Face expressive lifting (FEL): an original surgical concept
combined with bipolar radiofrequency
Malcolm D. Paul
Received: 20 June 2013 /Accepted: 10 November 2013 /Published online: 6 December 2013
The Author(s) 2013. This article is published with open access at Springerlink.com
Background Aging can lead to changes in facial expressions,
transforming the positive youth expression of happiness to
negative expressions as sadness, tiredness, and disgust. Local
skin distension is another consequence of aging, which can be
difficult to treat with rejuvenation procedures. The “face ex-
pressive lifting” (FEL) is an original concept in facial rejuve-
nation surgery. On the one hand, FEL integrates established
convergent surgical techniques aiming to correct the age-
related negative facial expressions. On the other hand, FEL
incorporates novel bipolar RF technology aiming to correct
local skin distension.
Methods One hundred twenty-six patients underwent FEL
procedure. Facial expression and local skin distension were
assessed with 2 years follow-up.
Results There was a correction of negative facial expression
for 96 patients (76 %) and a tightening of local skin distension
in 100 % of cases.
Conclusions FEL is an effective procedure taking into account
and able to correct both age-related negative changes in facial
expression and local skin distension using radiofrequency.
Level of Evidence: Level IV, therapeutic study.
Keywords Face Expressive Lifting (FEL)
The recent years have seen a better understanding of the
physiopathogenesis and manifestations of facial aging such
as sagging due to gravity, fat loss and redistribution, and loss
of bone volume [1–5].
However, aging can also lead to changes in facial
expressions, transforming the positive youth expressions
(happiness) to negative expressions (sadness, tiredness,
and disgust) overtime [6, 7]. These projected “negative
emotions” can impact other's views of us and social
interaction. This might explain that a high number of
patients ask not only for cosmetic improvement but also
for improvement of unattractive facial expression.
Almost no studies have clearly analyzed and shown how to
correct the age-related changes on facial expression.
The FEL concept was developed upon the convergence of
effects of rejuvenation surgical procedures on different levels
of the face with priority given to the re-establishment of
“vitality” in both the eyes and the smile, which are the key
of emotions expressions.
The present study aimed to address the question of wether
the FEL could correct negative facial expressions of the aging
Secondly, the skin of the face loses its tonicity over time.
Although a lift can eliminate remaining folds after
musculocutaneous tightening, simple redraping is not always
sufficient in cases of local distension.
The application of bipolar radiofrequency (RF), using
FaceTite™ (Invasix Ltd., Yokneam, Israel) makes it possible
to obtain stable quantitative and qualitative effects on the skin
M. Divaris (*)
Department of Plastic and Maxillo-Facial Surgery, University of Pitie
Salpetiere, Paris, France
Clinica B&S De Excelencia en Cirurgia Plastica, Buenos Aires,
M. D. Paul
Department of Surgery, Aesthetic and Plastic Surgery Institute,
University of California, Irvine, CA, USA
Eur J Plast Surg (2014) 37:69–76