SUBPERIOSTEAL MINIMALLY INVASIVE LASER ENDOSCOPIC RHYTIDECTOMY - THE SMILE FACELIFT

Current concepts of total facial rejuvenation involve a comprehensive integrated approach to achieve a balanced youthful appearance. Recentl y introduced endoscopic-assisted techniques allow us to rejuvenate the face through small, remote incisions. Previously, we have considered only young patients with good skin turgor as candidates for minimally invasive procedures, but the advent of the resurfacing laser has allow ed us to expand our indications for single stage minimal access rejuve nation. Full facial immediate laser resurfacing at the time of standar d rhytidectomy has been avoided due to risk of flap necrosis. Subperio steal minimally invasive endoscopic assisted techniques do not substan tially interfere with facial blood supply. We can now perform endoscop ic-assisted full facelifts combined with immediate laser resurfacing t o reposition the tissues in a more youthful position and then tighten the skin envelope. Extended endoscopic-assisted subperiosteal forehead lift is performed through three to five scalp incisions; subperiostea l midface lift is performed through a crow's foot or intraoral incisio n. Cervicoplasty, if needed, is performed through a small submental in cision. Full face laser resurfacing is done using a Coherent Ultrapuls e laser. To date we have performed eleven subperiosteal minimally inva sive laser endoscopic (SMILE) rhytidectomies. There has been no eviden ce of flap necrosis with this technique. Postoperative recovery has be en no different from patients treated only by full face resurfacing, e xcept perhaps for the slight increase in early facial edema. We believ e the SMILE facelift is a viable alternative to standard techniques. T he limitations of this procedure still need to be elucidated.