S124: Open and Closed Techniques for Upper Facial Rejuvenation

Abstract

Although lower facial rejuvenation techniques might be well known to the oral and maxillofacial surgeon, such as traditional facelift surgery, it is essential to understand the options available to rejuvenate the upper face and thereby bring about a pleasing, harmonious facial rejuvenation.A key component to choosing the correct operation is an adequate preoperative diagnosis. Assessment of brow ptosis and asymmetry, and the position of the hairline and balding patterns should be noted. Also important is a standardized assessment of skin quality and the presence of active and/or passive rhytids. The effect of upper facial aging on the periorbital region should also be recognized, including the presence of lateral hooding and pseudodermatochalasis.This lecture will acquaint the surgeon with current techniques of open and closed upper face rejuvenation. A spectrum of surgeries are available from the minimally invasive, such as suture suspension techniques, to endoscopic lifting, to the more invasive open procedures such as the coronal lift and trichophytic hairline incision methods. These procedures will be covered in some detail, with particular attention to the endoscopic forehead lift.Conservative, non-surgical, options for upper facial rejuvenation are becoming more popular with the general public. Botulinum toxin injections, soft tissue fillers, skin care, and skin resurfacing clearly have a role that is often complementary to our surgical procedures. These procedures may be used alone to help the patient with minimal aging stigmata, or be used in conjunction with a lifting procedure to produce a truly outstanding result. Indications, advantages and disadvantages of these materials will be discussed.With a solid understanding of diagnosis, and the surgical and non-surgical techniques available, a comprehensive treatment plan can be discussed with the patient. This allows for a proper informed consent and ultimately a happier patient.Finally, as with any procedure performed, it is important to be able to diagnose and treat any resulting complications and perform appropriate post-op care. Temporary or permanent asymmetries, relapse, muscle weaknesses and imbalances are all possible to be seen by the practitioner. Hematoma and visual disturbances should also be recognized and treated.The role of upper facial rejuvenation is critical to appreciate in order to achieve a balanced facial result and a pleased patient. The oral and maxillofacial surgeon is well suited to treat this area both conservatively and with a variety of surgical procedures. Although lower facial rejuvenation techniques might be well known to the oral and maxillofacial surgeon, such as traditional facelift surgery, it is essential to understand the options available to rejuvenate the upper face and thereby bring about a pleasing, harmonious facial rejuvenation. A key component to choosing the correct operation is an adequate preoperative diagnosis. Assessment of brow ptosis and asymmetry, and the position of the hairline and balding patterns should be noted. Also important is a standardized assessment of skin quality and the presence of active and/or passive rhytids. The effect of upper facial aging on the periorbital region should also be recognized, including the presence of lateral hooding and pseudodermatochalasis. This lecture will acquaint the surgeon with current techniques of open and closed upper face rejuvenation. A spectrum of surgeries are available from the minimally invasive, such as suture suspension techniques, to endoscopic lifting, to the more invasive open procedures such as the coronal lift and trichophytic hairline incision methods. These procedures will be covered in some detail, with particular attention to the endoscopic forehead lift. Conservative, non-surgical, options for upper facial rejuvenation are becoming more popular with the general public. Botulinum toxin injections, soft tissue fillers, skin care, and skin resurfacing clearly have a role that is often complementary to our surgical procedures. These procedures may be used alone to help the patient with minimal aging stigmata, or be used in conjunction with a lifting procedure to produce a truly outstanding result. Indications, advantages and disadvantages of these materials will be discussed. With a solid understanding of diagnosis, and the surgical and non-surgical techniques available, a comprehensive treatment plan can be discussed with the patient. This allows for a proper informed consent and ultimately a happier patient. Finally, as with any procedure performed, it is important to be able to diagnose and treat any resulting complications and perform appropriate post-op care. Temporary or permanent asymmetries, relapse, muscle weaknesses and imbalances are all possible to be seen by the practitioner. Hematoma and visual disturbances should also be recognized and treated. The role of upper facial rejuvenation is critical to appreciate in order to achieve a balanced facial result and a pleased patient. The oral and maxillofacial surgeon is well suited to treat this area both conservatively and with a variety of surgical procedures.