Jose L. Covarrubias1*, Jorge Olivares2, Richard Bensimon3, Luis Morales4.
Private practices at Hospital del Sol, Nogales, Sonora, Mexico.
2Private practices at Mexico City, Mexico.
3Private practices at Portland, Oregon, USA.
4Private practices at Tuxtla Gutierrez, Chiapas, Mexico.
1) Describe our results as a new surgical option in facial enhancement 2) Establish the indications and steps in the procedure3)
Show before and after results
Method: From March 2010 until October 2016 we analyzed 647 successive cases performed in our surgical department.
Results: In 157 cases were only with threads pull up (37 men and 120 women), 490 cases performed with complete technic. The duration
of surgery decreased a half of time compared to the classic Rhytidectomy. Only 1 patient had a nerve branch with successfully solved in
few weeks, other patient had a hyperchromia post peeling, which was treated and resolved.
Conclusion: Covas–Lift can be considered as a new facial surgery option in facial rejuvenation and enhancement. The benefits and
advantages of this technic decrease risk of nerve lesions, hematoma, big scars, alopecia and long recovery time. The results were
amazing and of great satisfaction to patients.
Facial rejuvenation procedures have evolved significantly since
they were first performed at the beginning of the 20th century.
New techniques of Rhytidectomy and other procedures focus
on providing natural facial rejuvenation, durable results, fewer
complications, and reduced morbidity.
Covas-Lift is a new technique for facial rejuvenation and
enhancement; it is an innovative technique, ideal to any type of
people, both for men or women even at an early age. It consists
in an integration of surgical and non-surgical procedures in order
to reposition the fallen tissues and give to the skin a complete
renovation, observing immediately an amazing change and giving
naturalness and beauty to the face.
Talking about Covas-Lift is to refer us the “new era in facial
rejuvenation and enhancement”. Compared with other procedures
like Facelift, Endoscopic Facelift and S-Lift it is safer than the
others, since it is a complex technique and at the same time very
practice as well. With the help of some creams, peeling and threads
you achieve really satisfactory results to the patients.
This technique is surgical because it can be combined with other
procedures, in order to get even more visible and significant
results, such as blepharoplasty, rhinoplasty, neck liposuction
and bichectomy, among others; and it is non-surgical technique
because combined with deep peeling application (key of CovasLift)
you achieve peerless results.
The preparation of the skin of the patient it is important and vital
because it is the 50% of the success of our procedure. The time of
skin preparation is four (4) to six (6) weeks. Stop using creams one
week prior to procedure.
The posterior care treatment it is simple. The application of
the after treatment cream is necessary once peeling phase is
concluded, since it guarantees us a skin hydration as it should be.
Recover time of this procedure is relatively short keeping up with
the medical indication.
Materials and Methods
The prospectively collected data of 647 patients in 6 years who
had undergone through facial enhancement were reviewed for
postoperative complications and aesthetic results. All patients,
which their age amount was of 50 years old, were reviewed
underwent the same procedure.
Procedure in Detail
The patients are taken to photograph since the first consultation
(Figure 4) for clinical history and assessment.
Preparation of the skin begins since the first day for four (4) to six
(6) weeks before the procedure with antipigment creams (night
care cream) in order to prevent black spots in the skin. During the
day, the days care cream (moisturize cream) and sunscreen 50%
every three hours. The patient must discontinue the application of
these anti-pigment creams one-week prior to the surgery in order
to prevent a serious damage in the peeling process.
In a sitting position, the vectors in the face of the patient are
marked (Figure 5); if we are going to do an additional surgery we
mark it at the same time.
The patient is taken to the operating room; we use general anesthesia
with SEVORANE® and local anesthesia with Xilocaine 2% plus
epinephrine, plus one ampule of adrenaline and we wait for 20
minutes. Prior to this we clean the surgical area with Microdacyn®
The 4 procedures that are done on
1.- Sub-periostal mid face-lift:
Intraoral incision (CADWELL LOOK Approach) (Figure 6) and
detach the tissue till the zigomatic arch (Figure 7).
2.- Suspension threads:
Then we do an incision on the temporal
area a 3 cm long (Figure 8), and we go to the deep temporal galea,
where a non-absorbable suture is placed to lift the malar tissue, with
a innovative 18-cm long curved double-beveled needle (COVAS
NEEDLE) (Figure 9), bearing a tiny sliding hole where a 2/0 non
absorbable suture may be anchored, so this creates suspension
loops (Figure 10) and we use as much as the patient needs. The
suture is anchored to the deep galea in the temporalarea (Figure
11) and this provides more tissue support.
3.- Fat transfer:
We harvested the fat from any part of the body
(Figure 12) and we placed it in preoperative marked areas (Figure
13) to increase volume. We also do the Nano graft in the tear
trough (Figure 14).
The skin was prepared 6 weeks before the procedure
with the night care cream based in retinol and hydroquinone.
The peel that we use it is based on the Hetter peel (Figure 15), a
very low percentage of Concentration is used (0.125) on all the
face; applied with a soft gause till you see the frost sign, then a
Nexcare® tape is placed over the face for five (5) days (Figure 16).
Postoperatively, the patient is placed into elastic compression
garment of the doble chin, to minimize edema. Nexcare® tape is
placed on the face and it is removed at the fifth day. They are put
in a semi-fowler position, then we give them a moister cream for
one week, they start to peel and we recommend a sunscreen FPS
50+, no less than that, every 3-4 hours by 2 months, no make-up,
no spray on hair, no perfume and stay out of the sun.
Much debate exists regarding facial enhancement techniques. The
literature is inundated with multiple techniques, with each author
providing insight into which techniques he or she feels provides
the greatest degree of facial rejuvenation. The face-lift surgeon
must realize that each patient presents a different challenge;
therefore, the surgeon must possess a vast armamentarium of
facial rejuvenation procedures in order to have consistent success.
This study includes 647 cases over a 6-year period that were
performed utilizing the of Covas-Lift technique (Figure 17). The
average age of the patient was 58 years (ranging from 38 to 86).
The maximum follow-up period was 24 months and the minimum
6 months. The mean followup period was 12 months.
Since beginning the technique in 2010, 157 patients only threads
(37 men, 120 women), the rest of the patients have been combined
with fat transfer or other surgical procedure.
The four qualities of a favorable technique include procedure
reliability and reproducibility, ease of learning, short operative
time, and safety of technique with fewer complications compared
with classic rhytidectomy and other invasive techniques like
hematoma (Figure 18), nerve lesions, big scars (Figure 19),
alopecia (Figure 20), necrosis, etc.
Rare but in early stages of the surgery some asymmetry or
distortion can happen. Complications with Covas-Lift procedure
would include nerve branch or vascular damage causing bleeding,
soft tissue damage, cheese wiring (Figure 22) and infection.
Anyway, the patients who had their procedure since expressed a
moderate to high satisfaction.
Repositioning of the tissue is the key to the enhancement, plus
the peeling that makes a difference of 50%. Compared with other
procedures, Covas-Lift has a lot of advantages:
very smaller scars,
the nerve is preserved, minimal bleeding, the time of patient’s
recovery is faster and the surgery time is really shorter. Meanwhile Facelift produce long scars, Covas-Lift procedure only needs
an incision of 3 cm in length (Figure 23-Right side). Also, an
Endoscopic Facelift surgery time is around of 5 or 6 hours but
with Covas-Lift it has a duration of 2 hours, which means a time
saving of 67%. Additionally, Facelift has an elevated probability
to provoke severe hematoma in the patient (Figure 23-Left Side).
In the other hand, Covas Lift only produces a minimal bleeding. This technique can be used
in any patient seeking look younger with naturalness and lasting
rejuvenation without the suggestion of an “over pulled” look.
We describe the Covas-Lift as a minimally invasive procedure, and
the importance of the midface liftis part of the facial contouring
and support system, which uses a double beveled needle 18 cm
long, curved and a tiny, sliding carriage to which a 2/0 Ethibond
suture my be anchored. We use it to create suspension loops, which
are anchored to temporalis fascia, and reach the midfacial fat pads
after doing a subperiostal midface, so we can have a better support
of the deep tissue.
In Figure 23 you can compare the effects of both procedures 5 days
after the surgery. As you can see, one of the complications of the
Facelift it is a hematoma, big scars and recovery time is longer.
- Shaw RB Jr, Katzel EB, Koltz PF, et al. Aging of the facial
skeleton: aesthetic implications and rejuvenation strategies. Plast
Reconstr Surg. 2011;127:374–383.
- Lambros V. Observations on periorbital and midface aging.
Plast Reconstr Surg. 2007;120:1367–1376; discussion 1377.
- Chaiet SR, Williams EF 3rd. Understanding midfacial
rejuvenation in the 21st century. Facial Plast Surg. 2013;29:40–45.
- Bernardini FP, Gennai A, Izzo L, et al. Minimal incisions vertical
endoscopic lifting and fat grafting as a systematic approach to the
rejuvenation of the periocular esthetic unit. Ophthal Plast Reconstr
- Matros E, Momoh A, Yaremchuk MJ. The aging midfacial
skeleton: implications for rejuvenation and reconstruction using
implants. Facial Plast Surg. 2009;25:252– 259.
- Hoenig JF, Knutti D, de la Fuente A. Vertical subperiosteal
mid-face-lift for treatment of malar festoons. Aesthetic Plast Surg.
- Besins T. The “R.A.R.E.” technique (reverse and repositioning
effect): the renaissance of the aging face and neck. Aesthetic Plast
- Le Louarn C, Buthiau D, Buis J. [Facial rejuvenation and
concentric malar lift: the FACE RECURVE concept]. Ann Chir
Plast Esthet. 2006;51:99–121.
- Chia CY, Almeida MW, Ritter PD, et al. Malar fat pad
repositioning in facelifting: a simple technique of suspen-sion and
fixation. Aesthet Surg J. 2010;30:790–797.
- Bisaccia E, Kadry R, Rogachefsky A, et al. Midface lift using
a minimally invasive technique and a novel absorbable suture.
Dermatol Surg. 2009;35:1073–1078.