Facelift Techniques Research Articles

Reconstruction of facial soft tissue: comparison between conventional procedures and the facelift technique

We compared the result of replacement using a modified facelift technique with those of other commonly used surgical techniques for the treatment of defects of the soft tissue of the infraorbital and cheek region. We made a retrospective observational study of 86 patients who had defects of the facial soft tissue after excision of malignant tumours. Procedures used for reconstructions included non-vascularised skin grafts, local flaps, facelift technique, and microvascular free flaps, and we evaluated morbidity; duration of hospital stay; the need for, and duration of stay in the intensive care unit (ICU); and functional and aesthetic outcomes.We studied 46 men and 40 women (mean (range) age 71 (8-99) years). We found no significant difference between the methods apart from shorter duration of hospital stay and lower incidence of ectropion in the facelift group. The facelift technique also gave the best aesthetic outcome. However, in defects larger than 60cm2, microvascular free tissue transfer was the only choice. The facelift technique is reliable and safe, and gives excellent aesthetic and functional outcomes, but its use is limited to defects smaller than 60cm2.

Building the Composite Face Lift: A Personal Odyssey.

This article is a 42-year history of the development of a comprehensive face-lift technique by the author. It describes how the composite rhytidectomy has been constructed, anatomical area by anatomical area, over the author's lifetime career as a plastic surgeon. Over the course of these years, beginning with Skoog's 1973 description of using the platysma muscle of the lower face, it describes how progressively the other significant structures of anatomy necessary to be used in achieving significant rejuvenation have been analyzed by the author and in turn surgically repositioned. The theory was based on creating a composite flap of the face, keeping the orbicularis oculi muscle, facial platysma muscle, and cheek fat in their normal anatomical and intimate relationship with each other by using the skin as the carriage. In addition, differences of vectors between the composite rhytidectomy and traditional techniques are demonstrated. The gradual and persistent pursuit of periorbital rejuvenation using the lower eyelid fat and the septal orbitale is described. Each of the anatomical structures involved and the description of their importance and surgical execution have been published over the surgical career of the author, including use of the same principles for reversing suboptimal face-lift results.

Face Lift.

After studying this article, the participant should be able to: 1. Identify the essential anatomy of the aging face and its relationship to face-lift surgery. 2. Understand the common operative approaches to the aging face and a historical perspective. 3. Understand and describe the common complications following face lifting and treatment options. Surgical rejuvenation of the aging face remains one of the most commonly performed plastic surgery procedures. This article reviews the anatomy of the face and its impact on surgical correction. In addition, this review discusses the evolution of various face-lift techniques and the current surgical approach to the aging face. Finally, this article discusses potential postoperative complications after rhytidectomy and management solutions.

How to Avoid Earlobe Deformation in Face Lift.

During the postoperative period following a facelift, caudal extension of the earlobe secondary to pulling of the submandibular tissues can occur. This earlobe shape, often termed "pixie ear", is unnatural, and patients often request its repair. The objective of this study was to design a modified facelift technique that provides natural, aesthetically acceptable, and long-lasting results. In patients with pixie ear secondary to classical rhytidectomy, we omitted the incision around the earlobe; instead, we interrupted it in front of the earlobe and finished it behind the earlobe, without fully dissecting the earlobe from its base. We then performed all required stages of the facelift: detachment of the cellulocutaneous flap, manipulation of the superficial musculoaponeurotic system, establishment of homeostasis, lifting of the cutaneous flap, and finally suturing of the retained edges of the skin onto the cartilage matrix of the pinna. The above-described operative technique was used in 24 patients from October 2008 to January 2014. Long-lasting projected results were achieved in each case. The modified facelift technique described herein can be used to perform facelifts with a pre-existing pixie ear, as well as to prevent the development of pixie ear.

Midface rejuvenation: a critical evaluation of a 7-year experience.

Although "traditional" face-lifting techniques can achieve excellent improvement along the jawline and neck, they often have little impact on the midface area. Thus, many different types of procedures have been developed to provide rejuvenation in this region, usually contemplating various dissection planes, incisions, and suspension vectors. A 7-year observational study of 350 patients undergoing midface lift was analyzed. The authors suspended the midface flap, anchoring to the deep temporal aponeurosis with a suspender-like suture (superolateral vector), or directly to the lower orbital rim with a belt-like suture (superomedial vector). Subjective and objective methods were used to evaluate the results. The subjective methods included a questionnaire completed by the patients. The objective method involved the evaluation of preoperative and postoperative photographs by a three-member jury instructed to compare the "critical" anatomical areas of the midface region: malar eminence, nasojugal groove, nasolabial fold, and jowls in the lower portion of the cheeks. The average follow-up period was 24 months. High satisfaction was noticeable from the perceptions of both the jury and the patients. Objective evaluation evidenced that midface lift with temporal anchoring was more efficient for the treatment of malar eminence, whereas midface lift with transosseous periorbital anchoring was more efficient for the treatment of nasojugal groove. The most satisfying aspect of the adopted techniques is a dramatic facial rejuvenation and preservation of the patient's original youthful identity. Furthermore, choosing the most suitable technique respects the patient's needs and enables correction of the specific defects. Therapeutic, IV.

Modified Short-Scar Face-Lift: Technique, Pearls, and Outcomes

Introduction: The modified small-incision face-lift is a safe, effective, minimally invasive way to treat facial rhytidosis in carefully selected patients. The purpose of this study is to describe a modified small-incision face-lift technique. Materials and Methods: Institutional review board– approved retrospective case series. Results: Twenty-six patients underwent a modified small-incision face-lift. The average age of the patients was 62.1 years. Two patients developed hypertrophic scarring requiring surgical revision. There were no other complications, including infection, wound dehiscence, or flap necrosis. Patient satisfaction with the procedure was high. Conclusions: The modified short-scar face-lift is a safe and effective procedure that can be done in the office with or without sedation and requires less recovery time than traditional face-lift techniques.

Commentary on: High superficial musculoaponeurotic system facelift with finger-assisted facial spaces dissection for Asian patients.

I have been asked to write a discussion of the article entitled “High Superficial Musculoaponeurotic System Facelift With Finger-Assisted Facial Spaces Dissection for Asian Patients” by Drs Ryu and Moon.1 The authors stated that few facelift procedures are designed specifically for Asian patients and that the facial characteristics of Asian patients make it difficult to achieve satisfactory results. After their study, they concluded that more studies are needed to redefine suitable facelift techniques for Asian patients. The authors' description of their surgical technique is comprehensible and concise, their diagrams are clear and support their surgical description, and their intraoperative photographs help to illustrate the procedures that they described. There are pre- and postoperative photographs of 2 patients that show aesthetic improvements. However, both sets of photographs make it impossible to ascertain the portion of the result that is purely related to the facelift technique described because both patients have had fat injections in multiple areas of the face, including the upper medial malar area, the nasolabial folds, and the cheeks. Of the 53 consecutive patients who underwent facelifts using the high superficial musculoaponeurotic system (SMAS) with finger-assisted facial spaces dissection technique, 40 patients underwent fat grafting, 11 patients underwent brow lifts, 7 patients underwent upper blepharoplasty, 13 patients underwent lower blepharoplasty, and 18 patients underwent submentoplasty in medial platysmarrhaphy and subplatysmal fat debulking. A brief summary of the authors’ technique is as follows: After skin flap elevation, an incision was …

High superficial musculoaponeurotic system facelift with finger-assisted facial spaces dissection for Asian patients.

Few facelift methods are designed specifically for Asian patients. Because of their characteristic thick skin and flat, wide facial geometry, satisfactory facelift results can be difficult to achieve in these patients. The authors evaluated outcomes achieved with a high superficial musculoaponeurotic system (high-SMAS) facelift with finger-assisted facial spaces dissection to rejuvenate the aging Asian face. Fifty-three patients underwent this facelift procedure. The indication for surgery was typical sagging of the face associated with aging; the relative contraindications were previous facelift and severe facial atrophy. Mean patient age was 50.7 years. Patients received follow-up for a mean of 19 months. In all cases, improvement was seen in soft-tissue sagging of the midface and lower face. One patient experienced unilateral temporal nerve injury, 3 experienced hematoma, and 2 had wound dehiscence. Understanding surgical anatomy including facial layers, spaces, and retaining ligaments is crucial for stable application of facelift techniques in Asian patients. Because of the small number of patients evaluated in this study and the limited follow-up period, more research is needed to define suitable facelift methods for these patients.

Merkel cell carcinoma of upper eyelid: Reconstruction with a combined lid switch flap and mid face lift technique

Results: After 2 weeks of vacuum-assisted dressing as an outpatient the entire wound was filled with a vital granulation tissue. A closure with a full-thickness skin graft was performed. Three weeks after that procedure the wound was closed and the aesthetic result was very satisfactory. Discussion: The VAC system for the treatment of larger defects in the head area is, in our experience, easy to use and well tolerated by the patient. Wound healing was expedited with minimal morbidity. We will discuss our experience with this technique, it′s pearls and pitfalls so that it can be added to the surgical armamentarium of all surgeons working in this area.

The Pinch Rhytidectomy: A Safe, Effective, "Low SMAS" Variation on the Theme.

The competitive efficacy of the superficial musculoaponeurotic system (SMAS) rhytidectomy (SMASectomy) facelift has been well established. However, the outcomes after an associated open necklift have not been as reliable; the persistent incidence of recurrent bands and iatrogenic deformities has prompted a change in technique. The author conducted a long-term retrospective review to evaluate a variation on the SMASectomy facelift technique. A solely lateral, "low SMAS" approach was substituted for direct necklift in all patients. Patients who were candidates for a facelift underwent this laterally based, SMASectomy technique. Those who underwent concomitant full-face CO2 laser resurfacing were excluded from the review. A total of 198 patients treated consecutively during a 7-year period (2006-2012) were included in the study. Postoperative follow-up ranged from 1 to 7 years. All patients' neck deformities were fully corrected by the solely lateral SMASectomy technique. In addition, the patients recovered more rapidly than with traditional direct necklift, with no nerve injuries, skin compromise, or hypertrophic scarring. Results indicate that midline open necklift can be replaced by the low SMASectomy. 4.

Short-scar facelift without temporal flap: a 10-year experience.

The understanding of facial anatomy and its changes through aging has led to the development of several different facelift techniques that focus on being less invasive and traumatic and, at the same time, providing natural long-lasting results. In this article we describe step by step our facelift technique as it has been done over the past 10 years by the senior author. This is a retrospective, descriptive, transversal study in which all patients who underwent a rhytidectomy using our technique from January 2002 to September 2012 were included. All patients were operated on under local anesthesia and superficial conscious sedation. All surgeries were performed by the same surgeon. A complete step-by-step description of the surgical technique can be found in the main article. Between January 2002 and September 2012, a total of 113 patients underwent facelift surgery. Of these, 88.9 % were women and 11.1 % were men. The mean age was 55.3 (± 8.66) years. Primary surgeries represented 80.3 % (n = 94), secondary 18.8 % (n = 22), and tertiary 0.85 % (n = 1). Only one major complication, representing 0.8 %, consisting of a right-sided temporal paresis with 2 months complete recovery was seen. The minor complications rate was 23.1 %. The most common minor complication was hypertrophic/keloid scars which made up 77.8 % of all minor complications. The technique described provides good and long-lasting aesthetic results with shorter scars, smaller areas of dissection (without temporal and postauricular flaps), and a shorter recovery period. 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 http://www.springer.com/00266 .

Book Review: Midface and Neck Aesthetic Plastic Surgery

Mario Pelle Ceravolo, Giovanni Botti . Midface and Neck Aesthetic Plastic Surgery. Vol 2. Parma, Italy: Acta Medica Edizioni, 2012. ISBN 10: 8897438350 The second volume of Drs Mario Pelle Ceravolo and Giovanni Botti's Midface and Neck Aesthetic Plastic Surgery consists of 3 chapters and 510 pages. The first chapter concerns orbitomalar aging. The second chapter consists of the authors' personal considerations on prominent eyes. A very detailed, long chapter follows on surgical treatment of the aging neck. This book is very rich in pre-, intra-, and postoperative pictures; schematic representations of procedures; and meticulous fresh cadaver dissections paralleling intraoperative surgical dissections. The first chapter concerns facial aging. Patient photos demonstrate different types and effects of soft tissue facial aging in the orbitomalar area. Skeletal changes with aging are discussed, with clear illustrations. The authors discuss the scientific perspective on aging to explain detailed indications for their wide-ranging use of various facial implants. There is extensive description of zygomatic implants, including thorough patient and implant selection criteria, surgical techniques and positioning, complications, and methods for integrating these implants into facelift techniques. The book contains beautiful intraoperative pictures of an implant insertion through a preauricular approach, in a superficial musculoaponeurotic system (SMAS) procedure. The authors incorporate fat grafting and dog-ear plication of the SMAS to achieve more natural contours. They present some secondary cases treated with lateral canthoplasty, implants, and spacers to …

Anatomic Evaluation of the Vertical Face-lift in Cadavers

This study investigates how different orientations of tension vectors affect the amount of soft-tissue lift in specific cervicofacial regions. To compare differences in cosmetic neck and face changes generated by 3 different face-lift techniques, to quantify the amount of lift across different points on the face, and to quantify changes in platysmal dehiscence in each of 3 standard superficial musculoaponeurotic system plication face-lift techniques applied to fresh-frozen cadaver heads. Ten cadaver heads in an academic tertiary care center. Three different superficial musculoaponeurotic system plication rhytidectomy procedures were conducted in the following sequence: (1) vertical tension vector plication (vertical lift), (2) superolateral tension vector plication (superolateral lift), and (3) superolateral tension vector plication combined with midline platysmal plication (superolateral lift with platysmal plication). After completion of each technique, the amount of lift at 4 standard key points was measured and recorded, and differences in lift at the key points were analyzed. Vertical lift was associated with greater total lift than superolateral lift alone or superolateral lift with platysmal plication (P < .001 for both). Platysmal dehiscence increased from baseline measurements after superolateral lift and decreased after vertical lift (P = .002 for both). Our findings establish how different orientations of tension vectors applied during face-lift surgery achieve different structural changes to various key points across the face. This study helps the face-lift surgeon and student understand the underlying structural anatomic changes associated with different face-lift techniques, which ultimately result in different cosmetic outcomes. NA.

Modified Lateral SMASectomy

Sir: Recently, advances on facial anatomy have been significantly achieved by Rohrich and Pessa1 and Mendelson et al.2 For this reason, various face-lift techniques have evolved and been introduced into clinical practice.3,4 Although limited-incision face lifts are popular, conventional face lifts have their own indications for treatment of aging face with severe skin laxity. Recently, face lifts with lateral superficial musculoaponeurotic system (SMAS)-ectomy technique have gained prominence among plastic surgeons. The theoretical benefits of lateral SMASectomy for facial rejuvenation are a short recovery time, relatively simple operation, low incidence of complications such as tearing of the SMAS and potential facial nerve injury, vertical elevation and strong fixation of the SMAS, comparable outcome with extended SMAS technique, and a short scar because of limited incision. Because of these advantages, we think the original technique is a good option with regard to overall improvement of skin tightness and effacement of fine wrinkles. However, we are somewhat suspicious of the effect on midface ptosis. Thus, following the original lateral SMASectomy described by Daniel Baker in 1992, various modified techniques have been introduced.5 We also adopted our own modified lateral SMASectomy design. The procedure was performed under local anesthesia with intravenous sedation. After access skin incision, dissection extends across the zygoma to release the zygomatic ligaments and masseteric cutaneous ligaments. We do not dissect further anteriorly. Then, we designed a trapezoid SMAS flap. The superior border of the incision was approximately at the level of the zygomatic arch and the inferior border was approximately 4 to 5 cm below the jaw line. A representative design is shown in Figure 1.Fig. 1: Intraoperative design of the modified lateral flap.Over a 2-year period, the patients underwent modified lateral SMASectomy. The treatment outcomes were evaluated both subjectively and objectively. All but four patients [33 of 37 (89.1 percent)] were satisfied with the outcomes after the surgical procedure. Consensus ratings by the two independent plastic surgeons found that objective outcomes were divided among excellent, good, and fair. None of the outcomes was rated as no change or worse. The postoperative course was uneventful, with the exception of five patients (13.5 percent) who presented with skin slough, hypertrophic scar, and hematoma. We think that our modified technique can be considered as another option that yields a better effect on midface ptosis, jowl, and jaw line and more powerful effacement of nasolabial folds. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Tae Hwan Park, M.D. Jin Hyuk Park, M.D. Kwi Whan Whang, M.D., Ph.D. Research Department Miz Aesthetic Surgery Clinic Seoul, Republic of Korea

Esthetic Outcome After Soft Tissue Reconstruction of the Face Using Deep Dissection and Composite Facelift Technique

Large defects in the face resulting from the excision of malignant tumors, trauma, and congenital malformation pose a significant challenge to reconstructive surgeons. Achieving good esthetic and functional outcomes is often very demanding. A facelift technique was used in 47 patients (25 female, 22 male; age range, 17.5 to 82.3 years; mean age, 49.3 years) to replace lost tissue of the face from 2009 through 2012. The minimum defect size was 2 cm in diameter and the maximum was 8 cm. To achieve tension-free coverage with a reliable blood supply, a deep-plane dissection, including the skin and superficial musculoaponeurotic system (SMAS), was performed. The deep sub-SMAS dissection was extended into the neck and the contralateral part, as needed. A thick flap was created and composite lifting was performed. No significant deformity concerning the lower eyelids, nose, and lip was registered. Most scars could be placed in hidden regions and became undetectable after a year. The facial nerve function remained intact in all patients. Using these facelift techniques, including the incision, sub-SMAS dissection for volumetric positioning of the skin, and the SMAS flap, the closure of extensive facial defects with excellent functional and esthetic results is conceivable.

Anatomic Study of the Retaining Ligaments of the Face and Applications for Facial Rejuvenation

The retaining ligaments of the face support the facial soft tissue in a normal anatomic position, thereby resisting gravitational change. In this study, a technique utilizing surgical plication of the superficial musculoaponeurotic system (SMAS) to the retaining ligaments of the face and finger-assisted malar elevation (FAME) dissection of the midface is presented. The anatomy of the facial retaining ligaments was studied in 20 half-faces of ten fresh cadavers, and the localization of the ligaments was examined macroscopically. Surgical correction of facial aging with plication of the SMAS to the retaining ligaments and FAME dissection of the midface has been performed in 74 face-lift patients since 2006. Outcomes were determined by case notes, clinical review, and a patient questionnaire. The studied ligaments (zygomatic and masseteric) were present in all cadaver dissections. The zygomatic ligament was located 4.3-5.5 cm from the tragus and originates near the inferior border of the anterior zygomatic arch. The masseteric ligament was located 3.7-5.2 cm from the tragus below the junction of the zygomatic arch and masseter muscle. All the patients answered a satisfaction questionnaire and reported high levels of satisfaction at least 1 year after treatment. We have identified the facial retaining ligaments in all cadaver dissections and their relationship with other structures of the face are described here. This study demonstrates that our face-lift technique is safe and produces highly predictable and natural results. 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 .

Rhytidectomy

To evaluate the current evidence-based medicine for rhytidectomy. Specific techniques and their scientific rationale are explored. The authors' practice modifications based on this evidence will be reviewed. The utilities of short scar facelift techniques are validated. Specific indications for the deep plane technique are also discussed. The reader will understand the rationale for choosing specific rhytidectomy techniques for young patients, older patients and specific anatomic findings.

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.

A Systematic Review of Comparison of Efficacy and Complication Rates among Face-Lift Techniques

A Systematic Review of Comparison of Efficacy and Complication Rates among Face-Lift Techniques

Face Lift

After reading this article, the participant should be able to: 1. Identify and describe the anatomy of and changes to the aging face, including changes in bone mass and structure and changes to the skin, tissue, and muscles. 2. Assess each individual's unique anatomy before embarking on face-lift surgery and incorporate various surgical techniques, including fat grafting and other corrective procedures in addition to shifting existing fat to a higher position on the face, into discussions with patients. 3. Identify risk factors and potential complications in prospective patients. 4. Describe the benefits and risks of various techniques. The ability to surgically rejuvenate the aging face has progressed in parallel with plastic surgeons' understanding of facial anatomy. In turn, a more clear explanation now exists for the visible changes seen in the aging face. This article and its associated video content review the current understanding of facial anatomy as it relates to facial aging. The standard face-lift techniques are explained and their various features, both good and bad, are reviewed. The objective is for surgeons to make a better aesthetic diagnosis before embarking on face-lift surgery, and to have the ability to use the appropriate technique depending on the clinical situation.