Minimal Access Cranial Suspension Research Articles

Open Neck Lift: Surgical Technique and A Clinical Classification for Cervical Rejuvenation.

Careful evaluation of the neck and its relationship to the lower third of the face is fundamental to provide appropriate recommendations for procedures. The authors propose a modified Baker "clinical" classification as a more reliable and reproducible evaluative basis for the treatment of the aging neck. A total of 450 patients underwent procedures for cervical rejuvenation between December 2012 and December 2022 by the senior author. These included 9 cases of neck liposuction, 6 isolated neck lifts, 15 minimal access cranial suspension face lifts, 94 face lifts with open neck lifts, and 326 extended R-face and neck lifts. The male-to-female ratio was 1:20. The mean patient age was 59.1 years and the mean follow-up was 14 months (range 11.5-20 months). From the data, a modified Baker clinical classification for the aging neck was formulated along with recommendations for possible solutions. Ninety-four percent of the patients expressed high satisfaction on the Owsley Facelift Satisfaction Survey at 1-year follow-up. The complication rate was 1.78% (8 patients), including 1 hematoma, 1 skin edge necrosis (1 cm), 1 slow healing site (postauricular), 3 limited postauricular/earlobe scar revisions, and 2 mild contour irregularities. Cervical rejuvenation can be achieved by a spectrum of interventions and approaches. A comprehensive preoperative assessment and a clinical neck lift classification are the keys to selecting the correct surgical technique for achieving reliable and consistent results. The authors propose a pragmatic approach for both isolated and integrated neck lift procedures with excellent aesthetic outcomes and minimal complications.

Facial fat necrosis after autologous fat transfer possibly associated with SARS-CoV-2 vaccine.

A 52-year-old female patient developed facial fat necrosis presenting with cutaneous induration three weeks after minimal access cranial suspension (MACS) lift with autologous fat grafting from the abdomen. Given that the patient received the Moderna SARS-CoV-2 vaccine one week after surgery, we hypothesize that the former predisposed her to tissue ischemia leading to fat necrosis. Histological findings after biopsy were consistent with fat necrosis, which included marked dermal fibrosis with areas of focal fat necrosis, lipophages, multinucleated giant cells, and siderophages. It is our hope that documenting this rare development in literature may serve as encouragement for adverse effect reporting after the SARS-CoV-2 vaccine administration and may boost inspection and monitoring of other health consequences by regulating agencies.

Cable-Stayed Face Lift: An Innovative Short-Scar Lift for Better Correction of Nasolabial Folds in East Asians.

The improvement of nasolabial folds by either lateral superficial musculoaponeurotic system rhytidectomy or minimal access cranial suspension lift alone is commonly performed, but patient satisfaction is often limited in East Asians. An innovative technique, termed the cable-stayed face lift, which combines the strengths of lateral superficial musculoaponeurotic system rhytidectomy and minimal access cranial suspension lift, was developed for improved results. Between 2016 and 2019, 20 cable-stayed face lifts were performed in a single hospital. Two plastic surgeons independently evaluated postsurgery outcomes using a five-point Likert scale, where 5 = excellent, 4 = good, 3 = fair, 2 = no change, and 1 = worse. Patient satisfaction was assessed by relevant items from the FACE-Q questionnaire. Twenty patients with a mean age of 51 years underwent face-lift surgery. The mean follow-up ± SD was 11.3 ± 9.8 months. The five-point Likert scale score evaluated by surgeons was 3.65 ± 1.08. Patient-perceived age visual analogue scale (7.8 ± 4.4) exhibited a difference between preoperative actual age and postoperative apparent age. Patients demonstrated high satisfaction with outcome (67.5 ± 16.2) and satisfaction with lower face and jawline (76.2 ± 14.9). No major complication, hematoma, or seroma was observed. The authors' approach-cable-stayed face lift-offers a good alternative to provide a more effective effacement of nasolabial folds, by lifting the nasolabial folds with parallel vector and lower face and neck with the vertical vector. Therapeutic, IV.

Turning Back the Clock: Artificial Intelligence Recognition of Age Reduction after Face-Lift Surgery Correlates with Patient Satisfaction.

Patients desire face-lifting procedures primarily to appear younger, more refreshed, and attractive. Because there are few objective studies assessing the success of face-lift surgery, the authors used artificial intelligence, in the form of convolutional neural network algorithms alongside FACE-Q patient-reported outcomes, to evaluate perceived age reduction and patient satisfaction following face-lift surgery. Standardized preoperative and postoperative (1 year) images of 50 consecutive patients who underwent face-lift procedures (platysmaplasty, superficial musculoaponeurotic system-ectomy, cheek minimal access cranial suspension malar lift, or fat grafting) were used by four neural networks (trained to identify age based on facial features) to estimate age reduction after surgery. In addition, FACE-Q surveys were used to measure patient-reported facial aesthetic outcome. Patient satisfaction was compared to age reduction. The neural network preoperative age accuracy score demonstrated that all four neural networks were accurate in identifying ages (mean score, 100.8). Patient self-appraisal age reduction reported a greater age reduction than neural network age reduction after a face lift (-6.7 years versus -4.3 years). FACE-Q scores demonstrated a high level of patient satisfaction for facial appearance (75.1 ± 8.1), quality of life (82.4 ± 8.3), and satisfaction with outcome (79.0 ± 6.3). Finally, there was a positive correlation between neural network age reduction and patient satisfaction. Artificial intelligence algorithms can reliably estimate the reduction in apparent age after face-lift surgery; this estimated age reduction correlates with patient satisfaction. Diagnostic, IV.

Special Considerations in Chinese Face-Lift Procedure: Insights From a 15-Year Experience of 1026 Cases.

There is extensive literature on different face-lift techniques; however, few articles published in the English language address the particularities of the face-lift for Chinese patients. Because of differences in facial anatomy, facial aging, and patient expectations, facial rejuvenation procedures for Chinese patients can be quite different from those of White patients. The study includes 1026 consecutive primary face-lift cases performed by the senior author (D.Y.) from 2006 to 2019. Of these, 1010 patients were female and 16 were male. The average age of the patient at the time of primary face-lift was 40.5 years. The face-lift procedures included midface lift in 108 cases, midface and lower-face lift in 882 cases, and midface and lower-face lift with brow lift in 36 cases. All patients received superficial musculoaponeurotic system (SMAS) treatment, in the form of lateral SMASectomy in 607 cases, high-SMAS technique in 84 cases, modified high-SMAS short-scar technique in 108 cases, minimal access cranial suspension technique in 38 cases, and modified minimal access cranial suspension technique in 189 cases. Photographs of patients were analyzed to assess persistent features of facial aging. Complications such as hematoma, skin slough, infection, and nerve injury were also reviewed. Most patients obtained consistently good results with minimal risk and complications. All surgical techniques discussed were safe and reproducible, providing various options for surgeons. Special attention should be taken when planning a facial rejuvenation procedure for Chinese patients. Anatomic variations dictate a greater emphasis on the management of tissue ptosis, particularly regarding lateral brow descent and malar fat pad descent. In our practice, various face-lift techniques can produce excellent results. Surgeons must adopt a technique that serves patients well and is, ideally, safe, consistent, easily reproducible, and applicable to various anatomic problems. In addition, every surgery is customized to the patient's anatomy and concerns. Therefore, the surgeon must adopt individualized technique according to the needs and desires of each patient.

Elastic thread modified minimal access cranial suspension lift for lower and middle third facial rejuvenation.

Thread lift boasts the advantage of minimal invasion for facial rejuvenation and has been increasingly used nowadays. The purpose of this study was to evaluate the outcomes and safety of elastic thread when it was used in the modified minimal access cranial suspension (MACS) lift for rejuvenation of the lower and middle third of the face.Forty-six patients with sagging and laxity of the lower face treated by the elastic thread modified MACS lift from December 2015 and December 2017 were enrolled in this study. A retrospective chart review was conducted. The degree of Wrinkle Severity Rating Scale (WSRS) score and satisfaction score were evaluated immediately, 6 months and 12 months after procedure. Complications during the study were also recorded.All the patients were female, with a mean age of 50.7 ± 6.4 years and a mean follow-up period of 15.4 ± 2.1 months. The mean operation time was 114 ± 13 minutes. For the left face, the mean WSRS score was 4.0 ± 0.8 preoperatively and 3.1 ± 0.8 on the 1-year follow-up; and 4.1 ± 0.9 and 3.1 ± 0.7 on the right face (P < .01). Thirty-nine (84.8%) patients considered the long-term results satisfactory. There were no major complications during the follow-up period.The elastic thread modified MACS lift is a minimally invasive, effective and safe method to improve lagging middle and lower third of the face without significant postoperative morbidity or complications.

Fat Grafting to Improve Results of Facelift: Systematic Review of Safety and Effectiveness of Current Treatment Paradigms

Autologous fat grafting is a helpful supplement to facelift surgery that helps to combat age-related volume loss of facial structures. Despite the widespread prevalence of combined facelift and fat-grafting, significant procedural variation exists between providers. The primary purpose of this systematic review was to study the efficacy and complication rates of facelift with lipofilling compared with facelift alone. A systematic review of the Cochrane Library and MEDLINE databases as completed was undertaken to identify all clinical reports of fat grafting combined with facelift surgery based on the following key terms: ("fat grafting" OR "lipotransfer" OR "lipofilling" OR "fat transfer") AND ("facelift" OR "rhytidectomy" OR "SMASectomy" OR "facial rejuvenation"). Data on techniques, outcomes, complications, and patient satisfaction were collected. The systematic review was performed in April 2017. In total, 248 articles were identified for review. After application of exclusion criteria, 15 primary studies were included in this review. Various facelift techniques were reported, including deep-plane or sub-superficial musculoaponeurotic system (SMAS) facelift, SMAS facelift, modified minimal access cranial suspension lift, component facelift, midface lift, SMAS plication, SMAS-stacking/SMASectomy, and SMASectomy. The most common locations of fat graft injection included the nasolabial folds, tear troughs, temporal regions, midface/cheek/malar eminence, marionette groove, lips, and ear lobes. The addition of fat grafting to facelift surgery resulted in significant improvements in facial volume and aesthetic assessments. Combined facelift and fat grafting is a safe and efficacious means to simultaneously address age-related ptosis and volume loss. Further research is required to validate and improve existing treatment modalities.

Reply: The Addition of Platelet-Rich Plasma to Facial Lipofilling: A Double-Blind, Placebo-Controlled, Randomized Trial

Reply: The Addition of Platelet-Rich Plasma to Facial Lipofilling: A Double-Blind, Placebo-Controlled, Randomized Trial

Overcoming limitations of short scar minimal access cranial suspension facelift for enhanced rejuvenation.

The minimal access cranial suspension lift, a short-scar facelift, has been described to correct sagging and laxity of the lower and middle third of the face. It does not, however, fully address the neck or the lateral periorbital area frequently needing rejuvenation in most patients. Another shortcoming of the minimal access cranial suspension lift technique is visible scarring anterior to the temporal hairline that usually occurs despite the suggested surgical maneuvers consisting in zigzag beveled incisions. We describe modifications of the standard subcutaneous musculoaponeurotic system lift technique, increasing its indications for full-face and neck rejuvenation (excluding the forehead) and improving final aesthetic outcome.

Lifting procedures in cosmetic facial surgery

A prominent characteristic of the aging face is the descent of skin and subcutaneous tissues. In order to reduce this and create a more youthful appearance, several lifting procedures can be employed. In the forehead and eyebrow region the transblepharoplastic brow lift, the direct brow lift, the temporal brow lift, the coronal brow lift and the endoscopic brow lift can be distinguished. For the mid-face, the facelift is known to be an effective treatment for aging characteristics. Classic facelifts can be divided into the one layer-, two layer- and the deep plane facelift. Nowadays the minimal access cranial suspension lift is popular. The lifting capacity of this lift may be less, but the risk of complications is lower and the result is often more natural. A neck lift improves the chin-neck angle and a submental liposuction/lipectomy can contribute to this. Complications in lifting procedures are rare. Hematoma is the most frequent complication. Skin necrosis of the wound edges and laceration of the end branches of the facial nerve can also occur. There is a tendency towards minimally invasive procedures with smaller risk of complications and shorter recovery periods.

The effects of platelet-rich plasma on recovery time and aesthetic outcome in facial rejuvenation: preliminary retrospective observations.

This study focused on the possible effect of platelet-rich plasma (PRP) on recovery time and aesthetic outcome after facial rejuvenation. We conducted a retrospective analysis with regard to recovery time and the aesthetic improvement after treatment among four groups of patients: those treated with fat grafting only (Group I), those treated with fat grafting and PRP (Group II), those treated with a minimal access cranial suspension (MACS)-lift and fat grafting (Group III), and those treated with a MACS-lift, fat grafting, and PRP (Group IV). For the first part of this study, i.e., evaluation of recovery time after surgery, the following selection criteria were used: nonsmoking females, aged 35-65years, with a complete documented follow-up. In total, 82 patients were included in the evaluation of patient-reported recovery time. For the second part of the study, i.e., evaluation of potential differences in aesthetic outcome, the records of these 82 patients were screened for the presence of pre- and postoperative standardized photographs in three views (AP, lateral, and oblique), leaving 37 patients to evaluate. A questionnaire was developed to evaluate the aesthetic outcome in all four groups of patients. This questionnaire was given to an expert panel that consisted of ten plastic surgeons. The addition of PRP to a lipofilling procedure resulted in a significant drop in the number of days needed to recover before returning to work or to restart social activities [Group I (no PRP) took 18.9days vs Group II (PRP) took 13.2days, p=0.019]. There seemed to be no effect when PRP was added to a MACS-lift+lipofilling procedure. Also, the aesthetic outcome of the lipofilling and MACS-lift+lipofilling groups that received PRP (Groups II and IV) was significantly better than the groups without PRP (Groups I and III). Adding PRP to facial lipofilling reduces recovery time and improves the overall aesthetic outcome of a MACS-lift. 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 .

Advantages and Limitations of the MACS Lift for Facial Rejuvenation

Minimal access cranial suspension (MACS) facelifts provide the potential advantage of less invasiveness with quicker recovery. However, there is deficient literature documenting its usefulness and limitations. This study aimed to evaluate the MACS lift for effectiveness in facial rejuvenation. Institutional review board approved record review of all facelift patients treated August 2006 to October 2011 by a single surgeon. Eighty-eight facelifts were done, 8 conventional and 80 MACS. Average age was 59 years with 97% being women. Average body mass index and American Society of Anesthesiology classification score were 25 and 1.6 Kilograms per meter squared, respectively. The only significant complications noted were 3 hematomas that required drainage: all in the MACS group (3.41%); and 1 temporary buccal branch paresis. Other facial procedures were done on all the conventional patients and 59 (74%) of the MACS patients. Notably 8 (10%) of the MACS patients had a nonfacial procedure done concurrently. Average operative times were significantly longer for the conventional lifts at 4:03 compared to 2:39 for all the MACS lifts (: -0.002); 2:05 for MACS alone. Follow-up averaged 6 months (4 to 49). Average return to work in the MACS group was 2 weeks. All conventional lift patients had a high level of satisfaction. Of the MACS patients, 3 expressed disappointment due to residual facial skin laxity or inadequate neck contouring. MACS lift is effective, providing a high level of patient satisfaction due to aesthetic results, combined with rapid recovery and return to normal activities. Compared to conventional facelift, the reduced operative time makes concurrent nonfacial procedures more feasible. Effectiveness has limitations in those with marked skin laxity and/or marked cervical lipodystrophy.

Correction of Severe "Pixie Ear" Deformity after Rhytidectomy with Modified Minimal Access Cranial Suspension Lift

The facelift remains the gold standard in facial rejuvenation, with a high satisfaction rate. However, excessive skin excision of the skin flap can produce unsatisfactory results and minor or even major complications. Amongst these complications, the pixie ear deformity can be recognized by its "stuck on" or "pulled" appearance, which is caused by the extrinsic pull of the medial cheek skin and jaw-line flaps at the earlobe attachment point, the otobasion inferius. Following rhytidectomy, the tension results in migration of the earlobe attachment point (otobasion inferius) from a posterior cephalad position to an anterior caudal position [[1]]. It is also possible that the pixie ear deformity can be accompanied by other tension-related complications such as a sweeping effect, scar migration, unnatural appearance of the tragus, and a "face-lift look."

Lipofilling With Minimal Access Cranial Suspension Lifting for Enhanced Rejuvenation

Lipofilling With Minimal Access Cranial Suspension Lifting for Enhanced Rejuvenation

Successful Treatment of Thread-Lifting Complication From APTOS Sutures Using a Simple MACS Lift and Fat Grafting

Facial soft tissue lifting with subdermal sutures has a significant attraction for physician and patient alike. The case report describes a 48year old woman who presented with pain and discomfort over the left cheek after a thread-lift procedure with anti-ptosis (APTOS) sutures performed 13months previously. The clinical examination showed extrusion of the APTOS thread (Aptos, Moscow, Russia) accompanied by slight soft tissue tightness and tenderness along its course to the temporal area, indicating complete removal of the thread. A simple minimal access cranial suspension lift was performed with the patient under local anesthesia to remove the subdermal sutures together with autologous fat grafting to enhance the aesthetic result. At the 1year follow-up visit, no complications were reported, and the patient was entirely satisfied with the final result. 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 .

Nasolabial fold augmentation with SMAS graft

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

The Canadian Society for Aesthetic Plastic Surgery 39th Annual Meeting

Understanding the anatomy of the superficial fascia and its relation to the deep fascia, retaining ligaments and facial nerve is critical to safe sub-SMAS surgery. Facial surgery is an exercise in understanding three-dimensional nuances of complex face and neck anatomy. While the topographic anatomy of the face and neck is straightforward, the anatomy superficial-to-deep is complex and less easily mastered. With clear understanding of the complex three-dimensional anatomy, grasp of facial proportions and understanding the means of biomechanically addressing facial aging, surgery becomes easier. In the first part of this presentation, the platysma-SMAS complex spatial relations will be described and the relationship of ligaments, facial nerve branches and muscles of facial expression will be outlined. These structures relate to one another consistently in three-dimensional fashion and once these relationships are mastered facelift operations become easier. Three prototype subSMAS procedures will be described and outlined: Extended (separate skin-SMAS) SMAS flap, deep-plane facelift and subperiosteal lift, illumination of benefits and the drawbacks and similarities of the three procedures. Surgical correction does not necessarily require extended release at the sub-SMAS level. SMASplication, lateral SMASectomy and minimal access cranial suspension procedures have their place in facial rejuvenation. The concepts behind the efficacy of these operations will be outlined. Finally, the neck will receive special attention as this is often the most difficult part of the facelift. The author’s preference for medial platysmaplasty, superficial deep-fat removal and muscle modification will be described and the biomechanical benefits elucidated. Other authors’ preferences regarding the posterior approach will also be described.

Managing the Neck in the Era of the Short Scar Face-Lift

A recent trend in rhytidectomy has included the introduction of various short incision techniques, particularly the S-lift, the minimal access cranial suspension lift, and other short scar methods. However, this trend has not been without a criticism that these minimally invasive techniques might be limited in what might be achievable by such surgery. As with more traditional face-lift surgery, the management of the neck often presents as the most challenging aspect of the procedure when using short scar techniques. This article will present a brief history of cervical rhytidectomy and relevant surgical anatomy, as well as the authors' algorithmic approach to surgical assessment and management of the neck, the short incision operative techniques, and potential complications. In the authors' experience, attention to both the selection criteria and operative modifications in the execution of short scar techniques are critical to optimizing outcomes in cervical rejuvenation.

The Canadian Society for Aesthetic Plastic Surgery 39th Annual Meeting

Understanding the anatomy of the superficial fascia and its relation to the deep fascia, retaining ligaments and facial nerve is critical to safe sub-SMAS surgery. Facial surgery is an exercise in understanding three-dimensional nuances of complex face and neck anatomy. While the topographic anatomy of the face and neck is straightforward, the anatomy superficial-to-deep is complex and less easily mastered. With clear understanding of the complex three-dimensional anatomy, grasp of facial proportions and understanding the means of biomechanically addressing facial aging, surgery becomes easier. In the first part of this presentation, the platysma-SMAS complex spatial relations will be described and the relationship of ligaments, facial nerve branches and muscles of facial expression will be outlined. These structures relate to one another consistently in three-dimensional fashion and once these relationships are mastered facelift operations become easier. Three prototype subSMAS procedures will be described and outlined: Extended (separate skin-SMAS) SMAS flap, deep-plane facelift and subperiosteal lift, illumination of benefits and the drawbacks and similarities of the three procedures. Surgical correction does not necessarily require extended release at the sub-SMAS level. SMASplication, lateral SMASectomy and minimal access cranial suspension procedures have their place in facial rejuvenation. The concepts behind the efficacy of these operations will be outlined. Finally, the neck will receive special attention as this is often the most difficult part of the facelift. The author’s preference for medial platysmaplasty, superficial deep-fat removal and muscle modification will be described and the biomechanical benefits elucidated. Other authors’ preferences regarding the posterior approach will also be described.

The Minimal Access Deep Plane Extended Vertical Facelift

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