Facelift Incision Research Articles

Robotic-assisted neck dissection

The neck dissection has had several evolutions in the last decades, most recently with the addition of the robotic neck dissection to the head and neck surgeon's arsenal. The robotic neck dissection has emerged as a viable option for patients and offers a minimally invasive approach to the cervical lymphatic system. The major advantage includes the avoidance of a visible neck scar, while its limitations include increased operative time and cost. After several iterations, the retro-auricular/modified facelift incision has developed into the surgical approach of choice, offering excellent cosmesis while securing oncologic effectiveness. In this chapter we describe this approach in detail.

Retroauricular endoscopic thyroidectomy: initial single-institution experiences.

Conventional thyroidectomy often results in visible scarring postoperatively. Endoscopic thyroidectomy offers the advantage of scarless surgery, especially beneficial for young adult women. The retroauricular approach uses a facelift incision well-known among surgeons and eliminates the need for gas insufflation due to the large working space. An early retrospective analysis was conducted on thirty-one individuals who underwent gasless retroauricular endoscopic thyroidectomy approach, focusing on isthmolobectomies (n = 26) and lobectomies (n = 5), with one case necessitating conversion to open thyroidectomy, from January 2016 to April 2017. Physical examination, laboratory, and histopathology findings were collected. The scar was evaluated using the Vancouver Scale System, while other surgical and oncological outcomes were documented and assessed. The average operative time was 154.2 ± 21.3min, with an average bleeding volume of 69.2 ± 52.1mL. The average length of stay was 4.7 ± 2.2days. All complications occurred were temporary and all subjects remained in good condition throughout the follow-up period. Most subjects (65.6%) were very satisfied with the scar concealed in the retroauricular area. Retroauricular endoscopic thyroidectomy is a safe and feasible remote access technique with excellent postoperative results.

Buccal Fat Advancement-Transposition Flap for Reconstruction of Midface Volume Defects.

Background: The buccal fat pad (BFP) has previously been utilized for repair of various defects of the head and neck. Objectives: We explore the utility of a pedicled buccal fat advancement-transposition (BFAT) flap in various forms of midface reconstruction through a variety of surgical approaches and characterize its volume and axial reach in human anatomic specimens. Methods: Ten adult full-head human anatomic specimens were dissected, and a single surgical case demonstrating the use of a BFAT flap is described. Results: Nasolabial, subciliary, and deep plane facelift incisions all provided access to the BFP for use as a BFAT flap. The mean volume of mobilizable fat contained within a BFAT flap accessible through external incision was 7.1 cm3. Once fully mobilized, the externalized BFAT flap had a mean axial reach of 6.9 cm without tension. We also present a case illustrating the successful use of a BFAT flap for volumization of a large midface defect secondary to Mohs micrographic surgical resection of a cutaneous malignancy. Discussion: The BFAT flap, which exhibited substantial volume and reach in this study, can be harvested through multiple dissection windows or pre-existing defects and be used to reconstruct a variety of midface defects.

Unilateral Platysma Muscle Rupture as an Effect of Using a Hard Wooden Block for Facial Massage.

Facial massages are frequently performed to achieve a feeling of freshness, rejuvenation, skin tightening, and delayed onset of wrinkles. However, vigorous massages can induce unexpected symptoms. Here, we present a case of a woman who complained of an asymmetric facial appearance and a mass-like lesion following a long-term facial massage intervention. A facelift incision was performed. Platysma muscle rupture was observed intraoperatively, which was then repaired. To our knowledge, this is the first report of a vigorous facial massage-induced ipsilateral platysma rupture.

Why the Facelift Incision Should Be the Preferred Approach for Benign Parotid Neoplasms

Background: The modified Blair incision is the most utilized incision for parotidectomy. The facelift incision is a well described, but underutilized approach to parotidectomy. Objective: To demonstrate the exposure afforded by the facelift incision for parotidectomy and the excellent postoperative appearance. Materials and Methods: This approach was applied to 12 parotidectomies in 11 patients between January 2022 and December 2022. Result: There was one case of temporary marginal mandibular nerve weakness. There were no cases of permanent nerve weakness. Patient satisfaction was particularly high in young patients. Conclusion: This video demonstrates the exposure afforded by the rhytidectomy approach to the parotid gland. No competing financial interests exist. No funding was received for this article. Runtime of video: 2 mins 28 secs

Remote-access thyroidectomy with the da Vinci SP system: feasibility in a cadaveric model.

This study aims to study the feasibility of a remote-access thyroidectomy through presternal and submental approaches with the da Vinci SP system. Bilateral thyroidectomies were performed in five cadaveric models. A single incision in the presternal area was used in two cadavers, and a submental facelift incision approach was used in three cadavers. Performing remote-access thyroidectomy was completed with a presternal approach in one cadaver and with the submental approach in three cadavers. The required skin flap development was minimal, and the docking time for the SP system was quick for all procedures. Time to full exposure of the thyroid gland after skin incision was less than 30 min for the presternal approach and less than 27 min for the submental procedure. Completing total thyroidectomies took 83 min in the presternal approach and between 67 and 127 min in the submental access. No additional ports were required to expose the gland and complete the bilateral resection. Total thyroidectomy was feasible with the da Vinci SP system in single incision presternal and submental approaches comparing promisingly with other currently applied robotic methods. Further studies will be required to assess whether a presternal or submental thyroidectomy with the da Vinci SP system provides clinical benefits in real patients.

Efficacy of modified face lift incision for the resection of benign parotid gland tumor located anteriorly or superiorly

Efficacy of modified face lift incision for the resection of benign parotid gland tumor located anteriorly or superiorly

Techniques for Creating Inconspicuous Facelift Scars: An Update.

Importance: Patients seeking rhytidectomy desire an improved neckline, jawline, and midface, but rarely at the cost of visible incision lines that divulge a facelift. Objective: To describe an update to our facelift incision planning and specific surgical maneuvers to create inconspicuous scars. Design: Surgical pearls-description of novel surgical technique. Setting: A private practice. Participants: Patients who underwent cervicofacial rhytidectomy.

Esthetic concerns in the planning of parotidectomy incisions

Background Surgeons have utilized the traditional Blair’s incision (or a variation of it) to conduct parotidectomy. A variety of esthetic deformities, including hollowed-out preauricular and infra-auricular abnormalities and visible scars, can arise. The Appiani and Delfino standard facelift incision was then changed to facilitate exposure of parotid gland lesions, which ranged in size from minor to moderate. Patients and methods A total of 50 consecutive patients who were scheduled for parotidectomy due to benign disease were included in this research. Included were patients with benign parotid illness recommended for either a superficial or complete conservative parotidectomy. Using the closed envelope procedure, all eligible patients were randomly divided into two groups: group A and group B (25 each). For a total of 3 months, the patients were monitored weekly for the first 4 weeks and then every 2 weeks to identify any early and late postoperative problems. Results In group A, the mean age was 42.6±8.65 years, while in group B, it was 44±10.1 years (P=0.126). In group A, the mean operating time was 140±18.8, but in group B, it was 164±26.9 (P=0.089). There was no discernible statistical difference between the two groups in terms of postoperative discomfort, operational hematoma, hospital stay, facial nerve palsy, or hypertrophic scars. Patients in group B were substantially happier with their esthetic results than those in group A (P=0.05). Conclusion It is safe to do the parotidectomy using the modified facelift incision and it allows good exposure of the parotid gland comparable to the conventional Blair’s incision. It provides a significantly better cosmetic outcome.

Lipofilling after total parotidectomy: a useful option to prevent functional and aesthetic sequelae

Parotidectomy is the main treatment for parotid tumours, but its functional and aesthetic sequelae can be very disturbing for patients. 15 patients underwent total conservative parotidectomy, harvesting of a superficial musculoaponeurotic system (SMAS) flap and lipofilling between May 2014 and June 2020 for a benign parotid tumour. Aesthetic, functional sequelae and cosmetic results were assessed with the House-Brackmann scale, Luna-Ortiz's classification and a semiquantitative questionnaire. Lipofilling resorption was analysed by maxillofacial and neck MRI imaging at 2 years after surgery. The results were compared to a group of 21 patients who underwent total parotidectomy without harvesting a SMAS flap and lipofilling. No complications were observed. No facial defects were seen during follow-up. Post-operative MRI showed fat resorption was less than 20% in 12 patients and from 20 to 30% in 3 patients. Cosmetic satisfaction was 100% in all cases. Only 1 patient (6%) complained of Frey's syndrome. Lipofilling is an excellent solution considering its efficacy, safety, simplicity, duration over time and economic costs. Donor site invasiveness is minimal, and reintervention is always possible. Face-lift incision and SMAS flap can improve aesthetic results and minimise the disfiguring impact of the surgical scar.

Comparative study between modified blair incision and modified facelift incision for benign parotid tumor

Background: Modified Blair incision is the classical incision for benign parotid lesions, it provides good surgical exposure, but it leaves a visible scar in the neck which bothers a wide range of patients, especially female and young patients. modified facelift incision is the new alternative approach for benign parotid lesions, it cosmetically better than the modified Blair incision because this incision is hidden behind the ear and in the hairline. Materials and Methods:This prospective clinical research comprised 16 individuals who had superficial parotidectomy for benign lesions. Group 1 = 8 patients had a modified facelift incision and Group 2 = 8 had a modified Blair incision. Variables included age, gender, histological diagnosis, operating time, and surgical exposure. The major outcomes were surgical complications and patient satisfaction. Descriptive statistics include mean, median, SD, ranges, frequencies, and proportions. Fisher's exact test compared frequencies, and student's t-test (independent two groups model) compared means P< 0.05 is significant. Results: There were no statistically significant differences in postoperative complications rates between the groups. Of modified blair incisions, 25.0% suffered seroma postoperatively versus12.5 % of modified facelift incisions. Of modified blair incisions, 12.5 % suffered gustatory sweating versus none following modified facelift incisions.

Complicated Facial Fillers: Management Algorithm.

Background:Various materials have been developed as skin fillers to correct wrinkles of the face. Dermal fillers are classified based on their biodegradability into bioresorbable versus nonbioresorbable. All dermal fillers have a potential risk of complications, which can be classified as early and late onset events. Among all the complications of filler injections, inflammatory nodules and granulomas are the most annoying and disfiguring. The purpose of the study was to provide a surgical treatment algorithm that allows us to deal with the complications of facial fillers through three surgical techniques.Methods:Thirty-one patients with complaints of facial contour abnormalities after filler injection, three surgical techniques were adopted according to the presenting case including face lift incision, needle aspiration and intraoral excision after preoperative preparation of the case with postoperative follow-up for 6 months.Results:Among our studied patients treated by these surgical techniques, dissection was difficult owing to the fibrosis and the granulomatous reaction post complicated filler injection. There were two cases of hematoma, 1 case of seroma, and 1 case of facial nerve injury that improved after 4 months, in which marked improvement of facial contour and skin quality was observed.Conclusions:The use of the facelift technique as a surgical treatment for post filler complication granuloma excision provides a useful and satisfactory method for patients complaining of major facial deformities following repeated complicated filler injections. Despite being more difficult than other techniques it is more satisfactory in facial rejuvenation post complicated facial fillers.

Easy and Safe Simultaneous Zygoma Reduction and Facelift by Single Incision Through Subcutaneous Approach

The surgery for facelift or zygoma reduction usually has a long operative time, swelling, and blood loss consideration; and therefore, these two procedures are often performed separately. In recent years, an increasing demand for simultaneous zygoma reduction and facelift has been observed; however, few studies have examined safe and effective of simultaneous zygoma reduction and facelift. The aim of this study was to present a safe, easy, and flexible method for combining facelift and zygoma reduction through single facelift incision with minimal blood loss. From 2015 to 2020, the senior author performed zygoma reduction with facelift by using a subcutaneous approach through single facelift incision in patients with wide zygoma and an aging face. Operative time, intraoperative blood loss, postoperative course, and complications were recorded. In total, 56 patients met the inclusion criteria and were included in the study. The combined surgery was successfully performed in all cases, and no serious complications were reported. The follow-up period ranged from 6.5 to 60 months. The average operating time was 187 minutes, and the mean intraoperative blood loss was minimal (30 mL). All patients were satisfied with the outcome, different scores were assessed with Global Aesthetic Improvement Scale (GAIS). Facelift and zygoma reduction using a subcutaneous approach through single facelift incision provides complete visualization of the zygoma, superior hemostasis control, resulting in an easy and safe surgery that does not require additional intraoral incisions.

Functional Outcome Comparison of Free Gracilis Muscle Anchoring Methods in Patients with Facial Paralysis: Upper Lip Red Line Incision versus Facelift Incision Approach.

The greatest challenge of a free-muscle transfer in facial reanimation surgery is anchoring muscle to perioral soft tissue. An additional incision provides a better way to anchor the transferred muscle but leaves a visible scar. Herein, we compared the functional and aesthetic outcomes in a conventional facelift incision approach with and without the addition of a red line incision. This study included patients experiencing unilateral facial paralysis who underwent free gracilis transfer between December 2016 and December 2018. Anchoring through facelift incision with extended neck incision was performed in the control group, while a red line incision was added in the red line group by avoiding extended neck incision. Oral commissure excursion, upper lip and commissure height differences, and symmetry were measured. A total of 24 patients met the criteria and were included in this study. Of these, 10 patients were assigned to the red line group and 14 to the control group. The red line and control groups demonstrated a similar symmetry index in both resting (0.96 ± 0.18 and 0.92 ± 0.10, respectively; p = 0.435) and smiling (0.94 ± 0.12 and 0.91 ± 0.10, respectively; p = 0.314). However, the upper lip height difference demonstrated greater postoperative improvement (resting: 2.12 ± 1.13 vs. 3.92 ± 1.41 mm, p = 0.002, and smiling: 1.68 ± 0.88 vs. 3.41 ± 1.69 mm, p = 0.004, respectively). A scar could be easily concealed on the mucocutaneous line of the lip. This novel method for muscle anchoring in facial reanimation surgery allows surgeons to approach perioral muscle more directly. This leads to improved surgical results by securely anchoring the transferred muscles using a fixation point that is more medially located than in other approaches. Our method is effective and offers an improved surgical outcome for the free functional gracilis muscle transfer.

Transoral finger-retraction for surgical resection of benign tumors involving masseter muscle and buccal space

The regular treatment of tumors involving masseter muscle and buccal space like accessory parotid pleomorphic adenoma is performed with external approaches including parotidectomy and facelift incision, which require a large flap elevation and leave an external scar. The current study aimed to revisit the clinical features of the benign tumors involving masseter muscle and buccal space in the mid-posterior cheek region and presented a case series of the patients (n = 10) who underwent surgical resection by transoral finger-retraction. The accessory parotid pleomorphic adenoma (n = 4) and hemangioma (n = 3) were a little bit more in this region. We focused on the surgical procedure of very rare masseteric schwannoma, due to the deep localization of the masseteric mass in the intraoral space. Transoral finger-retraction as a supplemental surgical technique was used to allow for the tumor involving the masseteric and buccal spaces to be delivered into the oral cavity for complete resection. The use of a facial nerve monitoring during the surgical dissection was also recommend. Collectively, this report demonstrated the ability to adequately and safely resect tumors involving masseter muscle and buccal space using a transoral approach facilitated by finger retraction, with better cosmetic results and without visible scar formation.

Systematic review and meta-analysis of modified facelift incision versus modified Blair incision in parotidectomy

Surgical removal is the treatment of choice for many neoplasms of the parotid gland. This meta-analysis aimed to evaluate the differences between parotidectomy using a modified facelift incision (MFI) and parotidectomy using a modified Blair incision (MBI). A systematic search of the available literature in PubMed, Embase and the Cochrane Library was performed. Studies of adult patients who underwent open parotidectomy with presumed benign parotid neoplasms based on preoperative examinations were reviewed. The surgical outcomes of the MFI and MBI groups were collected. Intraoperative and postoperative parameters, including operative time, tumor size, cosmetic satisfaction, and incidences of facial palsy, Frey’s syndrome and salivary complications, were compared. Dichotomous data and continuous data were analyzed by calculating the risk difference (RD) and the mean difference (MD) with the 95% confidence interval (CI), respectively. Seven studies were included in the final analysis. The pooled analysis demonstrated that the cosmetic satisfaction score was significantly higher in the MFI group (MD = 1.66; 95% CI 0.87–2.46). The operative duration in the MFI group was significantly longer than that in the MBI group (MD = 0.07; 95% CI 0.00–0.14). The MFI group exhibited a smaller tumor size (MD = − 2.27; 95% CI − 4.25 to − 0.30) and a lower incidence of Frey’s syndrome (RD = − 0.18; 95% CI − 0.27 to − 0.10). The incidence of postoperative temporary facial palsy (RD = − 0.05; 95% CI − 0.12 to 0.03), permanent facial palsy (RD = − 0.01; 95% CI − 0.06 to 0.03) and salivary complications (RD = − 0.00; 95% CI − 0.05 to 0.05) was comparable between the two groups. Based on these results, MFI may be a feasible technique for improving the cosmetic results of patients who need parotidectomy when oncological safety can be ensured.

71 The Use of Sternocleidomastoid Rotational and Cervicofacial Advancement Flap for Closure of a Persistent Mastoid Cutaneous Fistula

Abstract Introduction Postauricular mastoid fistula is a rare occurrence, typically following repeated soft tissue injury, commonly caused by chronic suppurative otitis media and repeated surgical treatments. Management is challenging with a limited number of reported, successful surgical techniques, which often have limited applicability. Case report We present a case of a 55-year-old male patient with a persistent right post-auricular cutaneous mastoid fistula as a result of two previous mastoidectomies. Although the patient underwent two simple primary closures, the fistula recurred. This was successfully treated with a new technique utilising a Sternocleidomastoid Rotational and Cervicofascial Advancement Flap which was completely healed at the 1-year follow-up without a recurrence of the fistula. Conclusions This novel technique provided a definitive obliteration of a persistent cutaneous mastoid fistula. By utilising a double layered flap, via a facelift incision, the flap results in an excellent functional and cosmetic result.

Trans-oral robotic surgery for Hilo-parenchymal submandibular stones

Sialolithiasis represents a common benign disease of the major salivary glands. Conventional therapeutic approaches include trans-oral sialendoscopy removal of the stones, duct incision and marsupialization, and trans-cervical sialadenectomy. However, the recent technological innovations of endoscopic and robot-assisted surgery provide unique opportunities to treat submandibular salivary gland stones. During the last decade, surgical robots have been utilized to remove submandibular glands in patients with sialolithiasis. In addition, they have used surgical access methods such as trans-hairline and facelift incisions for superior cosmesis. Most salivary stones involve the submandibular gland (80%–90%), and the most frequent locations are the distal tract of the duct, the hilum, and the hilo-parenchymal area. Trans-oral robotic surgery (TORS) has been proposed for the removal of hilo-parenchymal submandibular stones. TORS appears to be a viable option specifically in cases of deep and nonpalpable stones, multiple and recurrent intraparenchymal stones as well as iatrogenic duct stenoses. In this article, we review and discuss The role of TORS in the treatment of hilo-parenchymal submandibular stones.

Application analysis of a modified retroauricular hairline incision in the resection of a benign parotid gland tumor.

This study aimed to evaluate the application value of a modified retroauricular hairline incision and a sternocleidomastoid flap with an inferior pedicle in the resection of benign parotid gland tumors. Forty-eight patients with benign parotid gland tumors were retrospectively analyzed: 19 cases were included in the experimental group with an improved retroauricular hairline incision and a sternocleidomastoid flap with an inferior pedicle, and 29 cases were assigned in the control group with a modified facelift incision. Operation time, postoperative drainage, postoperative esthetic degree, and incidence of facial nerve paralysis, salivary fistula, and Frey's syndrome were compared. After the esthetic procedure, the average score of the experimental group was higher than that of the control group, and the esthetic effect of the former was better than that of the latter (P<0.05). The incidence of the operation time, facial nerve paralysis, salivary fistula, and Frey's syndrome of both groups had no statistically significant differences (P>0.05). The modified retroauricular hairline incision and sternocleidomastoid flap with an inferior pedicle can be applied to resect benign parotid gland tumors safely. It shows a better cosmetic effect and does not cause obvious postoperative complications. Therefore, it should be promoted for tumor treatments.

Efficacy of modified face lift incision for the resection of benign parotid gland tumor located anteriorly or superiorly

ObjectivesThe goals of resection of benign parotid gland tumor are complete resection of lesion and preservation of the facial nerve function. Traditionally, the bayonet-shaped incision (Blair incision: BI) and the modified face lift incision (mFLI) are commonly used for parotidectomy. However, concerns exist about the adequacy of exposure and identification of the facial nerve in anterior or superior parotid lesions. The aim of this study was to compare the surgical outcomes between BI and mFLI and to evaluate the adequacy, possible indications, and limitations of mFLI for the resection of benign parotid gland tumors located anteriorly or superiorly. MethodsThis retrospective study analyzed the medical records of 175 patients with various types of benign parotid tumor who underwent partial parotidectomy via BI (97 patients) or mFLI (78 patients). Tumors were divided into five categories depending on their location: anterior, superior, inferior, middle, and deep lobe tumors. The outcomes of operation were analyzed according to tumor location between the incision types. ResultsTumor locations were not significantly different between the two groups. Transient facial palsy occurred in 23 out of 152 patients (15.1%); permanent palsy was not observed in either group. The incidence rates of facial palsy were higher among patients with superior and deep lobe tumors; in the mFLI and BI groups, proportions of superior tumors were 22.2% and 27.2%, respectively, and those of deep lobe tumors were 35.7% and 23.5%, respectively. With regard to superior and anterior tumors, the incidence rate of postoperative facial palsy was insignificantly lower in the mFLI group (10.5%) than in the BI group (18.2%). ConclusionsThere were no differences in the incidence rates of postoperative facial palsy between mFLI and BI for any tumor location. Use of the mFLI is feasible for the resection of most benign parotid tumors located anteriorly or superiorly.