Cutting out The scars

Singaporean cosmetic surgeon Dr. Woffles Wu talks to Dan Childs about how surgeons today can deliver the results of the traditional facelift with fewer scars than ever before.

“Why would anyone want to do that?”

It is perhaps one of the most syndromatic questions in cosmetic surgery today, as the question of “why?” is a knee-jerk reaction for many.

Bigger breasts. A more prominent nose. Voluminous buttocks. Onlookers scoff and point, interrogating their friends as to why anyone would pay to have these procedures visited upon their bodies.

The murmurs, however, are quickly silenced when facelifts are the issue. The reason behind this is something that all of us know – sooner or later, the signs of aging are going to appear on our faces. None of us look forward to the day when we will stare into the mirror at an aged, haggard version of ourselves, and few of us wouldn’t do something to stop this inevitable process… as long as the results are natural, of course.

And therein really lies the problem, doesn’t it? Because for all we hear about the advances in facelift surgery, so many of us are quite quick to assume that the results will result in an assortment of visible scars, as well as the dreaded “wind tunnel” grimace.

However, as Singaporean cosmetic surgeon Dr. Woffles Wu points out, a host of techniques exist today that can endow the face with a natural-looking lift – all without the recovery pain and downtime associated with the traditional facelift. Welcome to the realm of short-scar techniques.

“We are currently using all of our experience with the traditional facelift to come up with the salient, essential features that make this kind of surgery effective,” he says.

Keeping it short: the short-scar technique

Nobody ever said that facelift surgery was a simple proposition – nor a painless one, for that matter. Dr. Wu notes that there are many reasons why a prospective patient today might be wary of the traditional facelift procedure of years past.

“The average patient undergoing facelift surgery 10 years ago, or even undergoing the traditional surgery today, would have swelling for a couple of weeks,” he notes. “They would also have a scar past the hairline and have the classical signs of a facelift – the lateral sweep and the pulled lines of the face.”

In particular, this unwanted “swept-back” appearance came part-and-parcel with a procedure known as the skin-lift. In this procedure, the incisions are made behind the ear on either side of the face, and the skin is pulled back in order to tighten out any wrinkles and crevices in the face (hence, the “skin-lift” moniker). Even though this procedure allowed excess wrinkles to be ironed out, however, the results were often less than natural. Because the behind-the-ear incisions become the points at which the ‘slack’ in the face is taken up, the entire face looks as if it is being pulled straight back.

“That gives the ‘wind tunnel’ look with the stretched mouth, because you’re pulling everything behind the ear,” Dr. Wu explains. “Normal aging, of course, does not occur in this direction; it occurs in the downward direction.”

Thus, over the past decade, a sector of cosmetic surgeons has been developing means to replace this swept-back pull with an upward lift. One such approach is the use of barbed sutures, which when properly used have the capability to shore up and support sagging tissues in the upward direction instead. One technique developed by Dr. Wu, known as the Woffles lift, achieves this goal through the use of barbed sutures that are passed through sagging tissues and anchored to the tougher tissues of the scalp. However, there is a trade-off for the scar-free results of this and other thread-based procedures. In short, these techniques sacrifice longevity, as the results achieved in this manner don’t tend to last as long as those achieved through facelift surgery.

So, do those who desire lasting results without copious visible scarring inevitably face the decision between having their cake and eating it too? Not necessarily, thanks to the development of the surgical techniques involved.

“For the last 10 to 25 years, surgeons have been developing a different technique that doesn’t leave an obvious scar behind the ears, yet still gives a reasonable longevity and degree of lift,” Dr. Wu says. “The short-scar facelift combines the philosophies of these approaches in that it is a minimally-invasive approach that also offers prolonged longevity.”

A brief history of the short-scar facelift

Despite the popularity of the skin-lift in the 1970s, as well as that of many other intensive facelifting procedures over the years, the development of a short-scar method of facelift surgery can hardly be described as a new innovation. 

“I think a lot of what we need to understand is the evolution of the facelift itself,” Dr. Wu notes. “It’s almost as if we have been going full circle in the last 100 years.”

In fact, he says, the first documentation of a short-scar facelift technique surfaced in 1896 – the innovation of a woman by the name of Madame Passot.

“She was doing a facelift with short scars that didn’t extend behind the ears,” he says. “She was able to get, I suppose, pretty good results. And don’t forget, this was at a time when there was no anaesthetic yet.”

The short incision, however, eventually gave way to longer cuts which allowed surgeons to better access the underlying muscular tissues of the face for a result that better stood the test of time.

“Thus, the length of the incision has been equated with the longevity of results. That kind of became the benchmark for facelift surgery,” Dr. Wu comments. “But the downside is that with longer and longer incisions and new variations in technique, the complications and risks, as well as downtime, have increased tremendously.”

Thus, for the last 10 to 25 years, many surgeons have strived to develop a different technique that doesn’t leave a scar behind the ears, yet still gives a reasonable longevity and degree of lift. Among these experts are New-York based surgeon Dr. Dan Baker (who is reputed to have done most of the cosmetic work for Ivana Trump!), MACS lift pioneers Patrick Tonnard and Alex Verpaele, and Ziya Saylan, who invented the S-lift.

Getting the most out of a short incision

So how can a surgeon get the most out of an economy of incisions? Dr. Wu says that the most notable difference between the incisions utilised in the short-scar technique and those used for the traditional facelift is in their placement.

“We make as short an incision as possible in front of the ear and up into the hairline,” he says. “This means that there will be no scar behind the ear and no incision past the hairline. How we do it is that we make a WW incision in the front of the ear, up to the hairline. This type of incision leaves a scar that is not so easily visible.”

The incision, albeit short, still gives adequate access to the key muscles of the face. The surgeon will then dissect these muscles and pull them upwards, thus correcting the downward pull that has been exerted on the face by years of gravity.

Following this, the surgeon must often remove a certain amount of excess skin.

“You have to take the skin up somewhere, so you will either be doing it behind the ear or in front of the ear,” he says, noting that placing the incision behind the ear has ramifications beyond the stereotypical ‘wind-tunnel’ look. Moving the incision to the front of the ear also lowers the risk of certain complications, most notably those having to do with loss of sensation after surgery.

“Cutting behind the ear may also have some consequences for the nerves,” he says.

“If the surgeon is not careful, the patient may end up with numbness around the ear. However, when the incision is placed at the front of the ear we don’t get that problem.”

Another potential problem avoided through the use of the short-scar technique is that of general anaesthetic. Dr. Wu says that the short-scar procedure can be performed under local anaesthetic – that is, the patient does not need the general anaesthetic required for the extensive traditional facelift procedure. Plus, with a total operating time of between two and a half to three hours, the short-scar method is also significantly quicker than its more invasive counterpart.

The Results

Just about everyone is familiar with the ‘no-pain-no-gain’ maxim so often thrown around in aesthetic surgery. So the question of results is a natural one when it comes to nearly any minimally-invasive procedure. However, Dr. Wu says that for selected patients, the results that can be garnered through the short scar approach are just as long-lasting – if not more so – than the more invasive alternatives.

“One thing that is important to remember is that although this is a short-scar facelift, it is not a mini-lift,” he says “This is still a full facelift. It is not a compromise procedure.”

Using the procedure, surgeons can turn the clock back roughly 10 years. These results, in turn, last for between five and seven years – a window of time quite comparable to that of the traditional approach. 

Dr. Wu adds that the short-scar approach is particularly good when it comes to rejuvenating the midface – a key area when it comes to facial aging. “This is very, very good for the midface,” he says. “Using this access approach, we can come directly to the muscles of the midface.”

Also, by virtue of the procedure being a minimally-invasive approach, patients can spend less time recovering from the surgery.

“The patient can return to work in a week,” Dr. Wu notes. “This is half to one-third the recovery time required for the traditional facelift.”

Putting it all together

Given that the short-scar facelift mainly deals with the aging midface, it should come as little surprise that the technique is routinely combined with other procedures in order to deliver a comprehensively younger-looking result.

“Almost invariably, this technique is done in conjunction with a forehead lift,” Dr. Wu says. “We also often combine it with neck liposuction in order to give a pleasing contour to the neck. For many patients, we also do the upper and lower eyelid at the same time.”

By combining different items from this ‘a-la carte’ list, Dr. Wu says that the short-scar facelift represents a flexible addition to a cosmetic surgeon’s arsenal of treatments.

“We can customise it for use in a variety of patients,” he notes. “This versatility is part of what makes this a very nice procedure.”

The bottom line

Since so much of the short-scar surgery is about giving patients less of what they don’t want – less visible scarring, less downtime after surgery – one might reasonably assume that patients will be paying less as well. However, Dr. Wu says that this is not the case.

“The traditional facelift costs about S$18,000-20,000 (RM40,500-45,500) in professional fees,” he says. “The MACS or the short-scar facelift costs between S$13,500 and S$17,000 (RM35,000-38,600) , which includes the neck and forehead lifts but is not inclusive of liposuction. So it is roughly the same cost.”

Also, older patients with significant sags of skin shouldn’t get their hopes up; the short scar procedure is performed only after careful consideration as to whether or not a particular patient will be able to benefit from this minimally-invasive alternative.

“The younger patients actually do better because we don’t have to cut out a lot of skin,” he says. “The more laxity you have in the skin, the more skin that has to be excised. So if the patient has a lot of saggy skin in the face, then we have no choice but to go with a traditional facelift.”

Thus, Dr. Wu notes, the short-scar technique is not for everybody. Rather, it is more for young individuals, in particular those aged from 35 to 55. And, as with any other procedure, a host of other conditions determine whether or not the short-scar option is the best one for a given patient. 

For certain selected patients, however, the benefits of this surgery could have their friends and neighbours talking. And for once, the gossip may not be so vicious.

Dr Woffles Wu
Dr Woffles Wu
MBBS (Singapore)
FRCS (Edin)
FAMS (Plastic Surgery)
Think of plastic surgery in Asia and one name immediately springs to mind – Dr Woffles Wu! This innovative and exciting plastic surgeon from Singapore has for years been the name on the lips of men and women seeking aesthetic perfection. Armed with an impeccable eye for beauty, balance and harmony Dr Wu, dubbed Asia’s Beauty Guru by the Hongkong press has reinvented and promoted the concept of Non Surgical Facial Rejuvenation(NSFR). He is today one of the most sought after speakers around the world on this topic demonstrating his combination of Injectables, Fillers, IPL Photorejuvenation and his invention, the WOFFLES LIFT to achieve facial rejuvenation without downtime.