Facelift Techniques Research Articles

Deep-plane facelift technique for managing extensive hemifacial tumors: A retrospective study

This study aimed to evaluate functional and aesthetic outcomes in patients undergoing deep-plane facelifts for the management of extensive hemifacial tumors. The retrospective study included patients who had been diagnosed with benign tumors with extensive hemifacial involvement. All patients underwent tumor debulking via a dual-plane facelift approach, assisted by an ICG camera to visualize the facial nerve structures. To manage the laxity of the skin envelope, the deep-plane face-lift was performed by suspending the superficial musculoaponeurotic layer, followed by suture fixation to the parotid-masseteric fascia.Clinical outcomes, including complications, House–Brackmann grading for facial paralysis, and tumor recurrence rate were investigated. Quantitative facial nerve examination was carried out using FACE-gram software (Massachusetts Eye and Ear Infirmary, Boston, USA) to measure mouth corner movement at rest and when smiling. Using preoperative and 1-year postoperative 3D photographs, facial symmetry was assessed using comparisons of facial volume and the root-mean-square deviation (RMSD) value to represent the height difference between each hemiface.In total, 25 patients who met the inclusion criteria were recruited to the study. Regarding the types of tumor, 13 of the 25 patients were diagnosed with vascular lesions and the other 12 with neurofibromatosis plexiform. Following surgery, two patients showed temporary palsy of the buccal branches — grade II on the House–Brackmann scale — but neural functioning was eventually restored during the follow-up period. During resting, the mouth corner excursion ratio was significantly improved, from 1.11 ± 0.19 preoperatively to 1.02 ± 0.08 postoperatively (p = 0.022). The facial volume ratio was significantly improved in the lower face, from 1.57 ± 0.66 preoperatively to 1.19 ± 0.18 postoperatively (p = 0.008). The RMSD was significantly decreased, from 4.56 ± 2.35 mm preoperatively to 2.08 ± 0.99 mm postoperatively (p < 0.001), representing a decrease in facial asymmetry. Within the limitations of the study, it seems that the ICG camera-assisted deep-plane facelift technique allows preservation of facial nerve functioning and enhances facial symmetry when managing extensive hemifacial tumors.

Modified facelift in severe plexiform neurofibromatosis associated with venous vascular malformation: Case report

Neurofibromatosis is an autosomal dominant disorder characterized by tumors of the nervous system and skin. Plexiform neurofibromas are common complications of neurofibromatosis type 1 and can cause large facial deformities. Vascular anomalies are in turn a rare manifestation of neurofibromatosis. We present the case of a 48-year-old female patient with right hemifacial neurofibromatosis associated with venous vascular malformation, previously treated surgically and then with sclerosing agents, determining severe residual facial deformity. Her surgical approach using a modified facelift technique associated with partial tumor debulking and lipofilling seems to be a valid technical alternative for these highly complex cases that require a customized approach after exhaustive preoperative evaluation.

FACELIFT TECHNIQUES: AN OVERVIEW.

Facelift techniques can be classified according to the depth and extent of the dissection applied. Imbrication and plication of the SMAS referred to as "SMAS lifts" or "classical facelifts" are the most commonly used techniques. Plication techniques involve in-folding of the SMAS and suture suspension without any SMAS incision whereas imbrication techniques involve a SMAS incision with a portion of the SMAS either removed or transposed with or without limited subSMAS dissection. Ageing changes in the lower face and neck can be successfully treated with SMAS lift techniques. However, there is no lifting effect at midface level or improvement of the nasolabial folds since the retaining (zygomatic cutaneous and masseteric cutaneous) ligaments that prevent the transmission of traction to the malar portion of the facelift dissection are not released. Extended facelift techniques involve surgical release of these ligaments, and produce combined, balanced and harmonious rejuvenation of the midface, cheek, and lower face without requiring a separate midface lift procedure. There are different techniques having similar extended midface dissections with some variations: The extended SMAS technique involves a long skin flap and a distinct SMAS flap dissected and pulled separately. The high SMAS technique has a similar dissection but involves a higher SMAS flap along the superior border of the zygomatic arch. The deep plane facelift involves undermining of skin-SMAS flap as a single unit following a more limited subcutaneous dissection. In the composite plane facelift, in addition to deep plane facelift dissection, the lower part of the orbicularis oculi muscle is also dissected and included in the flap. As they have a single unit, deep and composite flap facelifts allow excellent blood supply to the overlying skin. In this article, various facelift techniques are discussed in detail in line with the relevant surgical anatomy.

MODIFIED COMPOSITE PLANE FACELIFT WITH EXTENDED NECK DISSECTION.

The attenuation of retaining ligaments with aging leads to downward displacement of facial fat compartments, and is responsible for many of the stigmata that occur with aging. The zygomatic cutaneous and masseteric cutaneous ligaments prevent the transmission of adequate traction to the malar portion of the dissection during traditional low SMAS facelift techniques which involve plication or imbrication of the exposed surface of the SMAS because they do not include surgical release of these ligaments. Inadequate release of these ligaments, especially the zygomatic cutaneous ligament may lead to an unbalanced, unnatural appearance with unopposed nasolabial folds. In contrast, extended facelift techniques (extended SMAS, High SMAS, deep plane facelift, composite plane facelift) involving the release of these ligaments and can reposition the ptotic malar fat, and diminish the nasolabial folds. Additionally, the composite and modified composite plane facelifts include orbicularis oculi muscle elevation and can achieve a more harmonious rejuvenation. However, due to facial nerve injury risk, many facelift surgeons either inadequately release these ligamentous attachments or prefer less invasive techniques. Modified composite plane facelift allows safe release of the zygomatic cutaneous ligament, and safe entry into the right plane leaving all malar fat pad attached to the skin. Modified composite plane facelift technique also produces combined, balanced, and harmonious rejuvenation of the midface, cheek, lower face, and neck without requiring a separate midface lift procedure or a transblepharoplasty approach. Extending the subSMAS/subplatysmal dissection inferior to the angle of mandible, releasing of the cervical retaining ligaments, and adding a horizontal platysma myotomy below the angle of the mandible significantly improves the cervical contouring and enhances the jawline rejuvenation. This paper explains modified composite-flap facelift with extended neck dissection in a step by step manner, and highlights anatomical details to perform a safe, effective and successful extended face and neck lift surgery.

Stab access fascia suspension lift: A facelift technique without skin excision and visible scar.

Traditional middle and lower facelifts are not suitable for patients with mild skin laxity or who wish to avoid incision scars. We present the stab access fascia suspension lift (SAFS-lift) technique, which does not require regular skin incisions, as a reliable surgical facelift strategy for the lower and middle face. From September 2020 to September 2021, 38 patients underwent SAFS-lift. SAFS-lift involved (1) incomplete subcutaneous undermining with hydrodissection-assisted tunneling; (2) complete subcutaneous undermining with a dissecting cannula in the zygomatic buccal groove area and hollow below zygomatic arch; and (3) maximal firm superficial musculoaponeurotic system suspension with polydioxanone barbed threads in loops. All patients evaluated the outcome according to the Global Aesthetic Improvement Scale. Four plastic surgeons evaluated postsurgery result with a five-point Likert scale (5=excellent, 4=good, 3=fair, 2=no change, and 1=worse). Thirty-six patients were successfully enrolled. The mean follow-up period was 14.72 ± 3.89 months. No patients showed visible scarring 6months after surgery. The minor complication rate was 19.4%. They all subsided within 1-6 weeks without treatment. No infection, hematoma, seroma, or facial nerve injury was observed. Patients' outcome ratings were 4.22 ± 0.58 (3months), 4.69 ± 0.46 (6months), and 4.69 ± 0.54 (1year). Surgeons' outcome scoring was 3.98 ± 0.95. Stab access fascia suspension-lift is a predictable, effective, and safe facelift technique that can be performed without making noticeable incisions and resecting the skin.

Quantifying the Effective Lift of Skin-Only, SMAS Plication, and Extended SMAS Face-Lift Techniques in a Cadaveric Study.

Rhytidectomies are performed to rejuvenate the aging face. Various techniques exist to achieve soft-tissue elevation and skin tightening. This study analyzes three common face-lift techniques: skin-only, superficial musculoaponeurotic system (SMAS) plication, and extended SMAS lifts. The authors characterize effective facial changes with each procedure in a cadaver model. The authors performed face-lift procedures on 18 cadaver hemifaces. Each face was measured along horizontal and vertical vectors. The primary outcome was change along these vectors. Skin-only, SMAS plication, and extended SMAS lifts were performed sequentially on each hemiface. SMAS plication was used to approximate a lateral SMASectomy procedure. Parameter measurements were compared. All three procedures exhibited a significant tightening along horizontal vectors. SMAS procedures provided a significant lift along all vertical vectors, whereas the skin-only lift failed to demonstrate significant vertical elevation. SMAS procedures achieved significantly greater composite horizontal and vertical lifts compared to the skin-only operation. There was only an incremental increase in lift between the SMAS plication and extended SMAS procedures in the upper and midface regions. The extended SMAS led to the greatest lift in the lower face. SMAS procedures provided a greater lift along both horizontal and vertical vectors than the skin lift alone. The increased dissection in the extended SMAS technique resulted in only a modest increase in lift compared to SMAS plication. The extended SMAS approach appears to offer the most benefit at the lower face and may be the best choice for targeting this region.

Subcutaneous Face and Neck Lift With Prefabricated Skin Excision: A Practical Technique With Favorable Results in Young and Middle-Aged Chinese Patients.

Subcutaneous face and neck lift is a popular procedure in Chinese face and neck rejuvenation. However, there are limited studies focusing on the details and evaluation of this technique. To introduce our subcutaneous face and neck lift technique with prefabricated skin excision, evaluating the efficacy with patient reported FACE-Q Scale. In addition, to investigate on skin excision and patient's satisfaction under different circumstances. One hundred forty-five consecutive patients were identified who underwent subcutaneous face and neck lift with our technique. Online FACE-Q Scale was assessed for patients' satisfaction 6 months postoperatively. The skin excision and FACE-Q Scale were compared among different subgroups. Fifty-eight patients completed the FACE-Q. Patients demonstrated high satisfaction overall and felt 8.8 years younger than their actual age. Intraoperative skin excision data verified the practicality of the prefabricated technique. There was a constant trend with patients' satisfaction among different age groups. The preliminary comparison between the facial bone reduction group and the general group revealed no significant difference. The subcutaneous face and neck lift technique with prefabricated skin excision is an effective technique with favorable results in young and middle-aged Chinese patients. IV. Evidence obtained from a retrospective cohort analytic study.

Advances in Face-Lift Surgical Techniques: 2016-2021.

Face-lift surgery is the most crucial and constantly evolving technique of facial rejuvenation. Periodic reviews synthesizing the latest face-lift techniques may help surgeons sharpen their surgical procedures. A literature search was conducted of the PubMed databases using the search term "face lift" and "rhytidectomy." Articles reporting rhytidectomy of the forehead/brow, midface, lower face, and neck were included. Sixty-nine articles were selected after independent screening by three of the authors. The Oxford Centre for Evidence-based Medicine scale was used for evaluating evidence level. Of the 69 candidate articles, 10 studies (15%) reported techniques of neck lifting; 10 studies (15%) introduced techniques of endoscopic brow lifting; 7 studies (10%) pertained to brow lifting without endoscopic techniques. The most frequently reported locations of rhytidectomy were the brow/forehead (20%), neck (19%), and face-neck (17%). Additionally, articles regarding Asian face-lifts (14%) have been increasing. The evidence level of the articles was generally low, with only 10 articles assessed as level 1-3 with 59 articles as level 4-5. Face-lift articles with high-level evidence are still lacking. Prominently, forehead lifting and neck lifting have become upward trends of rhytidectomy in recent years, and the techniques of short-scar face-lift have been more valued. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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.

A Systematic Review and Meta-Analysis of Early Relapse After Facelift.

Early relapse is an adverse outcome of facelift surgery. The rate of early relapse is an indirect measure of the longevity and efficacy of facelift techniques. However, early relapse after facelift is ill-defined, under-evaluated, and under-reported, and literature data on the subject are dispersed. In this systematic review, we aimed to analyze facelift studies using relapse-related outcomes (RROs). Our secondary aim was to highlight the importance of early relapse as an essential outcome measure. The study design was a systematic review of the English literature and meta-analysis of RROs after facelift surgery. RROs that occurred within the first 2 years after surgery were considered "early". Performance, analysis, and reporting were performed in accordance with the PRISMA guidelines. The systematic search was conducted using the PubMed database as of February 2020. Initial screening was performed using the keywords "facelift", "rhytidectomy", "surgical rejuvenation", "face lift", "rhytidoplasty", and "facial rejuvenation". Articles were excluded by using a set of inclusion and exclusion criteria. RROs were reported only in 4.4% (19/433) of the papers that underwent full-text review. The frequency of RROs ranged between 0.2 and 50% among facelift papers. The weighted median rate of RROs after facelift surgery was found to be 2.4% in the meta-analysis. Future research on preventive measures will be successful upon acknowledgment of the actual prevalence of this problem. Consensus on its definition and objective criteria for its diagnosis are required for further progress. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of cosmetic outcomes between remote-access and conventional thyroidectomy: A review of the current literature.

The pursuit of an esthetically pleasing scar following open thyroid surgery has led to the development of endoscopic thyroidectomy through remote incisions placed in several locations outside the neck. The objective of this study is to review the recent literature and compare the incision site appearance and patient satisfaction with the cosmetic outcome after extracervical and conventional thyroidectomy. The English literature published since 2010 was searched through the PubMed/Medline database for studies comparing the cosmetic outcomes between remote-access endoscopic and conventional thyroidectomy using a form of scar assessment scale. A total of 9 relevant papers fulfilled the eligibility criteria including 1486 patients. Among them, 595 patients underwent endoscopic thyroidectomy through several remote-access approaches and 891 patients were assigned to the conventional group. Only one randomized-controlled trial was identified, whereas among the rest, four were prospective and four were retrospective nonrandomized cohorts. Regarding the extracervical modifications performed in the endoscopic groups, the axillary approach was performed in three studies and the breast approach in four studies, while the retroauricular facelift technique and the transoral vestibular method were applied in one study, respectively. Evaluation of the wound appearance and patient satisfaction with the cosmetic outcome at various time points during the follow-up highlighted the superiority of the extracervical approaches over the conventional cervicotomy. Considering these findings, remote-access techniques could possibly be the ideal surgical method for patients with high esthetic requirements, providing an excellent appearance of the thoroughly exposed neck.

Face Lift Practice Patterns: An American Society of Plastic Surgeons Member Survey, 2000 and 2020. How Much Have We Changed?

In 2000, Matarasso et al. performed a survey of American Society of Plastic Surgeons members' face lift practice patterns. Since that publication, the aesthetic marketplace has changed dramatically, as have ancillary face lift techniques. In an attempt to detail these changes, we repeated that original survey, adding questions to address more recent technical issues and advances. The goal of this report was to define current face lift practice patterns, compare current patterns to the previous ones, and define recent advances. A 38-question survey assessing face lift techniques, perioperative management, complications, and concomitant procedures was electronically distributed to a random cohort of American Society of Plastic Surgeons members. Data were recorded and statistically analyzed utilizing the Pearson chi-square test. A total of 251 forms were returned and analyzed. Details of demographics, face lift techniques, ancillary procedures, perioperative care, and complications are presented. Current results were compared to the previously published society member practice patterns delineated in the 2000 Plastic and Reconstructive Surgery publication. The basic approach of American Society of Plastic Surgeons members to the face lift operation has not changed dramatically over the past 20 years. The development of operative adjuncts, however, has been positive, including fat grafting techniques, concomitant use of skin resurfacing, and means of minimizing blood loss with tranexamic acid. In certain instances, respondents do not follow evidence-based guidelines for perioperative care. Finally, common complications of practicing members appear to coincide with published retrospective reviews.

Quantifying Skin Removal During a Face-lift: Does the Approach Matter?

The purpose of this study was to measure the amount of skin removed around the ears during a face-lift procedure. The secondary metric assessed skin removal comparing different face-lift techniques of SMASectomy versus deep plane approach and lastly comparing with and without midline corset platysmaplasty (MCP). One hundred fifty consecutive face-lift patients were measured for skin removal at 3 cardinal locations in the postauricular, preauricular, and temple regions. Measurements were quantitated and compared statistically with different face-lift techniques. The average skin removal in the postauricular area was 4 cm, the preauricular area was 2.4 cm, and the temple 1.9 cm. There was no difference in skin removal comparing SMASectomy and deep plane face-lift. There was a small but significant difference when MCP was performed, with more skin removal with MCP. Quantifying the amount of skin removal during a face-lift procedure provides surgeons and patients important information. There was no difference when comparing the simpler SMASectomy technique with the more invasive deep plane technique.

Asian Face Lift with the Composite Face Lift Technique.

The composite face lift is becoming increasingly popular following recent advances in understanding of facial anatomy that enable safe sub-superficial musculoaponeurotic system (SMAS) dissection. This article presents the authors' technique for composite face lift in Asian patients and reviews their experience and outcome with this procedure. Composite face lifts were performed on 128 Asian patients between January of 2010 and June of 2020. Ninety-four were primary face lifts, and 34 were secondary or tertiary face lifts. The authors' surgical technique and adaptations for the specific requirements of Asian patients are described in detail. The mean follow-up was 26 months (range, 6 to 108 months). Fat grafting was an integral part of our procedure, with 95 percent having concomitant facial fat grafting with their face lift. Patients were followed up in accordance with a standardized schedule. The majority of patients reported high satisfaction with the aesthetic outcome of the technique, with natural, long-lasting results. The face lift plane of dissection is through the facial soft-tissue spaces, which provide atraumatic sub-SMAS access with precise release of the intervening retaining ligaments for effective flap mobilization. By emphasizing tension on the composite flap with no tension on the skin closure, the scars were discrete in the great majority of patients. Complications were few, with no hematomas or skin flap necrosis. The temporary nerve injury rate was 1.5 percent, with no patient having a permanent nerve injury. The composite face lift is an ideal technique for Asian patients, as it delivers natural, long-lasting results; a quick recovery; and high patient satisfaction. Therapeutic, IV.

A New Approach to Thread Facelifting.

Facial rejuvenation has traditionally been achieved by repositioning soft tissue via invasive surgery. The present work describes a thread-based, face-lifting (TBFL) technique (BussoLyft&trade; that has provided reproducible and predictable results for 200 to 300 patients. To reposition the orbital, nasolabial, and jowl fat pads, three primary vectors (one vertical, two oblique) are established on the side(s) of the face that requires lifting. The vertical vector for the orbital fat pad is volumetric and the oblique vectors for the nasolabial and jowl fat pads lift by thread-tissue engagement and repositioning. Repositioning the superficial fat pads of the orbital, nasolabial, and jowls areas results in a pleasant cosmetic outcome. In the treated nasolabial and jowl fat pads, the primary repositioning vector results from engaging cogs with fat septa, which places fat in a cosmetically optimal position. The primary mobilization of the superficial fat pad through the septal attachments to the dermis and superficial fascia creates a secondary movement and repositions the overlying skin and underlying superficial muscular aponeurotic system (SMAS). Very few threads are needed to reposition full-face superficial fat. By optimizing every step of thread placement, the TBFL technique provides an efficient and effective method to reposition facial fat pads. J Drugs Dermatol. 2021;20(10):1085-1090. doi:10.36849/JDD.6139.

Review of Dr. Andrew Jacono's Book: The Art and Science of Extended Deep Plane Face Lifting and Complementary Facial Rejuvenation Procedures.

Dr. Andrew Jacono's book entitled “The Art and Science of Extended Deep Plane Face lifting and Complementary Facial Rejuvenation Procedures” has been recently published by Quality Medical Publishing. In this book, Dr. Jacono fully describes his extended deep plane facelift technique across 500 pages with the help of approximately 800 high-quality color photos/illustrations, including a stream access for two operation videos.

Evaluating Facelift Complications and the Effectiveness of the SMASectomy Technique: A Single Center's 15-Year Experience.

BackgroundFacelift continues to be one of the most common aesthetic procedures performed in the United States. Although there exist many techniques and variations, superficial musculoaponeurotic system (SMAS) manipulation, by way of plication, overlap, or SMASectomy, is common and has been shown to result in favorable cosmesis and durability. However, there is a lack of current complications data in the discussion of this technique.ObjectivesTo assess the benefits and risks of the SMASectomy technique.MethodsThe records of all patients who underwent a facelift procedure between December 2004 and March 2019 were reviewed for this study. All procedures were performed at an American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)-accredited outpatient facility in Marina Del Rey, California. This represents data on 241 total patients. Retrospective chart review was performed to include data on patient characteristics, operative technique, and complications.ResultsAverage operative time of 152.68 ± 51.50 minutes and anesthesia time of 175.00 ± 54.07 minutes were observed among those patients who underwent SMASectomy. This was significantly lower (P < 0.000001) than those who did not undergo SMASectomy (average operative time of 265.25 ± 85.25 minutes and anesthesia time of 294.22 ± 85.31 minutes). There were no observed facial nerve injuries among patients who underwent SMASectomy. No deep vein thrombosis (DVT) events were observed in this patient population. ConclusionsIn the hands of an experienced surgeon, the SMASectomy facelift technique offers the unique advantage of significantly reducing operating time and anesthesia time and can provide extremely favorable and long-lasting aesthetic results.Level of Evidence: 3

A Cosmetic Surgical Approach Effectively Reconstructed Facial Nerve Paralysis.

Summary:In general, facial nerve palsy is treated by reconstructive surgeons, and the role of cosmetic surgeons is largely seen as secondary. The present report describes a case of refractory facial nerve palsy that arose after malignant parotid-tumor resection and high-dose radiotherapy, and that we reconstructed with a combination of cosmetic and reconstructive procedures. The procedures consisted of facelift techniques (lateral SMASectomy, creation of a nasolabial fold with three suture loops anchored at the temporal fascia, and frontal lift), a new wrinkle-removing technique wherein the frontal-muscle function was disrupted, and excision of surplus skin to rejuvenate the face. The outcomes were good, including at 1 year after surgery, and the 71-year-old patient expressed considerable satisfaction. The frontalis muscle resection effectively removed the wrinkles, helped balance the left and right sides, and permitted anti-aging surgery. This procedure has permanent effects, unlike other methods (eg, botulinum-toxin injections) that serve to weaken facial muscle function. It is notable that despite the high-dose radiotherapy the patient had received and the resulting extensive subcutaneous-tissue adhesion, our surgical protocol was relatively easy to perform as well as highly effective. Thus, even static reconstruction can give great hope and satisfaction to patients with facial nerve palsy.

The Art and Science of Extended Deep Plane Facelifting and Complementary Facial Rejuvenation Procedures

Dr Jacono and the team at Quality Medical Publishing (St. Louis, MO) have produced a handsome volume dedicated to his personal surgical approach to the treatment of facial aging. The book, at 500 pages, closely follows the size, format, and high standard established by previous QMP hardcover books in aesthetic surgery, with plenty of beautiful illustrations and clinical color photos, and easy-to-read text. The first portion of the book focuses on Dr Jacono’s approach to facelifting. Dr Jacono, a respected facial plastic surgeon from New York, has been developing and refining this technique for over a decade. The first 4 chapters add up to nearly one-half of the book and thoroughly discuss the rationale, safety, and effectiveness of the technique; the relevant surgical anatomy; anatomic changes associated with aging; and the facelift technique itself, which is the longest chapter and very comprehensive. For those unfamiliar with the author’s facelift approach, I will try to summarize. First, the “deep plane” portion of the title is a reference to the work of Dr Sam Hamra, who in 1990 published a paper with a then-new technique utilizing that particular title. Like Dr Hamra’s method, Dr Jacono’s dissection into the deep plane starts on a line between lateral canthus and the angle of the mandible, dissecting deep to the malar fat pad and superficial musculo-aponeurotic system (SMAS), and over the mimetic muscles forward to the naso-facial crease. This develops a composite flap, which is not delaminated or separated from the skin, as in most lateral SMAS-based techniques. Jacono’s procedure differs from that discussed in Hamra’s 1990 paper in several key aspects: he performs a sub-platysmal dissection in the neck, beginning laterally and extending 5 cm below the angle of the mandible, and then makes a 4-cm superior platysmal myotomy, approximately 1 cm below the mandibular border, which is employed to contour the neck. Jacono also stresses the need to release the facial retaining ligaments—the zygomatic cutaneous, masseteric cutaneous, mandibular cutaneous, and cervical retaining ligaments—to obtain appropriate tissue mobility. He describes his anatomic approach to do so in detail, because these ligaments are so often in proximity to facial nerve branches. Numerous intra-operative photos are shown, detailing each step of the procedure, with pearls on incision placement, flap elevation, sub-SMAS dissection, fat contouring, and suspension of the flap and skin closure, and multiple cases are shown with long-term follow-up photos. Interested readers can get a flavor for the book by looking at the author’s recent publications in Facial Plastics Clinics of North America and ASJ.

Co2 and Erbium:Yag Lasers Improves Acne Scars

The facelift and skin resurfacing techniques are carried out during the same surgical procedure, in order to save time and improve the patient recovery. Acne scars, photo-aging sings such as pigmentations and changes in skin color are treated with the skin Resurfacing technique. Many surgeons for neck and cheeks is performed as usually have mentioned the face-lift technique. Using these two techniques, a full-face restoration is obtained with only one surgical procedure. The patient recovery is quicker and the result obtained is much better. 1064 cases were done with this procedure and minimal complications have been observed.