Facelift Procedures Research Articles

The Staged Face Lift

Although early secondary face lift is a highly scrutinized procedure, it is beneficial for a select group of patients. Justification for performing the early secondary face lift or staged face lift is more apparent when considering the biomechanical limitations of the primary face lift. All patients undergoing primary face-lift procedures performed by the senior author (T.A.M.) between 1998 and 2008 were followed for 2 years to determine which patients would benefit from an early secondary rhytidectomy. Early secondary face lifts were performed in the same sub-superficial musculoaponeurotic system plane as the primary procedure and entailed full undermining. Forty-seven of 742 patients (6.3 percent) undergoing a primary face-lift procedure underwent an early secondary rhytidectomy. Identified limiting factors of the primary face lift included suture-tearing force, viscoelastic properties (tissue creep and stress relaxation), blood supply, and an attempt to avoid an overly pulled appearance. Indications for early secondary rhytidectomy included early symptoms of recurrence or residual age-related changes in patients with severe preoperative laxity or poor soft-tissue elasticity and mainly involved the perioral region. There were no significant complications and there was high patient satisfaction in all cases. With thorough understanding of the viscoelastic properties of facial tissues and proper consultation with patients, the early secondary face lift can be used as a safe and effective option with which to address the limitations of a primary face lift. Therapeutic, IV.

Nasolabial fold augmentation with SMAS graft

This case report shows a new technique for inserting superficial musculoaponeurotic system (SMAS) tissue as autologous filling of deep nasolabial folds during an SMAS or minimal access cranial suspension (MACS) facelift procedure with satisfying aesthetic results. The technique avoids visible scars on the cheek and does not require insertion through a potential contaminated area such as nasal mucosa.

Facial Rejuvenation Surgery: A Retrospective Study of 8788 Cases

Surgical rejuvenation of the aging face is common in aesthetic surgery, and many surgical techniques have been described for accomplishing it. The keys to consistent results are the surgeon's judgment and ability to individualize a treatment plan according to the patient's needs. To obtain natural-appearing results, the surgeon must consider the morphological characteristics of the aging face. The authors describe their approach for "round" facelift technique and strategies for avoiding complications. This retrospective study included 8788 consecutive patients who underwent facelift procedures in a single clinic between 1958 and 2010. All cases involved the round-lifting technique. Patients in this series ranged in age from 28 to 84 years. The percentage of male patients increased in later years (6.3% in 1970-1974 vs 18.6% in 1986-2010), and there was a trend toward increasing age after 1979 (17.7% of patients aged 60 years or older vs 8.3% before 1980). Submental liposuction was the most common facelift procedure performed (92.2% of patients, 1990-2010). Up to 97% of the cases treated after 1999 underwent repositioning of the malar fat pad. The overall complication rate was 4.5%, with the most frequent complications being hematoma (3%) and cutaneous slough or necrosis (1%). Repositioning the vector connecting the tragus with the Darwin tubercle provides more natural correction of aging tissues than do other techniques. The authors' intent was to keep the structures in their natural location, as they had been prior to aging. Superficial musculo-aponeurotic system (SMAS) plication, malar fat pad repositioning, and correct traction of facial tissues showed satisfactory results. This technique is less aggressive than undermining of the SMAS and deep-plane techniques. 4.

Facelift Complications and the Risk of Venous Thromboembolism: A Single Center’s Experience

The number of facelifts performed in the United States has steadily increased over the past decade. Moreover, the risk of venous thromboembolism in plastic surgery has been established in recent studies. The authors investigate the overall complication rate in a single-center series to identify risk factors and determine the risk of venous thromboembolism. A retrospective chart review was performed for patients who underwent a facelift procedure at a private clinic in Atlanta, Georgia, between January 2004 and December 2010. A total of 630 patients were included. The data collected included patient demographics, comorbidities, body mass index, smoking history, operative time, and concurrent procedures. All postoperative complications were recorded. The mean age of the patients in this series was 58.4±7.3 years. A small percentage of the patients were men (8.1%); 23.2% had hypertension; 4.9% were smokers; and 3.5% had a history of taking prophylactic aspirin. The mean operative time was 255.6±81.6 minutes. Almost a quarter (23.6%) of the patients underwent concurrent procedures. There were 38 complications, including 29 hematomas, two deep vein thromboses (DVTs), two eye infections, two instances of partial skin loss, and one ectropion. Risk of complications was significantly higher in men, patients over 55, and those with a body mass index>30 kg/m2. The risk of hematoma was higher (P<.05) in men, patients over 55, those with a history of hypertension, and those taking aspirin. The risk of DVT increased when the procedure time was longer than five hours. Both patients who developed DVT had undergone a facelift in combination with another procedure. There was also an increase in the risk of complications when the facelift was combined with two or more procedures. Identifying various risk factors for complications, especially DVT, can help to minimize those factors in the postoperative period and treat complications effectively when they occur. The data indicate that the number of concurrent procedures is a specific risk factor for development of DVT, so care should be taken when planning for multiple treatment sites. Combining facelift with other procedures also increases the risk of complications, especially DVT. 4.

Ultrasonically Assisted Face-Lift

The face-lift procedure is one of the most skillful interventions performed by plastic surgeons. Ultrasonic energy is used to elevate the facial skin flap, which allows for preservation of vascular, lymphatic, and nervous structures, thereby decreasing the morbidity associated with this procedure. A retrospective study to compare the outcomes of ultrasound and non-ultrasound-assisted face-lifts is reported. All the procedures were performed at the Institute for Plastic Surgery. Each group consisted of 104 patients. Statistical analysis was performed to determine differences between the groups. The mean operating time was 4 h in the treatment group versus 4.2 h in the control group (p>0.05). The incidence of hematoma formation was 0.96% in the treatment group versus 2.4% in the control group (p<0.05). The incidence of flap necrosis was 0% in both groups. The duration of ecchymosis was 13 days in the experimental group versus 17.2 days in the control group (p<0.05). The duration of postoperative swelling was 17.4 days in the treatment group versus 20.4 days in the control group (p<0.05). As reported, 85% of patients in the treatment group were very satisfied, 14.42% were satisfied, 0% were mildly satisfied, and 0% were not satisfied. In the control group, 80.7% were very satisfied, 18.26% were satisfied, 0.96% were mildly satisfied, and 0% were not satisfied. According to Fisher's exact test, the p value for patient satisfaction exceeded 0.05%. The preservation of the blood and lymphatic vessels diminishes postoperative swelling and shortens the duration of ecchymosis considerably. The incidence of hematoma formation is lower than with a non-ultrasonic face-lift. This study failed to prove any statistically significant difference in operating time or patient satisfaction between the two groups.

The Percutaneous Trampoline Platysmaplasty: Technique and Experience With 105 Consecutive Patients

Controversy persists regarding the optimal procedure to rejuvenate the aging neck. More invasive procedures carry increased risks of complications, whereas less invasive approaches may deliver marginal results. The challenge is selecting the appropriate procedure for delivering consistent, durable results meeting both the patient's and surgeon's expectations. The authors describe their trampoline platysmaplasty (TPP) approach, a percutaneous suture suspension necklift that constitutes a less invasive approach for neck rejuvenation. A retrospective study was conducted of 105 consecutive patients who underwent TPP. Age, sex, procedure(s) performed, complications, and patient satisfaction were recorded. Cadaver studies were conducted to compare the tensile strength of the ligaments that anchor the TPP to the tensile strength of the sutures placed to approximate the medial platysma borders. In addition, the accuracy of light transillumination to determine depth of travel of the light-emitting diode (LED) lighted rod was evaluated. Patients underwent either TPP alone (18 women, 24 men) or TPP with a facelift (35 women, 28 men) between October 2007 and June 2009. The average age of the patients was 52 years, and average length of follow-up was 33 months. Patient satisfaction was high. Three early patients underwent immediate revision to improve results secondary to the suture matrix being too loose. Six additional patients had recurrent banding around one year postoperatively, but correction was achieved in all six by replacing the matrix with the help of the lighted rod. The results of the cadaver study revealed that the tensile strength of the retaining ligaments was statistically identical to the medial platysma borders, and the light transillumination feedback was accurate with regard to the depth of travel of the illuminated rod tip. The TPP approach for neck rejuvenation is effective and durable in properly-selected patients. It works well as a stand-alone procedure and in conjunction with facelift procedures. It also offers younger patients a less-invasive option to improve neck contours inherited through genetics. After nearly three years of follow-up of the patients in this report, the results appear to be long-lasting.

Maxillomandibular Advancement in Obstructive Sleep Apnea Syndrome

The aging process is characterized by multiple signs affecting the upper, the middle, and the lower third of the face; coventionally, face-lift procedures and structural fat grafting are performed to create a younger face. During the life, craniofacial skeleton atrophies, leading to a reduction of the facial height and depth, while increasing the facial width. Maxillomandibular advancement (MMA) by orthognathic surgery restores the lost space dimension, projecting the cheeks, the mouth, and the nose. The aim of this study was to analyze the morphologic change of the face after MMA in patients with obstructive sleep apnea syndrome, focusing on the previously mentioned stigmata of the middle and the lower third of the aging face. The records of 16 patients who underwent MMA for obstructive sleep apnea syndrome between January 2005 and December 2008 in the Unit of Maxillofacial Surgery at the Novara Major Hospital were included in this study. We explained to the patients the stigmata of a standard aging face, and we asked them to evaluate each sign affecting the middle and the lower third of their preoperative condition. One positive point was given for the presence of each sign reported by the patients. At 2 years after surgery, we asked the patients to evaluate the previously mentioned aging signs of their postoperative face. Again, 1 positive point was given for the presence of each sign reported by the patients. Although we did not perform statistical evaluation, 13 patients showed a degree of rejuvenation after MMA (the score of the postoperative face is less than the score of the preoperative face). Three patients reported no postoperative change; none reported a more aging face, with a successful “reverse face-lift” occurred in 81% of our cases. Simultaneous maxillary and mandibular advancements change the skeletal framework of the face, improving soft-tissue support and resulting in rejuvenation of the middle and the lower third of the face. This condition is demonstrated by the results of our study in that all patients appeared postoperatively more youthful from a self-evaluation.

The Minimal Access Deep Plane Extended Vertical Facelift

Modern facelift techniques have benefited from a "repopularization" of shorter incisions, limited skin elevation, and more limited dissection of the superficial musculoaponeurotic system (SMAS) and platysma in order to shorten postoperative recovery times and reduce surgical risks for patients. The authors describe their minimal access deep plane extended (MADE) vertical vector facelift, which is a hybrid technique combining the optimal features of the deep plane facelift and the short scar, minimal access cranial suspension (MACS) lift. The authors retrospectively reviewed the case records of 181 patients who underwent facelift procedures performed by the senior author (AAJ) during a two year period between March 2008 and March 2010. Of those patients, 153 underwent facelifting with the MADE vertical technique. With this technique, deep plane dissection releases the zygomatico-cutaneous ligaments, allowing for more significant vertical motion of the midface and jawline during suspension. Extended platysmal dissection was utilized with a lateral platysmal myotomy, which is not traditionally included in a deep plane facelift. The lateral platysmal myotomy allowed for separation of the vertical vector of suspension in the midface and jawline from the superolateral vector of suspension that is required for neck rejuvenation, obviating the need for additional anterior platysmal surgery. The average age of the patients was 57.8 years. The average length of follow-up was 12.7 months. In 69 consecutive patients from this series, average vertical skin excision measured 3.02 cm on each side of the face at the junction of the pre auricular and temporal hair tuft incision (resulting in a total excision of 6.04 cm of skin). Data from the entire series revealed a revision rate of 3.9%, a hematoma rate of 1.9%, and a temporary facial nerve injury rate of 1.3%. The common goal of all facelifting procedures is to provide a long-lasting, natural, balanced, rejuvenated aesthetic result with few complications and minimal downtime. The MADE vertical facelift fulfills these criteria and often yields superior results in the midface and neck areas, where many short scar techniques fail. Furthermore, this procedure can be performed under local anesthesia, which is a benefit to both patients and surgeons.

Laser Face-Lifts: A New Paradigm in Face-Lift Surgery

Laser-assisted liposuction has been successfully applied to remove fat and contract skin in nonfacial areas. This study evaluated the efficacy and safety of this technique in the face. Patients ( N = 40) requesting improvement and a shorter recovery time received one of four laser face-lift (LFL) procedures. The target area was divided into ~15 squares, each around 5 × 5 cm. Each square was treated individually by laser-assisted liposuction to surface temperature end points of 38°C to 40°C. Anatomic areas treated included the submentum, jowls, neck skin, jaw line, cervicomental angle, oral commissures, and nasolabial grooves. Wavelengths were 1064 nm and 1319/1320 nm. Patients returned to their normal lifestyle within 6 to 7 days after treatment. Patient satisfaction was generally higher than that seen in patients receiving a conventional face-lift. Adverse events were limited to burns in two patients. The LFL is a less invasive treatment with acceptable efficacy, reduced downtime, shorter recovery, and lower cost compared with the traditional face-lift.

Further Experience With Permafacial Implants for Lip Augmentation: A Review of 100 Implants

Although fillers and surgical lip lifts are effective ways of treating the perioral area, both have inherent downsides. Fillers lack permanence, and lip lifts do not address the issue of fullness. The authors present the results of a long-term follow-up study of Permafacial implants (SurgiSil LLC, Plano, Texas) for lip augmentation. This report is a follow-up from their first publication. The original publication demonstrated the benefit of the procedure at the time of a facelift. The present study reports a long-term follow-up on all of the authors' first 50 patients. The authors' original publication demonstrated the benefits of inserting Permafacial implants concurrent with a facelift procedure. In this long-term follow-up study, the results of the first 100 implants (50 patients) are presented; this initial group of patients was followed up for one to two years. Implant migration, lip function, implant position, sensation, and patient satisfaction are reviewed. Very few complications were reported; they included migration with revision, along with patient-requested size adjustments or removal. No extrusions were reported. The degree of patient satisfaction with these implants was high. Although the authors initially experienced a significant migration rate, a modification in technique reduced this rate over the long term. Permafacial implants are an effective method of increasing fullness in the lip area, and they are associated with few complications and high patient satisfaction.

Multimodal Management of Atrophic Acne Scarring in the Aging Face

Atrophic facial acne scarring is a widely prevalent condition that can have a negative impact on a patient’s quality of life. The appearance of these scars is often worsened by the normal effects of aging. A number of options are available for the treatment of acne scarring, including chemical peeling, dermabrasion, ablative or nonablative laser resurfacing, dermal fillers, and surgical techniques such as subcision or punch excision. Depending on the type and extent of scarring, a multimodal approach is generally necessary to provide satisfactory results. Resurfacing techniques correct surface irregularities, long-lasting dermal fillers address the volume loss resulting from acne, and sub-superficial musculoaponeurotic system (SMAS) face-lift procedures counter the soft tissue laxity and ptosis associated with aging. This article briefly reviews the evolution of individual approaches to treating atrophic acne scarring, followed by case examples illustrating results that can be achieved using a multimodal approach. Representative cases from patients in their 30s, 40s, and 50s are presented. In the author’s clinical practice, multimodal approaches incorporating fractionated laser, injectable poly-l-lactic acid, and sub-SMAS face-lift procedures have achieved optimal aesthetic outcomes, high patient satisfaction, and durability of aesthetic effect over time.

Bony Anatomic Landmarks to Avoid Injury to the Marginal Mandibular Nerve

Marginal mandibular nerve injuries are more likely to be symptomatic than other facial nerve injuries following facelift procedures. The marginal mandibular nerve courses over the facial artery in the region of the mandible. The nerve is most susceptible to injury in this location because it lies superficial to the anterior facial artery. The authors describe the location of the marginal mandibular nerve based on superficial anatomic landmarks as it crosses the facial artery above the mandibular border, in order to help surgeons avoid injury to this nerve during facelift procedures. Eighteen cadaveric facial halves were dissected with the aid of loupe magnification. The distance from the facial artery to the palpable masseteric tuberosity at the angle of the mandible was measured. The distance from the masseteric tuberosity to the mental midline was also measured to determine a ratio of the facial nerve from the masseteric tuberosity to the mental midline. The facial artery was found to be an average of 3.05 ± 0.13 cm anterior to the masseteric tuberosity along the mandible. The marginal mandibular nerve crossed the facial artery along the mandibular border approximately 3 cm anterior to the masseteric tuberosity. The distance from the masseteric tuberosity to the mental midline averaged 11.3 ± 0.54 cm. Therefore, the marginal mandibular nerve courses superficial to the facial artery at approximately one-fourth of the distance from the masseteric tuberosity to the mental midline. Knowledge of the masseteric tuberosity and mental midline landmarks of the facial artery can provide a reliable and safe approach to surgery of the lower face.

Outcome Analysis in 93 Facial Rejuvenation Patients Treated with a Deep-Plane Face Lift

This prospective study assessed outcomes in patients undergoing a deep-plane face lift and other simultaneous facial cosmetic procedures. It is the first prospective outcome study to assess and compare these patients and provide data on patient satisfaction and quality of life—the most important determinants of surgical success. From 2002 to 2007, in-person interviews were conducted with 93 patients who attended a follow-up appointment at least 1 month after surgery from a total of 122 consecutive patients treated with a deep-plane face lift and other facial rejuvenation procedures (response rate, 76 percent). Questions were asked in six categories: patient data, indications, recovery, results, complications, and psychological effects. Responses were analyzed in four groups: face lift alone; face lift and blepharoplasties; face lift and forehead lift; and face lift, blepharoplasties, and endoscopic forehead lift. The average subjective reduction in apparent age was 11.9 years (range, 0 to 27.5 years). Seventy-seven patients (82.8 percent) reported an improvement in self-esteem, and 64 patients (69.6 percent) reported an improved quality of life. There was no significant correlation between result rating and procedure groups, age, gender, smoking history, previous face lift, body mass index, or the occurrence of a complication. Despite a significant recovery period, patient satisfaction was high, with 96.7 percent of patients reporting a more youthful appearance after surgery. Scar dissatisfaction was rare (2.2 percent). With proper patient preparation and education, facial rejuvenation effectively meets patient expectations. These findings support the recommendation of surgical facial rejuvenation to patients who wish to look younger.

Modified Superficial Musculoaponeurotic System Face-Lift: A Review of 327 Consecutive Procedures and a Patient Satisfaction Assessment

A conventional superficial musculoaponeurotic system (SMAS) face-lift is well established because it allows the skin envelope to be rotated in a bit more lateral direction than the cephalad redirection of the SMAS flap. This ensures an individualization of the treatment plan according to the needs of the patient and avoids a postoperative stretched look. However, this technique has some limitations with respect to its long-term effects on the sagging tissue, inadequate lifting of the malar fat pad, and flattening of the nasolabial fold. The procedure described by the authors consisted of a modified approach to conventional SMAS flap dissection for 327 patients with facial aging signs undergoing a face-lift. A pointing tongue-shaped flap of zygomaticotemporal fascia was dissected and preserved in the posterior half of the upper edge of the SMAS flap and anchored to the deep temporal fascia, enhancing the vertical support of the facial soft tissues. Outcomes were determined by case notes, clinical review, and a questionnaire. The study investigated 327 consecutive modified SMAS face-lifting procedures. Few complications were observed. Only two patients experienced small hematomas needing evacuation. Some patients reported bearable pain in the temporal region and tension during mouth opening. Temporary weakness in the branches of the facial nerve experienced by two patients resolved completely within some months. Two patients presented with dehiscence of the scar, and one patient experienced punctual retroauricular skin necrosis, which healed uneventfully with conservative treatment. Two patients reported that the knot in the temporal region was palpable through the skin. One patient experienced retroauricular infection. Only two patients required additional procedures. One mild hypertrophic scar responding to steroid injection over the mastoid area was observed in the entire series. With the reported technique, the authors achieved pleasing, natural, durable results with minimal morbidity and an overall complication rate of 3.9%. All the patients were sent a satisfaction questionnaire or contacted for a telephone interview. A total of 235 patients replied. The patients reported high levels of satisfaction after treatment. The authors believe that the rhytidectomy technique described in this report has several beneficial attributes. High vertical elevation of the SMAS flap delivers a long-lasting benefit and addresses the problem of neck laxity and platysma redundancy, leading to a correction of the neck contouring and jowls. Nasolabial folds appear to be smoothed, and malar flattening is restored by imbrications of the SMAS flap over the cut edge in the malar prominence. This investigation demonstrates that the rhytidectomy technique is safe and produces highly predictable results.

Effect of Perioperative Hyperbaric Oxygen on Bruising in Face-lifts

Effect of Perioperative Hyperbaric Oxygen on Bruising in Face-lifts

Locating the Cervical Motor Branch of the Facial Nerve: Anatomy and Clinical Application

Platysma innervation has various clinical applications. Although some patients have unsightly platysmal bands, others suffer from hyperkinetic motility disorders of the platysma that constitute both an aesthetic and functional impairment. Recently, the cervical motor branch has been used to reconstruct brachial plexus injuries. Dissection in this area can be precarious. The authors describe surface landmarks to help predict the location of the cervical motor branch of the facial nerve to more efficiently and safely operate in this area. Sixteen fresh heminecks were dissected with the aid of loupe magnification. Measurements were taken to the branching point of the cervical nerve from the angle of the mandible and to a line from the mentum to the mastoid process. The cervical branch of the facial nerve was identified to branch below the mandible in all specimens. The branching point of the cervical nerve was consistently found in line with a perpendicular line from the angle of the mandible to the mastoid-mentum line. The branching point was located within 1.75 +/- 0.26 cm of this line. Dividing the mastoid-mentum line by the length of the ramus accurately predicted the distance from the angle of the mandible to the branching point. The cervical branch of the facial nerve can be reliably located within 1 cm below a perpendicular line from the angle of the mandible to a line drawn from the mentum to the mastoid process. Clinical applications of these findings range from cosmetic face-lift procedures to brachial plexus reconstructions.

An Analysis of Unsolved Problems of Face-lift Procedures

The face-lift/rhytidectomy, considered a premier surgical procedure in the specialty, is designed to reverse the effects of aging on the face. Yet our understanding of aging is incomplete, for example, only recently has it been recognized that there are different fat compartments in the face: how aging affects these different compartments is not known. Some surgeons consider the baggy lower eyelid to be due to excess fat and remove the fat. Others consider the problem to be due to a weak orbital septum and recommend septal tightening, while recent work suggests that facial bone retrusion is responsible.Furthermore, many different face-lift techniques exist, with each surgeon showing good postoperative photographs. However, the face is a complex 3-dimensional structure with different contours even within an anatomic subunit, and assessment of results by a 2-dimensional photograph must be crude and inaccurate.Also, these articles discuss the surgical maneuvers necessary to achieve the purported result, but do not discuss the mechanics of the procedure. Is there a rationale for considering the SMASectomy better than submuscular aponeurotic system (SMAS) plication, for example? Basic principles of surgical wound healing will be extrapolated in an endeavor to find an answer.This article aims to highlight the divergent opinions, challenge the present thinking of the facelift procedure, and reevaluate the goals and mechanism for achieving this. Ten facets of the procedure will be examined. New methods of assessment of results are required, as photography is inadequate.

Smoking and Soft-Tissue Dermal Fillers: A Potentially Detrimental Combination?

Sir: We read with great interest the report by Rohrich et al. regarding complications when using soft-tissue fillers.1 Given the enormous increase in the use of soft-tissue filler injections, the complication rate is likely to increase. Besides biofilms, which are comprehensively addressed in Rohrich et al.'s stimulating special topic report, we believe that other patient-related risk factors should be highlighted in this regard as well. Dr. Rees and colleagues have reported in the Journal the detrimental effect of cigarette smoking on skin flap survival in the face lift patient.2 They reported on 1186 face lift procedures performed between 1975 and 1981, with a 10.2 percent total complication rate. Active smokers had a 12.5-fold increased risk for skin flap complications compared with nonsmokers. Notably, active smoking for more than 10 years leads to facial aging by 2.5 years, according to a comprehensive twin study from the Twins Day Festival in Twinsburg, Ohio, published in the Journal in 2009.3 In May of 2008, the Journal again reported four late infections after New-Fill injections in the cheek and lips in four female patients aged 48 years.4 All suffered late infections 2 to 6 months after filler injection, and all four women were active smokers. Notably, a recent case series with three female patients with alar necrosis following dermal filler injection did not comment on any smoking history that might have interfered with an altered nasal perfusion.5 Therefore, we would suggest physicians evaluate the smoking status of a given cosmetic customer before performing soft-tissue filler injections and, when in doubt, perform quantitative cotinine assays to estimate the risk for potential malperfusion. This is especially important among patients who have had previous surgical interventions, such as rhinoplasty or face lifts, with potentially altered vasculature. Karsten Knobloch, M.D. Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery Hannover Medical School Hannover, Germany

The Ultralift: A Simple, Safe, Effective Facelift Technique

Background: Experience with smaller ultrasonic liposuction cannulas for neck and lower facial contouring has led to the incorporation of this technique into face-lifting procedures. Combining ultrasonic liposuction of the neck and a subcutaneous face-lift with the superficial musculoaponeurotic system plication (hereby called the Ultralift) provides a benefit greater than either technique alone. Objective: To determine if incorporating ultrasonic liposuction of the submental, jowl, and lateral neck regions is a safe and effective adjunct to a face-lift. Methods: The Vaser lipoplasty system was used to emulsify fat in the submental, jowl, and lateral neck regions. The fat was then evacuated with a VentX cannula, and the face-lift was then performed. Results: A retrospective chart review was performed on all patients who underwent the Ultralift procedure. This technique has been used on 47 patients. Patient ages ranged from 39 to 78 years, with an average age of 57 years. Follow-up ranged from 4 months to 4 years. There were no hematomas, seromas, skin burns, sloughs, or persistent nerve injuries. Conclusions: Ultrasonic liposuction combined with face-lifting is an effective and safe method of facial rejuvenation.

Aesthetic Surgery for the Mestizo/Hispanic Patient: Special Considerations

Mestizo patients, also known as Hispanic or Latino patients, are a growing ethnic group worldwide. Cosmetic procedures have become more accessible, and more patients are looking for procedures that will not only improve their facial features but also make them have a more youthful appearance. Mestizo facial characteristics are reviewed, and a stepwise approach to the aging Mestizo face is presented where nonsurgical and surgical options are discussed including midface-lifting techniques and short scar face-lifting procedures.