The S-Lift is like a mini face lift, a popular procedure for those not quite ready for the full facelift. Dr Jayson Oates gives us some great insights into the S-Lift (mini face lift) procedure, who and when it’s suitable for, what’s involved with the recovery and a whole lot more.Trish: Great. I’m here today with Dr Jayson Oates again who is from Academy Face & Body in WA and also in New South Wales. He’s a facial plastic surgeon, specialist ENT. Thank you so much for joining us today, Dr Oates.
Jayson: Great to be with you again, Trish.
Trish: Excellent. Actually, can I just call you Jayson? It just seems so much better.
Jayson: Yeah. Yeah.
Trish: Great. I’m really excited because we’re going to talk about the S-lift procedure today, which for those listeners out there that don’t know, the S-lift is like a Mini Face Lift. Is that right?
Jayson: Yes, it is. Exactly.
Trish: Do you want to tell us exactly what it is?
Jayson: It’s an interesting thing because exactly what it is will vary depending on who’s doing the procedure. The original description of the S-lift was a fairly small incision that started at the base of the ear lobe and it hugs in very closely to the ear, even going slightly behind the little flap of cartilage that is right on top of the ear hole and then very closely then in front of the top part of the ear and then potentially it just stops there. That was the incision for the classical S-lift. Then you would elevate the skin in front of the ear and then make a looping suture around into the deeper tissue called the SMAS, which is that fibrous muscular layer where all the Face Lifting surgery is really done and the strength is and will just hitch it up a little bit.
The idea of the S-lift as it was originally described was to be relatively minimal. In reality, that’s not what I do anymore when I’m doing a Mini Face Lift or an S-Lift and I think a lot of surgeons when they’re doing Mini S-lifts, they’re not really doing that unless you’re perhaps having something done under local anaesthetic so there’s no sedation at all. If you’re having something done that’s really inexpensive, then they might be doing that because it’s quick, much less invasive, you get less lift and you get a lot less duration out of the lift. That’s what some doctors are doing when they’re doing an S-lift. When I do an S-lift or talk about having a Mini Face Lift, then I’m doing essentially the same thing that I do with a Face Lift, but just with a shorter incision.
Trish: Right. What about the scar? Where’s the scar then?
Jayson: As I was describing, where the earlobe joins the side of the face in the natural little crease there, that’s the lowest part of the incision. Sometimes when I’m lifting up more skin, I’ll curl it around behind the earlobe and onto the back of the ear. As you go up from the earlobe, there’s a little flap of cartilage that we call the tragus and so it goes just on the inside there and then hugs the curve of the ear in the natural shadow in that top third of the ear.
When I’m doing an S-Lift now and I’m going into the deep plane, which is a slightly more invasive procedure, a slightly more intense, a stronger lifting procedure, I need to now curve my incision around into that tuft of hair and up into the temple region because I’ll get so much skin lift up that if I only have those really tiny incisions that were originally described with an S-Lift, I’ve got nowhere for the skin to go and I get a lot of skin off.
Trish: Would that be obvious? Would people know that … Say, for example, someone with short hair, would it be more obvious, the scars or it is something that you can …
Jayson: The whole idea with any kind of Face Lifting surgery is to have a scar that hides and that you could be meeting people, you can have your hair styled however you want to have it and the scars aren’t going to be obvious. If you really go hunting for scars, you’ve got a good light and mirror, then sure, you might be able to still see the scars, but the idea is that yeah, it’s not something that you’re going to have to worry about.
Trish: Great. What about is there the perfect patient for an S-Lift as opposed to a full Face Lift? Who would that be? Is there a perfect patient?
Jayson: Yeah, there probably is a perfect patient. It’s probably somebody who is a little bit younger than say the patient having the full Face Lift so mid-40s to mid-50s. I certainly see people in their 60s who are still good candidates for an S-Lift, a Mini Lift. Generally don’t want somebody who’s got really thick, heavy skin, a lot of fat and weight that you’re trying to pull up with a lesser procedure, but sometimes I’ll see younger people.
I’ll see somebody who’s 50 and they’ve just got a lot of gravitational change, maybe they’ve lost a lot of weight. They’ve had that kind of bariatric surgery, the stomach stapling, the lap band, that sort of thing and they might have a lot of skin sagging. Sure, I can do an S-lift on somebody like that, but you’re starting to try and achieve big changes with an incision that’s suited for small to moderate changes. There are people who mainly for financial reasons are trying to choose a lesser option and therefore, we’ll do an S-Lift where I’d much rather do a Face Lift. Because otherwise, they don’t get to have anything, and they haven’t achieved any benefit.
Trish: Obviously, the procedure is quicker than a Face Lift procedure, takes lesser time to do?
Jayson: It’s a bit quicker and it depends a little bit on the person and how intricate … If it’s one of those ones where you’re trying to do perhaps more than an S-Lift is designed for and sometimes it can almost take as long as a Face Lift because they’re tailoring to get the skin tucked in and hidden can take quite a while, but generally, I would say for me and as I said, when I do an S-lift it’s I’m still doing a deep plane Face Lift. I’m still lifting up underneath that SMAS layer, getting really strong lift. It’ll take me two hours to do it whereas it’ll take me three hours to do a Face Lift.
Trish: By the way, I love the way that you said younger like 50. I love that so it makes me feel young. I was going to say if someone’s got … Is that going to help with a bit of a floppy neck at all or not really?
Jayson: Interesting because the neck is something that worries a lot of people and if it’s that skin right underneath the chin so … I’m doing it right now, grabbing that skin underneath my chin thinking I wouldn’t mind it myself.
Trish: Me, too.
Jayson: I turned 50 not that long. Yes, when you do a very vertical lift, which is what I do with an S-Lift, a Mini Lift, then yes, you sort of get that sling effect under there and it lifts up, it lifts the jowls, and it pulls into that skin underneath the chin. If we’re looking lower down in front of the voice box area and even going further down from there, then no, I don’t think S-Lift is appropriate for that. That’s when the lower half of the Face Lift so from the earlobe going up the back of the ear, quite high up behind the ear crossing into the hairline and then coming down into the hair of the back of the neck, that then gives you access into that muscle layer in the neck. When you really grimace and you get the bands in your neck, you can grab that and then pull that back and lift that up. That’s when the Face Lift becomes more powerful than an S-Lift in that part of the neck.
Trish: Sure. Sure. Would I be wasting my money on the S-Lift and then in a couple of years or five years or so need a full Face or Neck Lift or you would determine when … If I have an S-Lift, do I have to have a Face Lift down the track?
Jayson: Yes. It’s one of these discussions that I have with every patient. It’s all about where do you want to get to and what are you willing to do to get there? I was actually seeing somebody just an hour ago and telling her, “What you need is a Face Lift to make the change in that angle underneath the jaw, what we call the cervicomental angle.” A Face Lift is the ideal procedure to do that, but she doesn’t want to go through a bigger operation. I was saying to her, “Then you could have neck lift.” Her main concern was lower down the neck. “You can have a neck lift.” Said, “I’m not sure if I actually want to have open surgery at all.” I said, “What about threads?” Said, “Okay.” Threads are an option. They’re definitely not going to achieve the same kind of lift that I can achieve in surgery and it’s not going to last as long.
Once we establish what a patient is willing to do, we can then explain, “This is where it’s going to get you.” Now that I’ve been doing S-Lifts for 17 years, yeah, I’m getting patients who come back to see me and say, “I had an S-Lift 12 years, 10 years ago, 8 years ago. Now gravity has continued and sagged things down. Then do I now need to have something bigger?” Sometimes yeah, they do. They’ve got to that point where they now progress onto a Face Lift and I find that with the deep plane Face Lifting, you’re getting a longer benefit with it and hopefully, that’ll see them through.
Trish: Yeah, actually that was my next question, how long have you been doing it? Seventeen years, so you would have done a few in that time.
Jayson: Yeah, yes, 600 odd Face Lifts and S-Lifts combined.
Trish: Yeah. Wow. You know what you’re doing. I know that some surgeons are against doing anything that’s mini like mini tummy tuck, Mini Face Lift. How do you feel about that?
Jayson: I do understand that completely, but I don’t think it’s our job as a surgeon to tell the patient what it is that they want. As I said, it’s finding out where they want to get to and what they’re willing to do. If they’re not willing to go through the bigger procedure, if you can explain to them, “You’re not going to get to the same endpoint, but this is the endpoint you’re going to get to, if you’re willing to go there and this is the path that you want to follow,” then I think that’s entirely reasonable to have that as an option to patients.
Trish: Yeah, I totally agree. I’ve always thought that I’m going to get a Face Lift soon, but I don’t need a full Face Lift because to me, the top up to my eyes and above is fine. I would just want the bottom bit done. It sounds like that might be the perfect procedure for me. I’m nearly in my mid-50s.
Trish: It’s something I could look at because I hadn’t even thought of that before. I just thought not full Face Lift, not ready so not going to do it yet, but perhaps it is something I could actually do relatively soon because that’s the part that bothers me, but I thought I’d just wait ’til it gets a whole lot worse and do the whole lot.
Jayson: Absolutely. I’ll just pop you into my diary here and get you in and …
Jayson: Yeah. That’s right. You’re the kind of person who is perhaps more suited to the mini Face Lift, the S-Lift kind of procedure, but I’ll come back to that concept of that upper half of the face because what we … People often use that term, full Face Lift. The Facelift procedure is still something aimed at the jowls, the jaw line, the under the chin area. When we get to above the cheekbones and we’re looking at the eyebrows and eyelids, that sort of thing, that’s really going into the realms of brow lifting procedures and so, I treat that as a separate procedure to Face Lifts.
Now, there are certainly some surgeons who say, “When I’m doing it, I do everything,” and so you’ve got to lift the whole lot. You’ve got to have your brow lifted, your face lifted, your neck lifted, have your eyelids done and do everything. I can see how financially that’s really good for the surgeon. If that is the population of people you’re getting, if you’re getting that perhaps slightly older population who wants to, needs to have all of that done, then that’s fine.
The population that I’m seeing and surgically I’m operating in Western Australia mostly, my patients don’t necessarily want to have everything done. They just want a little bit of a tuck. They want to look a little bit better. They don’t even necessarily want everybody noticing. They don’t necessarily want anybody knowing that they’ve had surgery, that they’ve had a Face Lift, an S-Lift procedure. They just want people to think, “Yeah, she’s looking good.”
Trish: She’s looking really good. Guys as well, of course, there’s more and more guys having it done. It’s the same procedure for women and for men, isn’t it?
Trish: It’s a different procedure, but men can have a lift as well, can’t they?
Jayson: Absolutely. We modify the incision just slightly because what you don’t want to do is pull the side burn, the hair into their ears. Guys of this age are generally concerned enough about hair growing out of their ears.
Jayson: They don’t want you putting more in there. We modify the incision slightly, but actually, yeah, underneath the skin, but basically comes down to the same procedure.
Trish: What about recovery? As a patient in hospital, is it day procedure, overnight, a week … It’s not a week, but how long are you in hospital for?
Jayson: It will vary from surgeon to surgeon. We have a accredited twilight sedation hospital in-house here in Perth and so, I do all of my S-Lifts and in fact even my Face Lifts under twilight sedation as a day procedure. If the operation is taking two to three hours, you’re probably here for about six hours. You need somebody who can drop you off and pick you up. It’s not a painful procedure. You don’t have drains hanging out, anything like that. Years ago, I used to use drains, but now I just find that it’s not necessary. You’ll have a little bit of swelling, a little bit of bruising. We get everybody back the following day, take the bandages off, clean them up a little bit, but you’re able to shower, wash your hair that day after surgery.
Trish: That’s great.
Jayson: Depending on your hairstyle and depending on how much swelling and bruising you get, some people will walk out the day after and you have people in the waiting room won’t even give them a second glance and know what they look like. For some people, they’ll be bruised and swollen and be a little bit different.
At one week, we start taking out the stitches. If there are stitches in the hairline, say in front of the ear, then we may use dissolving stitches that we just leave in and let them slowly dissolve away. At one week, with a little bit of makeup, hopefully, you’re out and about and people aren’t really going to notice at all.
Just last week, we went to an opening of a clinic in Melbourne. One of my wife’s partners, actually, maybe I’d better not tell too much, but basically, she was one week after a Face Lift out in front of everybody and … Sorry, one week after an S-Lift and nobody knew, nobody could tell.
Trish: Nice. What age range was she?
Jayson: She just turned 50.
Trish: Yeah, right. Sounds really good. It’s something that I never even thought of believe it or not, but now I’m like mmm, this sounds interesting. If someone wanted to, they could basically travel to WA or any other doctor, of course, but if they weren’t in WA, could even travel to WA, couple weeks holiday you reckon and then come back and no one would know anything?
Jayson: Yeah, that would be fine.
Trish: Sounds very enticing. Awesome. Great. I reckon if I was having a consult, that’s pretty much covered every question that I would want to know. You said it’s not painful so you wouldn’t really need any drugs to take afterwards or anything like that?
Jayson: We supply everybody with pain killing medications and often people come back at one week when we’re taking the stitches out and they say, “What was I supposed to do with these?” “If you had pain, you were supposed to take them.”
When we’re doing a full consultation, we have a long in-depth discussion about potential risks and complications, try to set their expectations of how they’re going to look, what the recovery is going to be as being really realistic. You’re not going to look the same as when you were 21. In fact, most people don’t want to do that. What they want is look good and fresh for how old they are now.
Trish: Yeah. They just want to look good for their age.
Jayson: Yeah, that’s most people.
Trish: Yeah, that’s true. Can you give us an indication of … There’s no Medicare or item number or rebate available from health insurance or anything like that, is there?
Jayson: No. Most, the vast majority of health insurance don’t pay anything towards cosmetic surgery at all. This is just a straight expense as a cosmetic procedure and for us, it’s around about a $10,000 procedure and that covers the operating theatre, sedation, the surgery, all the aftercare, any other medications that we give you, that sort of thing. At least when you get a price from us, you know that’s the total price.
Trish: Yeah, ok. I had another question, but it just slipped mind. I got so carried away with thinking about it, but anyway, all right, that’s been fantastic. No, I already covered that, covered the aftercare. Oh, God, there was one more question about aftercare. Yeah, compression garments, do you have to wear compression garments?
Jayson: For the first seven years, eight years maybe, I used to get everybody to wear, I used to call it the face bra, a garment to hold things up. I gave all of those up several years ago. Very occasionally, I’ll have somebody wear one if they’re getting a little bit of extra swelling or fluid in there, but actually no, I don’t think it makes the difference that I used to think it made and my patients are very happy to not wear one and …
Trish: At all, at all?
Jayson: Yeah, at all. A bandage for 24 hours, just a little bit pressure just to help minimise the bruising and make sure the blood vessels have sealed and closed themselves off. After that first 24 hours, nothing at all.
Trish: Last question, is there any prep from the patient’s side? The normal thing like if they smoke, stop smoking, but is there any, should they start taking arnica before or is there any prep that …
Jayson: I’m happy for people to take arnica. I don’t believe there’s good evidence to say that it makes a difference. Some things like not taking aspirin so if you’re on preventative low dose aspirin, then we definitely want them to stop that because it reduces the amount of bruising that you’ll get. A lot of supplements, fish oil, ginseng, Gingko biloba, a lot of these things just slightly thin the blood and so, if you can get away without having any of those, then I get them to stop all of that, but really, nothing that much.
Trish: Yeah, so usual pretty much really?
Trish: Yeah. Awesome. Thank you so much. That’s been really, really interesting. It’s probably been my favourite podcast so far. Could that be because it’s a personal thing maybe? No, that’s great because it’s really good because a lot of people don’t know that that option is available and they do just do something here and there and trying to … And think, “Oh, I’m going to have a facelift, but not for 10 years,” but maybe this is actually a solution.
Jayson: Yeah, it’s good to get the information out and that’s what people really need. They can make an informed decision.
Trish: Yeah, absolutely. Thank you so much for taking the time today.
Jayson: Great. Good talking to you, Trish.