Vectorial Analysis of Deep Plane Face and Neck Lift.

Abstract

The vector of aging and consequently the vector of lift in rhytidectomy has aided surgeons in improving movement of tissues during facial rejuvenation procedures. The goal was to analyze the vector of lift in patients undergoing primary and revisional facelift to achieve proper vectorial lifting. Patients undergoing deep-plane facelift surgery were included for analysis. Intraoperative photographs and measurements were taken of the skin, superficial musculoaponeurotic system (SMAS), and platysmal suture suspension with mastoid crevasse inset. Measurements were compared between patients who were undergoing primary vs secondary surgery, site of lift, age, and gender. Seventy-one patients (90% female, mean age 57.8) with a total of 142 hemifaces were analyzed, 57 (73%) of which were primary and 14 (27%) secondary facelifts. The average vector of SMAS lifting was 70.8°. Females had a more vertical vector than males (71.3° vs 65.4°; P < .01). The average vectors of platysmal and skin lift were 87.0° and 58.2°, respectively. There was intrapatient difference between hemifaces. Despite there being more intersuture disparity in secondary cases than primary cases (16.9° vs 4.5°; P < .05), the mean vector of lifting was similar between them. Proper release of the deep plane helps determine the appropriate vectors of lift, without relying on guidelines based on population averages. Each patient presents with a unique vector required to correct their descent. This technique provides an optimal result by directly suspending against the vectors of greatest descent.