A Face-Off That's More Than Cosmetic

Plastic surgeons disagree about the value, safety of new techniques

SUNDAY, Oct. 14, 2001 (HealthDayNews) -- What's the face value of two new kinds of cosmetic procedures? Depends on which plastic surgeon you ask.

The "mid-face lift" and "external ultrasound" were introduced in the last few years, but viewpoints differ on whether they offer any real benefits to patients.

Dr. Elliot Jacobs, a New York City plastic surgeon, has done about 200 mid-face lifts during the last three years and says the operation is a good alternative to a full face lift for people in their late 20s or early 30s.

Jacobs says the mid-face lift is a precise procedure that addresses the first signs of aging that show up on your face in the form of naso-labial folds, also known as smile lines, located on the sides of your mouth.

The mid-face lift begins with an incision just under the lower eyelid and continues slightly down and outward, Jacobs says. The surgeon loosens the tissues down to the corner of the mouth and then lifts the tissues higher in the face and secures them to bones in the face.

"The operation restores the smooth contours of that entire area in one fell swoop," Jacobs says.

The procedure takes about 90 minutes and requires only a local anesthetic and sedation for the patient. Jacobs says he often does it right in his office.

But a Miami-based plastic surgeon disagrees with Jacobs' endorsement of the procedure.

"I think that is not a very good operation," says Dr. Stephan Baker, who has a private practice and is a clinical assistant professor in the plastic surgery division at the University of Miami/Jackson Memorial Medical Center.

"I think that procedure, even in the best of hands, has a high rate of complications," Baker adds.

The main problem is a potential sagging of the lower eyelids, which happens in about 30 percent of patients who receive a mid-face lift, Baker explains.

"This is a complication that is difficult to repair and best not gotten," he says.

While Baker agrees the mid-face lift looks good on paper, the high complication rate makes it impossible for him to endorse it and he doesn't recommend it for his patients.

"Our job as surgeons is to balance the pros and cons for these people. They don't have that medical knowledge to really understand the potential complications. I think it's very important that we educate patients to the fullest degree possible," Baker says.

Jacobs acknowledges a mid-face lift can be tricky.

"It's a technically difficult procedure because you're lifting up tissue and supporting it [next to] the lower lid. One of the potential complications is that the lid comes down a bit, and that's something I'm extraordinarily aware of and take absolute precaution against and have been successful in it," Jacobs says.

Another point of contention is the external ultrasound, a non-surgical procedure that removes small pockets of fat found most anywhere on the body. It can be used in conjunction with liposuction or on its own to deal with small bulges of fat, Jacobs says.

The fat areas are injected with a saline solution that helps the fat absorb ultrasound waves, Jacobs says. A high-powered external ultrasound machine is applied to the skin, which kills many of the fat cells. It takes about a month for the body to expel those dead fat cells, Jacobs says.

"So anybody who is looking for immediate gratification, this is not for them," he says.

Jacobs stresses that external ultrasound is useful only for small areas and amounts to a touch-up procedure.

But Baker dismisses external ultrasound as "ineffective," even when coupled with liposuction." The success of liposuction rests solely on the surgeon's skills, he says. Using external ultrasound won't enhance the results of the liposuction surgery, Baker says, adding, "I think it adds nothing."

What to Do: For more information about plastic surgery, go to the American Society of Plastic Surgeons or the University of Iowa College of Medicine.

SOURCES: Interviews with Elliot Jacobs, M.D., plastic surgeon, New York City; Stephan Baker, M.D., plastic surgeon, Miami, and clinical assistant professor, plastic surgery division, department of surgery, University of Miami/Jackson Memorial Medical Center
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