Facelift Patients Research Articles

Exosomes, peptides and peri-procedure management – comparative investigations

Introduction: Exosome technology is a promising new advancement in therapeutic options but is still in its early stages, leading to uncertainties. A small pilot study compared traditional peptide technology (Regenerating Skin Nectar with TriHex Technology® and TriHex Technology® peptide + Octapeptide) to two leading exosome products (Stem cell derived Lyophilized exosomes and Platelet derived exosomes) for post-procedure use. These studies were carried out on pre-clinical (ex vivo) and clinical front to investigate effects on the extracellular matrix, dermo-epidermal junction, and skin tolerance as post-procedure outcomes. Methods and materials: The ex vivo model study was conducted by 3D Genomics using photodamaged skin from facelift patients. The skin was divided, processed under BSL2 conditions and cultured in transwells with specific media. Treatments, including peptides and platelet-derived products, were applied daily for 7 days, while stem cell-derived exosomes were applied as a single application as per the described usage. One set was left untreated as a control. Skin samples were treated and analyzed using immunohistochemistry staining for tropoelastin and CD44. RNA was isolated after treatments and sequenced to assess changes in gene expression. The study aimed to compare the effects of different treatments on skin regeneration and tolerance. Clinically, the participants underwent microneedling of the face and applied exosomes and peptides on each side of the face as comparisons. Participants completed questionnaires on Day 0. On Days 0,1,2,3 and 4 participants completed their self-healing ratings and were also assessed by an assessor on their healing rating on a 5-point scale. Results: The plated exosome products exhibited significant toxicity in the ex vivo model and neither of the exosome products produced relevant changes in gene expression or regenerative effects in this model. Participants in the small clinical series experienced unpleasant burning and stinging in keeping with the effects seen in the ex vivo model. In contrast, the peptide technology showed favorable gene expression upregulation and histological changes in the extracellular matrix and was well-tolerated and comfortable for post-procedure use, as has been demonstrated in multiple clinical trials. Conclusion: The overall impression from these pilot studies suggests that peptide formulations are better tolerated and more effectively target ECM regenerative effects. Conversely, exosome preparations appear to be prone to skin reactions and lack clear targeting of skin regenerative pathways.

Assessing Patient Satisfaction Following Facelifts with Social Media Reviews.

Facelifts are one of the most common facial aesthetic surgery procedures. Patient satisfaction determines success of most aesthetic surgery but has been historically difficult to assess. This study evaluated reviews by facelift patients on the aesthetic surgery social media website RealSelf.com to determine positive and negative factors underlying patient satisfaction following facelifts. Facelift reviews were gathered from RealSelf.com with an automated web crawler. Reviews were categorized as positive or negative and by the primary and secondary reasons for the positive or negative review. Patient "worth it" and star ratings, physician specialty, and cost of procedure were also collected. A total of 2153 facelift reviews were collected. Overall, 1986 (92.24%) were positive and 167 (7.76%) were negative. The most common overall reasons for a positive review were aesthetic results (n=1571, 79.10%) and bedside manner (n=1488, 74.92%). The most common overall reasons for a negative review were outcome (n=137, 82.04%) and bedside manner (n=82, 49.10%). Most facelifts were performed by plastic surgeons (n=1796, 83.42%). The greatest 5-star rating percentages were seen for oral and maxillofacial surgeons (n=29, 93.55%), otolaryngologists (n=96, 92.31%), and plastic surgeons (n=1642, 91.43%). Of patients who provided a "worth it" rating, 1216 (91.91%) stated that their facelift was "worth it." Overall patient sentiment toward facelifts was positive. The factors most commonly affecting a positive patient experience were bedside manner and aesthetic results. Negative patient reviews were primarily attributed to dissatisfaction with aesthetic outcomes. Social media serves as a valuable tool for evaluating patient satisfaction with aesthetic surgery. 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 .

Is Bipolar Radiofrequency-Assisted Liposuction Equivalent to Open Anterior Platysmaplasty in Facelift Surgery?

BackgroundDuring facelift surgery, anterior platysmaplasty (AP) has been used for decades, but it limits lateral advancement and can induce contour irregularities. Radiofrequency-assisted-liposuction (RF) in the anterior neck can avoid these disadvantages by tightening skin without open surgery. PurposeThe purpose of the study was to compare the esthetic outcomes in facelift surgery with AP and RF. Study designA five-year retrospective cohort study was performed on facelift patients treated by a single surgeon. Exclusions were single-side surgery, previous facelift, chin/lip augmentation/reduction, and inadequate data. Primary predictor variableThe predictor variable was neck management technique (AP vs RF). Outcome variablesThe primary outcome variable was the change in cervicomental-angle (CMA) following surgery as measured on facial photographs. Secondary outcomes included distance changes from the central CMA point in vertical and horizontal planes to repeatable reference planes. CovariatesCovariates were age, BMI, ASA classification, smoking, and simultaneous procedures. AnalysesThe statistical analysis was performed using Wilcoxon sum-rank, Fisher exact, Kruskal-Wallis tests, Pearson’s correlation, and linear regressions. The level of statistical significance was P<.05. ResultsThere were 132 patients included in the study; 67 received AP and 65 received RF. AP trended toward better performance in CMA change in the unadjusted analysis (-18.7° ± 13.8° versus -22.3° ± 13.7°, respectively, P=.08). AP and RF performed similarly in the adjusted analysis (P=.29). Techniques were similar in horizontal distance change to the CMA (P=.31). RF was associated with less change in the vertical distance to the CMA in the unadjusted analysis (-11.9mm ± 11.0mm versus -6.7mm ± 8.7mm, respectively, P=.01) and adjusted analysis (β=4.3mm, 95% CI .8 to 7.9mm, P=.02). ConclusionUtilization of the RF technique for management of the anterior neck in facelift surgery is associated with similar outcomes to the AP technique in horizontal distance to the CMA but, AP performed better in CMA change and vertical distance to the CMA.

Tranexamic acid in rhytidectomy: a scoping review.

Intraoperative and postoperative bleeding is considered one of the most common risks in rhytidectomy. Recently, the use of antifibrinolytic agents in facial plastic and reconstructive surgeries has been evaluated, but their use in rhytidectomy remains a topic of ongoing discussion. Tranexamic acid (TXA) is an antifibrinolytic agent that prevents enzymatic degradation of the fibrin clot by blocking the conversion of plasminogen to plasmin, improves platelet function, and has a direct anti-inflammatory effect. This review covers pertinent literature to elucidate whether the use of TXA in rhytidectomy confers intraoperative and postoperative benefits. A systematic literature search was conducted in online databases: PubMed, Google Scholar, Cochrane, Scopus, and Web of Science for all articles on the topic of TXA in facelift published up to and including June, 2023 using the following terms: "TXA," "tranexamic acid," "plastic surgery," "aesthetic surgery," "facelift," "rhytidectomy". They were either searched individually or in combination. All relevant original research articles, of any study design were included and narratively discussed in this review. Studies not carried out in humans and studies centred on the use of TXA in other specialties were excluded. English Language was included. Eight articles were reviewed in this paper. Through these articles, the authors provided in detail the possible beneficial effects of TXA in facelift patients in evaluating several clinical outcomes: intraoperative blood loss, postoperative drain output, postoperative oedema, ecchymosis, operative time, and surgical field quality. Although there is still a lack of information on TXA in facelift patients, we are not able to deny the beneficial effects of TXA on this topic. Therefore, further investigations including prospective, case-controlled multi-institutional studies comparing routes of delivery should be performed until reaching, at the end, an evidence-based guideline providing a clear protocol in terms of the administration and dosage of TXA in facelift.

Potential Effects of Panfacial Filler Injections on Facelift Surgery and Outcomes: Survey Results of the Members of the Aesthetic Society

Abstract Goals/Purpose Facial soft tissue filler injections are being performed in the United States with increasing popularity. Even though there has been a trend towards noninvasive facial rejuvenation, surgery remains the standard of care for long lasting results for treatment of facial aging. Despite the well-known complications of soft tissue fillers, there remains a paucity of data regarding the potential adverse effects of prior repetitive panfacial soft tissue fillers on the technical aspects or outcome of facelift surgeries. The aim of this study was to understand the observations of the national aesthetic surgery community regarding facelift surgery in patients who have undergone repetitive panfacial fillers prior to their surgery. The primary outcome was to determine if the aesthetic community believed that a patient’s history of panfacial fillers led to potential difficulties or complications with their facelift procedure, so as to develop safer guidelines when performing surgery on these patients. Methods/Technique The authors developed a survey to examine the experiences among members of the Aesthetic Society with patients who have a history of repetitive panfacial fillers and then undergo facelift surgery. More specifically, it was to understand if a history of repetitive panfacial fillers had potential effects on the surgery itself and the post-operative outcomes. This survey contained 10 questions in total, included closed and open-ended questions, and was sent through email to 4,180 Aesthetic Society members. The survey was e-mailed twice, first in March 2022 and again in May 2022. The data was tabulated and examined to analyze the current techniques and perceived outcomes with repetitive panfacial fillers and facelifts. Categorial variables were reported as frequencies/percentages. Results/Complications In total, there were 156 responses, which was a 3.7% response rate. The majority of the respondents (80.8%) believed that less than 60% of their facelift patients had previous repetitive panfacial filler injections. Approximately one-half (51.9%) reported that a history of panfacial filler injections increased the difficulty of performing facelifts. A larger subset (39.7%) of respondents believed that a history of panfacial fillers increased complication rates, compared to the remaining who either disagreed (28.9%) or were unsure (31.4%). The most common complications following facelift surgery in those patients with known filler history included the undesirable palpability or visibility of filler (32.7%), compromised flap vascularity (15.4%), and decreased longevity of the lifting effect (9.6%). Conclusion The outcome of this survey identified that there may be a potential association with repetitive panfacial filler injections and outcomes following facelift surgery, although the exact effect on postoperative outcomes remained unclear. Large prospectively designed studies are needed to capture objective data comparing facelift patients with history of repetitive panfacial fillers with those facelift patients who have never had injectables. Given these results, the authors encourage careful history-taking to elicit an accurate filler injection record including complications after filler injections, as well as a thorough discussion with these patients preoperatively regarding the potential of panfacial fillers on the facelift procedure and potential outcomes.

Hemostatic Net in Facelift Surgery: A 5-Year Single-Surgeon Experience.

The Hemostatic Net has been promoted as a safe and effective method to prevent hematoma formation following facelift procedures. To date there is little published evidence to validate the replicability and effectiveness of the technique. This study presents 2 cohorts of facelift patients from a single surgeon's practice to assess the impact of the Hemostatic Net on hematoma formation. The records of 304 patients were reviewed in whom the Hemostatic Net was placed following a facelift between July 2017 and October 2022. Data was collected and assessed for complications and compared with a control group of 359 patients who underwent a facelift procedure by the same surgeon between 1999 and 2004. A total of 663 patients were included. In this retrospective cohort study, analysis of available data showed a significantly reduced hematoma rate of 0.6% in the intervention group compared to 3.9% in the control group (p = 0.006722). The use of the Hemostatic Net is a safe, reproducible and effective technique in reducing the risk of hematoma in facelift surgery.

Potential Effects of Repetitive Panfacial Filler Injections on Facelift Surgery and Surgical Outcomes: Survey Results of the Members of The Aesthetic Society.

Facial soft-tissue filler injections are being performed in the United States with increasing popularity.f. This study aimed to characterize the observations of The Aesthetic Society members regarding the potential impact of repetitive panfacial fillers on the outcomes of subsequent facelift surgery. A survey containing closed and open-ended questions was sent to The Aesthetic Society members through email. The response rate was 3.7%. The majority of the respondents (80.8%) believed that less than 60% of their facelift patients had previous repetitive panfacial filler injections. One half (51.9%) reported that a history of panfacial filler injections increased the difficulty of performing facelifts. A large subset (39.7%) of respondents believed that a history of panfacial fillers increased postoperative complication rates, while the remaining either disagreed (28.9%) or were unsure (31.4%). The most common complications following the facelift surgery included undesirable palpability or visibility of filler (32.7%), compromised flap vascularity (15.4%), and decreased longevity of the lifting effect (9.6%). This study identified a potential association with repetitive panfacial filler injections and outcomes following facelift surgery, although the exact effect on postoperative outcomes remains unclear. Large prospectively designed studies are needed to capture objective data comparing facelift patients with a history of repetitive panfacial fillers with those facelift patients who have never had injectables. Given the results of The Aesthetic Society members' survey, the authors encourage careful history-taking to elicit an accurate filler injection record including complications after filler injections, as well as engaging patients in a thorough preoperative discussion regarding the potential of panfacial fillers on the facelift procedure and postoperative outcomes.

Assessing the Efficacy of Hyperbaric Oxygen Therapy on Facelift Outcomes: A Case-Control Study Comparing Outcomes in Patients With and Without Hyperbaric Oxygen Therapy.

Wound healing remains among the most concerning complications in aesthetic surgery. The use of hyperbaric oxygen therapy (HBOT) is an accepted method of supporting wound healing. The aim of this study is to assess the role of HBOT in postoperative healing and complication rates following facelift surgery. This case-control study comprised facelift patients who received HBOT and those who did not between 2019 and 2022. Data were extracted from the patients' medical records, with the primary outcomes being the presence of complications, wound-healing duration, and patient satisfaction. The authors recruited 20 female patients who underwent facelift for this study, with 9 patients in the HBOT group and 11 patients in the control group. The average number of HBOT sessions received was 7.22, and each session lasted an average of 78 ± 5 min. The duration of wound healing in the HBOT group ranged from 7 to 30 days (mean of 13.3 days), whereas the control group ranged from 6 to 90 days (mean of 36.9 days). This indicates a statistically significant shorter time to wound healing in the HBOT group compared to the control group (P < .001). Future prospective randomized controlled trials with larger sample sizes and blinding are needed to further evaluate the potential benefits of HBOT in the postoperative period. Nonetheless, our findings suggest that HBOT may be a promising adjunctive therapy for patients undergoing facelift surgery.

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.

The use of radiofrequency-assisted lipolysis with radiofrequency microneedling in premature jowl and neck laxity following facialplasty.

A subset of facelift patients have premature redevelopment of skin laxity in the lower face and neck. Many patients seek alternatives to revision facelifts to avoid high risks and costs. Radiofrequency-assisted lipolysis (RFAL) with Radiofrequency (RF) microneedling may be alternative minimally invasive options. To evaluate the efficacy of radiofrequency energy devices for treatment of premature jowl and neck skin laxity following facialplasty. This is a single-center, prospective study of patients seeking treatment for jowl and neck skin laxity 1-5years following facialplasty. Treatment was performed with the InMode radiofrequency AccuTite® and Morpheus8® systems. Study duration was 12months with 6months of follow-up. Endpoints included improvement in skin tightening assessed by blinded investigators, and investigator and subject assessment of skin appearance. Subjects also rated satisfaction with treatment and pain levels. The study protocol was completed by nine patients. Based on investigator evaluations, 33% had marked improvement at 3months, which increased to 55% at 6-month postprocedure. Patient-reported improvement was "markedly improved" in 67%, "moderate improvement" in 11%, and "slight improvement" in 22% at 3months. Overall patient satisfaction was rated as "very satisfied" by 33% and "satisfied" by 67% at 3months. There were no adverse events reported. The results of this study provide supporting evidence that RFAL technology can provide a safe, minimally invasive, and effective treatment for skin laxity in the jowls and neck in patients who desire further correction after undergoing primary facelift.

Photographic Comparison of Malar Projection in 100 Facelift Patients Treated with and without Fat Injection.

Background:Facelifts are frequently combined with fat injection to restore volume. However, the efficacy of simultaneous fat grafting has not been objectively evaluated in a large number of patients that includes a control group. This study was undertaken to fill this gap in our knowledge base.Methods:A retrospective comparative cohort study was undertaken among 100 patients who underwent a subsuperficial musculoaponeurotic system facelift with (n = 61) or without (n = 39) simultaneous malar fat injection. Rigorously standardized photographs were obtained 1, 3, and 6 months after surgery, including oblique photographs with the nasion aligned with the far inner canthus. Malar projection and area were measured with the assistance of a computer imaging software.Results:Fat injection produced a significant (P < 0.001) increase in right and left malar projection. The mean increase in projection was 3 mm, significantly greater than control patients, who also demonstrated a significant (P < 0.001) but more modest (<1 mm) increase. Malar projection was significantly correlated with the fat injection volume (P ≤ 0.001). The increase was sustained at follow-up times up to 6 months, and 1 year in a smaller patient cohort (n = 44), with no evidence of a decline or rebound. The calculated fat retention was 34%.Conclusions:Fat injection at the time of a facelift effectively adds malar volume, and this increase is sustained at time points up to 1 year after surgery, consistent with the cell survival theory.

Response to "Does Sub-SMAS Buccal Fat Pad Transposition Augment Malar Volume in Facelift Patients?"

Response to "Does Sub-SMAS Buccal Fat Pad Transposition Augment Malar Volume in Facelift Patients?"

External Approach to Buccal Fat Excision in Facelift: Anatomy and Technique.

Masculinization of the face is a common finding in facelift patients. It is attributed to deflation and decent of the midface-jowls coupled with skin laxity. Fullness is evident lateral to the jowl in a small percentage due to prominent buccal fat pad (BFP). The authors sought to examine the anatomy of the BFP, triangulate the prominent BFP with surgical landmarks, and describe an external approach to excise the BFP during facelift surgery. Eighteen cadaveric dissections were performed. Facelift flap was elevated and the prominent buccal extension of the BFP protruding through the superficial-musculo-aponeurotic-system was identified. Measurements were taken from the BFP to surgical landmarks: zygomatic arch, tragus, and gonial angle. The locations of the facial nerve, parotid duct, and vascular pedicle relative to the BFP were calculated. BFP was 4.1 cm inferior to the zygomatic arch, 7.5 cm anterior the tragus, and 4.5 cm medial the gonial angle. The middle facial artery supplied the BFP on the inferior-lateral quadrant in 61% and inferior-medial quadrant in 39% of specimens . In all specimens, the parotid duct traversed the BFP superiorly, and the buccal branches of the facial nerve traversed the capsule superficially. The buccal extension of the BFP can pseudoherniate in the aging face. Excision may improve lower facial contour. Measurements from facial landmarks may help surgeons identify the buccal extension of the BFP intraoperatively. The surgeon must be careful of the vascular pedicle, parotid duct, and the facial nerve. The external approach safely excises buccal fat during facelift dissection while avoiding intraoral incisions and unnecessary contamination.

Face Lifting in Bald Male Patients: New Trends and Specific Needs.

Aesthetic surgery has recently become popular also among men. The ever-increasing number of bald men wishing to undergo facial surgery represents a challenge for the surgeon, as the scars cannot be hidden in the hair and must therefore be as short as possible. The authors present their experience in face lifting in bald male patients and propose an innovative technique to handle the skin excess to achieve practically invisible scars. A 10-year observational study was carried out on 68 bald male face-lift patients. All patients underwent deep plane lifting with a specific method for handling skin excess. This technique is the innovation presented in this article. Subjective and objective methods were used to evaluate the results. The well-known FACE-Q questionnaire was sent to all the patients together with an explanatory letter. Three ad hoc questions were added to the questionnaire to assess the degree of satisfaction with the scars. The objective method involved the evaluation of preoperative and postoperative photographs by a three-member jury. The average follow-up period was 12 months. All patients showed a high degree of satisfaction with the final appearance of the surgical scars and appreciation of the overall quality of the result, 1 year after face-lift surgery. No patient expressed regret about choosing to undergo this type of surgery. Very high scores were registered for the overall facial appearance and for the various critical areas examined, including scars, from patients and experts alike. The face-lifting technique for bald men proposed by the authors, involving a peculiar and innovative way of handling the skin excess, has proven to be reliably effective in obtaining virtually invisible scars.

Does Sub-SMAS Buccal Fat Pad Transposition Augment Malar Volume in Facelift Patients?

Does Sub-SMAS Buccal Fat Pad Transposition Augment Malar Volume in Facelift Patients?

Sub-SMAS Transposition of the Buccal Fat Pad.

Regardless of the technique chosen to treat the aging midface, the isolated lateral approach facelift has a limited impact on the midface volume deficit. In an effort to overcome this limitation, modern facial rejuvenation procedures incorporate an additional modality for replenishing the midface volume. Some of the author's facelift patients present with bulging buccal fat pads despite volume deficiency in the inframalar region. The author's technique is designed to utilize the buccal fat pad to replenish the inframalar volume deficit. The author sought to present the fat pad transposition surgical technique along with objective outcome data. This study was a retrospective review of nonconsecutive cases where the sub-superficial-musculo-aponeurotic-system transposition of the buccal fat pad was performed. A total of 22 patients underwent the fat pad transposition technique by the author (O.B.) between July 2013 and December 2017. Patient data were obtained from patient records, 3-dimensional models, magnetic resonance images, and standardized photography. Preoperative differences in midface volume were assessed utilizing curvilinear surface measurements on 3-dimensional models and the Allergan midface volume deficit scale on standardized photography. The average midface volume deficit score significantly improved, and the average midfacial curvilinear surface measurement significantly increased after surgery. Magnetic resonance imaging confirmed a stable position of the buccal fat pad after surgery. The sub-superficial-musculo-aponeurotic-system transposition of the buccal fat pad is an effective technique that can be safely employed for autologous inframalar augmentation in patients with a favorable facial morphology.

Apparent Age is a Reliable Assessment Tool in 20 Facelift Patients.

Although the literature is replete with favorable facelift results, there are few validated facial rejuvenation outcome measures. Apparent age (AA), a visual estimate of age by objective observers, has been utilized in several studies; although attractive, AA lacks validation. The aim of this study is to examine the reliability of AA, highlighting the importance of the exclusive use of validated outcome measures in future studies. Ten blinded reviewers assessed pre- and postoperative photographs of 32 patients who underwent facelift. Each reviewer completed 3 surveys at 3-month intervals composed of 40 randomly ordered photos; totaling 1200 photographs assigned an AA. The intra-class correlation coefficient was classified as "excellent," "good," "fair," or "poor." The accuracy of assigned AA, agreement within 5 years, and reduction in AA were also evaluated. The mean difference of preoperative true age from assigned AA was 2.74 ± 4.36 years. Forty-three percent of raters were within 5-years (±2.5) of the mean. Intra-rater reliability preoperatively and postoperatively were 0.77 (95% CI, 0.82-0.72) and 0.75 (95% CI, 0.79-0.71), respectively. Inter-rater reliability preoperatively was 0.98 (95% CI, 0.99-0.96), while postoperatively was 0.95 (95% CI, 0.99-0.95). Mean AA reduction was 5.23 ± 2.81, with an intra-rater reliability 0.15 (95% CI, 0.03-0.34) and inter-rater reliability 0.65 (95% CI, 0.84-0.38). Using current statistical measures and analysis, AA is an acceptable tool for pre- and postoperative facial evaluation when assessed by a group of 10 reviewers. Therefore, apparent age represents a reliable and valid objective observer assigned measure for evaluation of facelift outcomes.

Histological case–control study of peeling-induced skin changes by different peeling agents in surgically subcutaneous undermined skin flaps in facelift patients

A histological evaluation of peeling-induced skin changes in subcutaneous undermined preauricular facial skin flaps of nine patients was performed. There were three treatment groups: Trichloroacetic acid (TCA) 25%, TCA 40% and phenol/croton oil; one group served as control. Two independent evaluators determined the epidermal and dermal thickness and the depth of necrosis (micrometre). The percentual tissue damage due to the peeling was calculated, and a one-sample t-test for statistical significance was performed. On the basis of the histomorphological changes, peeling depth was classified as superficial, superficial-partial, deep-partial and full thickness chemical burn. The histological results revealed a progression of wound depth for different peeling agents without full thickness necrosis. TCA peels of up to 40% can be safely applied on subcutaneous undermined facial skin flaps without impairing the vascular patency, producing a predictable chemical burn, whereas deep peels such as phenol/croton oil peels should not be applied on subcutaneous undermined skin so as to not produce skin slough or necrosis by impairing vascular patency.

Psychology of the Facelift Patient.

This paper presents an extensive literature review of the psychology of facelift patients as it has evolved over the past 50 years. Earlier studies revealed significant levels of pre and perioperative depression. Facelift patients generally exhibit emotional and social concerns about facial appearance that are higher than the general population. Many are undergoing midlife situational stresses and may lack the positive characteristics to deal with them. The most common diagnoses seen include depression, impulsivity, unstable personality, and passive dependence, albeit not necessarily serious. Improvement in body image is the major driver for surgery. Characteristics of female patients as defined by their age are described. These include the younger emotionally dependent group, the worker group of middle age, and the older grief group. Male patients are seen to have a higher level of psychological dysfunction, but a higher improvement in postoperative quality of life. Motivations for surgery include increasing self-esteem, making new friends, improving relationships, and getting better jobs. Overall patient satisfaction is more than 95%, with improvement seen in positive changes in their life, increased self-confidence and self-esteem, decreased self-consciousness about their appearance, and overall improvement in quality of life. Postoperative psychological reactions are seen in about half the patients, these primarily being anxiety and depression of varying degrees. Predictors of patient satisfaction include the desire for self-image improvement in contradistinction to a change in life situation. Negative predictors include male sex, young age, unrealistic expectations, relationship disturbances, and preexisting psychological pathology. The importance of good patient selection in achieving a satisfied patient is outlined and emphasized.

Validating Facial Aesthetic Surgery Results with the FACE-Q.

In aesthetic clinical practice, surgical outcome is best measured by patient satisfaction and quality of life. For many years, there has been a lack of validated questionnaires. Recently, the FACE-Q was introduced, and the authors present the largest series of face-lift patients evaluated by the FACE-Q with the longest follow-up to date. Two hundred consecutive patients were identified who underwent high-superficial musculoaponeurotic system face lifts, with or without additional facial rejuvenation procedures, between January of 2005 and January of 2015. Patients were sent eight FACE-Q scales and were asked to answer questions with regard to their satisfaction. Rank analysis of covariance was used to compare different subgroups. The response rate was 38 percent. Combination of face lift with other procedures resulted in higher satisfaction than face lift alone (p < 0.05). Patients who underwent lipofilling as part of their face lift showed higher satisfaction than patients without lipofilling in three subscales (p < 0.05). Facial rejuvenation surgery, combining a high-superficial musculoaponeurotic system face lift with lipofilling and/or other facial rejuvenation procedures, resulted in a high level of patient satisfaction. The authors recommend the implementation of the FACE-Q by physicians involved in aesthetic facial surgery, to validate their clinical outcomes from a patient's perspective.