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Surgeon introduces new facelift procedure John Robinson, M.D., the new director for the MUSC plastic surgery residency program, brought a modified facelift procedure to MUSC. The out-patient procedure gives patients improved appearance after approximately one-hour using a local anesthetic and a less than two-week recovery time. SMILE Plus (Selected Micro Incision Lipo Elevation) is the trademarked name of procedure developed by Robinson. It is based on two other mini facelift operations and uses a special instrument he designed specifically for the surgery. Robinson performed approximately 120 of these procedures during the past four years in Toledo, Ohio,  and said his patients were very satisfied. The results are a subtle change without the distorted appearance of the traditional facelift. “The result is very natural looking,” he said. My patients have told me that following surgery they are told that they look less tired and happier. One patient was told that she didn’t look grumpy anymore.” Most patients can walk outside after two weeks, and no one would know they had surgery. “I’ve had patients go back to work after 12 days,” he said.  “Patients having the traditional face lift don’t return to public life until three to four weeks at the earliest, and some much longer than that.”  The standard facelift takes from three and a half to six hours in the operating room under general anesthesia, and the expanded facelift takes from six to 10 hours. Robinson’s procedure takes from one hour to one hour and 40 minutes. He said that some patients like to be completely alert and desire only a local anesthetic. Others prefer to be less alert and are given a local anesthetic along with mild sedation. General anesthesia is never used. The surgery targets the cheeks, the jowls, and the vertical creases going down from the corners of the mouth, known as marionette lines. The traditional facelift operation requires lifting skin off underlying tissue over a large area, causing significant injury under the skin. With Robinson’s technique, the skin is not elevated from the structures underneath it. As a consequence, there is far less bruising and swelling. During the procedure, Robinson places an instrument through small needle-like incisions over the area he wishes to lift. With the instrument he designed and trademarked, he retrieves a suture from an incision in the hairline. He lowers the suture under the skin and loops it around the tissue to be lifted. The tissue is lifted up to where it is supposed be, and the suture permanently holds the tissue in the desired place. Robinson felt the approach of facelifts for many years was wrong. Rather than pulling back and stretching the skin, he feels that sagging tissue needs to be lifted up. He said he best illustrated this point with two photographs of his own face side by side. The photographs were taken minutes apart, but in one he looks 20 years younger than in the other. The difference, he says, is that in one picture he is standing up and in the other his face is photographed while he is standing on his head. It illustrates the effect of gravity on the facial tissue. His surgical procedure counteracts the downward pull of gravity by using sutures to hold the facial tissue up and in place. Robinson explains that he adapted his technique from procedures done by two other surgeons. One did a similar procedure to his, but only on the cheeks. Most of Robinson’s patients preferred the additional work on the jowls and under the marionette lines.  Another surgeon did all three areas, but used a barbed suture to hold the tissue in place.  Robinson had reservations about the type of suture as it failed in hand surgery. So he adopted the procedure of doing three areas of the face, but rejected the use of the barbed suture in favor of looping the suture over the area to be lifted and drawing it up using the instrument he designed for the purpose. In addition to the aesthetic, safety and shortened recovery time advantages, the cost of the procedure is about a fourth that of the traditional facelift surgery.   Prior to coming to MUSC Robinson was director of the residency program at the Medical College of Ohio for four years and had a private plastic surgery practice for 30 years in Toledo. He plans to teach his procedure to MUSC plastic surgery residents.     Friday, March 18, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.