the extra skin. In terms of downtime though, is there a big difference or not so much?

Dr. Smoot (09:07):
There is a lot less downtime with the mini lift or the short scar lift, it's about a week, 10 days with a full face, it's about two weeks.

Monique Ramsey (09:14):
So it's not that much longer. But it's a little longer?

Dr. Smoot (09:17):
Yes.

Monique Ramsey (09:17):
Okay. And I see patients, they have the head dress on and they've got bulbs and drains. Do they have drains for a short scar?

Dr. Smoot (09:26):
Yes, they do, but it's not like the one I use for a full face neck. It's a little drain. It just comes out behind the ear.. We take the drains out the next day, so they don't even know it's there for the most part.

Monique Ramsey (09:36):
Do you find your patients when they come back and you're hearing them on that day one, day two post-op, if they had a mini lift or they had a full facelift, are they kind of feeling the same?

Dr. Smoot (09:46):
Well, it's not a terribly painful procedure. I mean, there is some pain and discomfort, but it's not bad. Mostly what I tell patients, be prepared to look awful for about a week to 10 days, bruising, swelling. Now there is some numbness that goes along with any facelift, and that sometimes takes weeks, months to recover, but it does recover.

Monique Ramsey (10:04):
And a mini facelift, would that still require, I'm assuming the answer is yes, but I'm asking the question anyway. Would it still require general anesthesia?

Dr. Smoot (10:13):
I usually do it on general anesthesia because patients don't know to go on. You can do it under a local, but it takes a special patient to be able to understand what you're doing. There's got to be injections, but it's doable. Not many patients want that. They don't want to know what's going on. Just do it. I wake up and it's done.

Monique Ramsey (10:27):
Yeah, if you go to sleep for two hours, you don't want to run the risk of feeling so uncomfortable in the middle of the procedure that you as the doctor can't do their job. In terms of side effects or risks, are they the same between a full facelift and a mini?

Dr. Smoot (10:44):
The risks are the same. They're a little less for the mini, but still the major risks of a bleeding, that's the one we most are concerned about. Nerve injury, you are working around the muscles and nerves of the face. Infections are pretty rare, but it can happen. The other issue was healing issues. Sometimes there's not good circulation to the skin and it can have some heating issues in front of the ear or behind the year.

Monique Ramsey (11:05):
I think you do such a good job and the team does such a good job of helping prepare people for what it's going to be like, real talk. And then if you're better, like you say, prepared to look awful, but then you might go on day two or three, well, I don't look so bad. It's not bad.

Dr. Smoot (11:21):
Yeah, you kind of tell 'em a worst case scenario then if they heal quicker and faster, oh, I was just a good healer. He did such a good job.

Monique Ramsey (11:31):
Would you say people, like let's say you're going to have a mini facelift. You could be back to work in 10 days, maybe?

Dr. Smoot (11:38):
Pretty much. 10 days is usually what I say. At that point, you can put some makeup on, be out in the public eye, could be a week, but I like to take patients pretty much. I just plan for a week to be incognito.

Monique Ramsey (11:51):
And take that time to really heal, give yourself permission to let your body do its thing, because I think we start to feel good and then we start to do too much, and that's when problems happen.

Dr. Smoot (12:03):
That's the big problem, is these people that are highly motivated and won't sit still because the number one problem is bleeding. If they bleed, then it's a semi emergent issue and you've got to bring them back to the operating room and you've got to stop the bleeding.

Monique Ramsey (12:15):
And that delays your healing. I mean, at the end of the day, I'm sure your result will turn out great, but who wants to go backwards? If you're on day four, just hang in there. Folks start to do housework or who knows? People get the craziest ideas when they're bored.

Dr. Smoot (12:30):
I think I've seen it all.

Monique Ramsey (12:33):
Yeah, one of our recent podcast guests, her name is Amie, and she's a nurse and she called it a friend a day, and she had a different friend every day come to her house, and I thought, that's such a great idea because the friend isn't over having to see you every day. Each friend sees you for a little bit, it keeps you calm. And so she had a friend today and I thought that was cute. So talking about cost, you mentioned that earlier it's going to be more cost because we're doing more work. And so I looked up on our website, we have all our prices on our website. We have a range because of course it might be slightly different, but the range will give you a good idea. So a mini or short scar facelift, the range is 9,800 to 10,800. So that gives you a good idea of what you would be expecting, and that includes your operating room, your anesthesia, pre and post skincare kit and regimen, everything. Then if you say, I, maybe I'm not a candidate for the short scar, I really need more. Then that full facelift is about 18,700 to 20,700.

Dr. Smoot (13:40):
And that depends on the ancillary procedures. If you're going to do your eyes, you're going to do fat transfers, any laser lip lifts, things like that.

Monique Ramsey (13:48):
Good thinking lip lift. Yeah, that's becoming pretty popular. And do you find that a lot of people come asking for that?

Dr. Smoot (13:55):
Not a lot. Mostly the people want to know about it and ask about it. There are times when someone has a very long upper lip and you mention it to 'em. Oh yeah, maybe I would do that. But I'm not one to upsell. I can sometimes see things that could be done, but I'm not one to say, if this doesn't bother you, I'm not going to mention of it. But if it is important to their overall outcome, I will mention it to them.

Monique Ramsey (14:18):
I think that's important too, because patients, they might think, if you don't mention it, well maybe they're fine and he didn't mention it, so it must be okay. But we as patients really want authentic opinion. We know what we know, but that doesn't mean it's right.

Dr. Smoot (14:32):
Oh yeah, that's right.

Monique Ramsey (14:33):
I think that's nice. So anything else that we didn't cover about this topic?

Dr. Smoot (14:40):
Like I say, I'm not trying to coerce or talk anybody into this. I just want to make sure this is what I can do. These are the realistic outcomes, and that's where the rubber meets the road for me, is being realistic on what we can achieve here. I don't see it as much in faces that I do as in breast and body, but it's really hard to show somebody what you're going to look like after the surgery. You try to pick out certain people that have similarities, but they've got to be realistic because what I tell 'em, I have to work with what you have to work with, and that's the best I can do.

Monique Ramsey (15:11):
Your anatomy does get involved.

Dr. Smoot (15:14):
Well, it's the analogy of some people come in and they have beautiful skin, but it's saggy. Some come in and have very sun damaged, difficult skin and says, yeah, I can straighten the sheets, but if the sheets are still stained, they're going to stain. So you have these skin issues you got to take care of, which requires skincare and laser work. Sometimes it's loss of volume, so you need to either put fillers, but I like to use fat and fat's a good filler, but it's not always predictable, but it's the best thing we have, and it's easy to get at the time of surgery.

Monique Ramsey (15:43):
Right, and it's all yours. It's a hundred percent natural. So one last thing, because thinking there's a fair amount of people who might've had a face and neck lift or something a couple decades ago and they need a refresher, would a mini lift be able to be a refresher for those people?

Dr. Smoot (16:02):
Yes. It can be an option for those people who need a little pick me up. It doesn't necessarily mean since you've had a full face neck, you can't have to have another one. It just depends on what you're trying to achieve. Now I've done both where they've come back years later and say, no, you need everything done again. It's usually in the neck area that we recur the soonest, the jowls drops some, but it's usually the neck that tends to age quicker than any other part of the body.

Monique Ramsey (16:25):
Isn't that fun?

Dr. Smoot (16:27):
Isn't that fun? Yeah.

Monique Ramsey (16:28):
Yeah. Well, just because I think in our 36 years plus of business, you have a lot of patients who come back years later, and so it's good to know that it's not only good for somebody in their thirties or forties or that is thinking about a little fresh a refresher, but it could be if you had previous work and now you're looking for a little refresher. But I do love the analogy of the sheets, and I think for faces, it's like having that skincare routine is so important.

Dr. Smoot (16:56):
Yeah, I mean, it's part and parcel of it. You've got to take care of your skin. Even if you do the skin and muscle, you still sometimes need volume, and that's where the fat comes in. Fat can be kind of an anti-aging because it's volume that gives us our youthful look. As we age, we tend to thin out. That's what causes the sagging. So most facial surgeons and plastic surgeons are using fat transfers now, and we're getting much better at it. The techniques are getting better to getting this fat to last longer.

Monique Ramsey (17:24):
Where would you say if you're going to do a fat transfer on somebody, where are the typical areas that you would do that?

Dr. Smoot (17:31):
Well, I take it from three areas. Mostly, I like to take it from the abdomen because it's easy to access or take it from the flanks or the lateral thighs usually don't need more than 50, 60 ccs of fat, which is pretty easy to harvest. That's usually where we get it.

Monique Ramsey (17:45):
And then where do you like to put it?

Dr. Smoot (17:46):
The key spot is what we call the peri oral, around the mouth, the nasal labial lines, up in the cheek areas, up in this area right here and down in this area. Now, sometimes you can put it out here if we want to smooth over some things. Sometimes we'll put it in the temporal area up in here to fill that out.

Monique Ramsey (18:02):
Okay. So you can put it all over.

Dr. Smoot (18:03):
I don't personally put it under the eyes. I'm not good enough at it because you've got to be very good at what you do when you put the fat underneath the eyes.

Monique Ramsey (18:09):
Oh, interesting. That skin is so delicate there, and you don't want to end up with some blob.

Dr. Smoot (18:16):
I agree.

Monique Ramsey (18:16):
Underneath the eye.

Dr. Smoot (18:17):
You don't want it to lump up.

Monique Ramsey (18:18):
Exactly. Okay. Well thank you Dr. Smoot. This was a good little conversation and I hope everybody out there got some value out of it. And if you have any questions, feel free, shoot us an email lookgreat@ljcsc.com. Or if you're watching us on YouTube, throw in a question if you have a question, and Dr. Smoot will be happy to answer. And you can have your consultation in the office, but if you live far away and you want to come see him, he does zoom consults. So that is something that we can accommodate for anybody who might live out of town and is thinking about the surgery. So thank you very much again, Dr. Smoot.

Dr. Smoot (19:01):
Thank you, Monique. It's a pleasure to be here and I'd say I'm happy to see or talk to anyone who would like to know more.

Monique Ramsey (19:07):
Alright, well thanks everybody. We'll see you on the next one.

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