Secondary Face Lifts Research Articles

Vectorial Analysis of Deep Plane Face and Neck Lift.

The vector of aging and consequently the vector of lift in rhytidectomy has aided surgeons in improving movement of tissues during facial rejuvenation procedures. The goal was to analyze the vector of lift in patients undergoing primary and revisional facelift to achieve proper vectorial lifting. Patients undergoing deep-plane facelift surgery were included for analysis. Intraoperative photographs and measurements were taken of the skin, superficial musculoaponeurotic system (SMAS), and platysmal suture suspension with mastoid crevasse inset. Measurements were compared between patients who were undergoing primary vs secondary surgery, site of lift, age, and gender. Seventy-one patients (90% female, mean age 57.8) with a total of 142 hemifaces were analyzed, 57 (73%) of which were primary and 14 (27%) secondary facelifts. The average vector of SMAS lifting was 70.8°. Females had a more vertical vector than males (71.3° vs 65.4°; P < .01). The average vectors of platysmal and skin lift were 87.0° and 58.2°, respectively. There was intrapatient difference between hemifaces. Despite there being more intersuture disparity in secondary cases than primary cases (16.9° vs 4.5°; P < .05), the mean vector of lifting was similar between them. Proper release of the deep plane helps determine the appropriate vectors of lift, without relying on guidelines based on population averages. Each patient presents with a unique vector required to correct their descent. This technique provides an optimal result by directly suspending against the vectors of greatest descent.

Clinical Practice Patterns in Facelift Surgery: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery.

This study evaluates change in practice patterns in facelift surgery based on a 15-year review of tracer data collected by the American Board of Plastic Surgery as part of the Continuous Certification process. Tracer data for facelift was reviewed from 2006 to 2021. The 15-year collection period was divided into an "early cohort (EC)" from 2006 to 2014 and a "recent cohort (RC)" from 2015 to 2021. Of 3400 facelifts (1710 EC/1690 RC) performed, 18% were done in hospital and 76% were done in an accredited office facility. Ninety one percent of patients were female with an average age of 61years. There was an increase in the number of secondary facelifts (4% EC vs 18% RC; p < 0.001) and an increased number of patients concerned about volume loss/deflation (25% EC vs 37% RC; p < 0.001). The surgical approach to the SMAS involved plication (40%), flaps (35%), SMASectomy (22%) and MACS lift (6%). One percent of facelifts were subperiosteal and 8% skin-only. Significantly more surgeons used the lateral SMAS flap (14% EC vs 18% RC, p < 0.005), while less used an extended SMAS flap (21% vs 18%; p = 0.001) and MACS lift (10% EC vs 6% RC; p = 0.021) techniques. The concomitant use of facial fat grafting is becoming more common (15% EC vs 24% RC, p = 0.0001). A 15-year review of ABPS tracer data provides an excellent venue for the objective assessment of the current status of facelift surgery, and key changes in practice patterns during that time. 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 .

The Use of Multifilament Suture for SMAS Plication in Rytidectomy.

In the public's mind, rhytidectomy, better known as a facelift procedure, is the technique most closely associated with plastic surgery. When done correctly, it yields highly satisfactory results. The aim of our study was to retrospectively review results of our patients whose procedures were performed using the superficial musculoaponeurotic system (SMAS) plication technique. Plication was performed with multifilament braided sutures, which provided a sustainable lift and satisfactory results. This study involves a retrospective review of 137 patients who underwent primary or secondary facelift procedures over a period of 46 months. The average patient age was 59 years, with ages ranging from 30 to 77. Patients were reviewed at 6 and 12 months postoperatively. Subjective evaluation based on photographic analysis was performed pre- and postoperatively. All cases included in this study indicated satisfaction with postoperative results on 1 year postoperative review for both the patients and performing surgeons. Four patients presented with a postoperative hematoma that required surgical intervention. One patient developed skin infection that was followed by skin necrosis. Another patient presented with wound infection that resulted in partial wound dehiscence. Both cases were managed conservatively. With the abundance of techniques directed toward the SMAS layer, it has become a pivot point for facelift procedures. This expansion in approaches places emphasis on the SMAS layer and its manipulations. The type of suture material utilized in SMAS plication is, therefore, undoubtedly essential. Our use of braided multifilament sutures for SMAS plication provided satisfactory results at 1-year postoperative review.

Revision Facelift and Neck Lift.

Facial rejuvenation procedures have become more commonly performed due to an increasing elderly population and greater general public acceptance. As a result, patients are now increasingly undergoing secondary and tertiary rhytidectomies to treat natural aging and/or to correct complications from prior procedures. Revision face and neck lifts are more complex by nature of the procedure and require a comprehensive preoperative assessment for enhanced outcomes. In this review, we discuss the preoperative evaluation, surgical challenges encountered, primary face and neck lift deformities, and their surgical management for patients undergoing secondary face and neck lifts.

Revision and Secondary Facelift: Problems Frequently Encountered.

Background:Revision facelift is a very challenging operation. The goal of our study was to examine the most common problems that the facelift surgeon has to face in a revision case and to suggest ways of solving them.Methods:A review of all patients from 2012 to 2017 in whom rhytidectomy was performed by the senior author was conducted.Results:During the 5-year study period, the author performed 552 face lifts. After the review to confirm revision procedures, a total of 72 revision facelifts were found. On reviewing the most common problems encountered in our facelifts, we found that in addition to the stigmata of the primary facelift, which are thoroughly analyzed in our article, a new type of stigmata has been added nowadays to the revision facelift—that of the various noninvasive interventions that patients undergo after their first facelift, in their effort to postpone or avoid a second operation. In all the abovementioned cases, the surgeon has to modify his basic surgical plan accordingly, to be able to improve or solve all of those problems during the revision surgery.Conclusions:The modern facelift surgeon often has to face much more than the stigmata of the primary facelift or the natural aging process. Thus, he/she should be appropriately trained to solve any problem we might encounter in a revision case.

Clinical Evaluation of 225 Sub-SMAS Facelifts with No Temporal Incision.

Background:Despite their name, “short scar” procedures leave scars in the temples and the postauricular scar often requires extension. Redraping the orbicularis muscle for periorbital rejuvenation increases the risk of facial nerve injury. This retrospective cohort study was undertaken to clinically evaluate a surgical approach that eliminates the temporal incision.Methods:A sub-superficial musculoaponeurotic system (SMAS) facelift was used, incorporating a triple-vector platysmaplasty and fat injection for periorbital rejuvenation. From 2009 to 2019, 225 consecutive outpatients underwent a sub-SMAS facelift with a triple-vector (superior, lateral, medial) platysmaplasty, either alone or in combination with fat injection, laser resurfacing, blepharoplasties, endoscopic forehead lift, and other cosmetic procedures. Release of the retaining ligaments optimized SMAS mobilization. A temporal incision was not used. Fat (mean volume 32 ml) was injected into the undissected subcutaneous tissue plane. The mean follow-up time was 28 months.Results:The most frequent complication was a neuropraxia (7.6%), usually affecting a frontal nerve branch, and always temporary. Two deep venous thromboses were detected by ultrasound surveillance. No significant correlation was detected between complications and age, sex, body mass index, smoking history, or a previous facelift. Sixteen patients (7%) returned for a secondary facelift (mean interval, 3.5 years).Conclusions:A sub-SMAS facelift and triple-vector platysmaplasty with fat injection combine effective neckline rejuvenation with facial volume restoration. Avoiding a temporal incision eliminates a telltale scar. Orbicularis preservation avoids additional dissection, possibly reducing the risk of neuropraxia. Fat injection provides a net increase in facial volume. Long-term measurement studies are recommended.

The Fate of Fogli's Lore's Fascial Platysma Fixation Optimalising the Results of Fogli's Neck Lift Procedure.

The author has modified previously described techniques of the superior suspension of the platysma muscle to Lore's fascia by developing an auriculoplastysmal fascial flap, which detaches the posterior platysma from its retaining ligaments to the sternomastoid muscle. Anterior to this flap, the platysma muscle is undermined and suture captured with three throws of a permanent 2.0 Tevdek suture. This suture and its three throws are fixed anterior to the tragus, which includes Lore's fascia and on tightening elevates the whole of the anterior neck as well as defines the cervicomental angle. A separate submental dissection may be required to assess and deal with pathology and resect excessive laxity of the platysma which has not been adequately addressed by the lateral superior traction suturing technique. Follow-up of fifteen cases of secondary facelift surgery with recurrent neck laxity demonstrated the fate of the suturing to Lore's fascia. The permanent knot at the pre-tragal fixation point descended approximately 3cm from the original position at the pre-tragal region. Secondary surgery is facilitated by capture of the knot and re-suturing it to its original primary position, restoring the neck to the approximate pre-operative condition and avoiding excessive dissection including return to the submental incision.Level of Evidence IV 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 .

Le microlift biplan. Principes, technique, résultats

There has been a growing number of patients asking for a lighter face lift than the classical biplane procedure with wide undermining; This explains the popularity of medical threads lifts. A surgical approach is nevertheless possible by performing a new technique, derived from minilfts, but with a dissection elevating skin and SMAS layers together, preserving as much retaining ligaments as possible, and allowing a predesigned skin excision. Thirty-two patients have been operated this way since 2014; 3 asked and sustained for a redo because of skin relapse at one year postoperatively. Few complications have occurred, mostly limited hematomas, or skin problems because of suture threads rejection. The best indications seemed to be young patients presenting a jowl ptosis or cervical skin laxity, and patients who require a secondary facelift as a lighter procedure.

Endoscopic assistance in a variety of complicated facelift and postoperative repair in frontal and temporal areas

Objective To introduce the advantages of the endoscopic assistance in primary and secondary face-lift in the frontal and temporal areas.Methods 67 cases were involved in the study,22 of them were secondary facelift cases.The follow-up period ranged from 1 month to 2 years.The patients and doctors satisfactory rate were recorded and the complications were also reported.Results All 67 cases had complete recovery without serious complications.The patient's satisfactory rate was 85％ (57/67),and the doctor's satisfactory rate was 89％ (60/67).Some early minor complications included dimpling at the suture site,asymmetry,overcorrection,transitory paralysis,late edema,scar and fall-off of hair among 80％ or so of patients.4 cases experienced hematoma on the frontal areas.The hematoma disappeared after early aspiration and later fomentation.2 cases had wound ulceration in the temporal 3 months after operation.The anchoring materials were removed and the ulceration tissues were excised 6 months after operation.The wound healed completely.2 patients experienced skin necrosis and depression due to careless electric cauterization on the frontal area.The depression gradually became smooth and inconspicuous after 6 months.All these complications were resolved and became negligible about 6 months after operation.Conclusions Endoscopic assistance is valuable in primary and secondary face-lift in the frontal and temporal areas.It is reliable and worthwhile to introduce the technique for patients aged less than 50-year-old. Key words: Facelift; Endoscope; Frontal; Temporal; Reconstructive surgical procedures

The Staged Face Lift

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

Periauricular Contouring Suspension in Secondary Face-Lift

The management of revision face-lift surgery is always challenging and controversial. We introduce the periauricular contouring suspension which combines a concentric SMAS suspension with a linear platysmal suspension for optimal facial rejuvenation. Complete clinical examination was a prerequisite to any secondary face-lift. We included every patient who had undergone a secondary face-lift between 2007 and 2010 in this study. The periauricular contouring suspension technique was used. It is inspired by Stocchero's round-block SMAS treatment procedure and also features a linear platysmal suspension associated with liposuction. Data gathered for every patient included sex, age, delay between primary and secondary procedures, and follow-up. Sixty-two patients (50 women and 12 men) underwent the procedure and were included in this study. The average age was 66 years old. The average delay between primary and secondary surgery was 11 years. Average follow-up was 29 months. Periauricular contouring suspension is a reliable technique for a secondary face-lift. It is a minimally SMAS-invasive technique in which postoperative outcomes are excellent and has become our preferred technique for revision face-lifting. 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 at http://www.springer.com/00266.

Longevity of SMAS Facial Rejuvenation and Support

One of the most common questions asked by patients when they present for face lift surgery is "How long will this last?" The answer to this question is not clear from the literature. The purpose of the study was to review a series of secondary face lifts performed between 2001 and 2008 with both the primary and secondary face lift performed by a single surgeon. There were 42 patients with full records available for review. Data were collected with regard to timing, surgical technique, complications, and reasons for early revision. The average age at the primary face lift was 50.2 years (range, 34.9 to 69.9 years) and the average age at the secondary face lift was 61.9 years (range, 43.6 to 77.2 years). The average length of time from the primary to secondary face lift was 11.9 years. Nine patients required a secondary face lift before it had been 5 years since the primary face lift (21.4 percent). Reasons for early secondary face lift (within 5 years of the primary) included loss of skin elasticity in five patients and increase in subplatysmal fat and skin neck folds due to weight gain, loss of elasticity secondary to protease inhibitors for human immunodeficiency virus infection, loss of skin elasticity due to corticosteroid use, and residual fullness of digastric and residual submental fat in one patient each. On average, a well-performed superficial musculoaponeurotic system flap face lift will last 12 years. Those patients who present with very poor skin elasticity secondary to sun damage may require an earlier secondary face lift.

The Use of Intra-SMAS Absorbable Barbed Sutures to Reinforce a High-Vector Pull during Rhytidectomy

Sir: Sometimes, the superficial musculoaponeurotic system (SMAS) is insubstantial and must be folded over a Vicryl (Ethicon, Inc., Somerville, N.J.) mesh1 to resist suspension without tear. Described in this viewpoint is a combination of open face lift with lateral SMASectomy2 and the use of four to six bidirectional absorbable barbed sutures3 that are placed under direct vision in a “weave” intra-SMAS fashion, catching with the barbs both edges of the SMAS and closing a 2.5- to 3.5-cm breach by traction and anchor to the temporal area. The lateral and medial edges of the SMASectomy are perforated with a blunt Coleman cannula and a 12-cm-long, 2-0, absorbable, bidirectional, barbed suture (PromoItalia International, Italy) is placed through the cannula. After grasping the end of the suture distally with a forceps, the needle is withdrawn and a small “pull” is transmitted to the suture to feel the “spiral barbs” impact the SMAS tissue (Fig. 1). A 0.5-cm tip of caudal barbed suture is left and the proximal part is passed through a 22-gauge needle and taken out in the temporal area. We control the pull on the sutures that protrude from the temporal hair by placing the patient in front of a mirror and letting them tell us how much to pull or release.Fig. 1.: (Above) A 3-cm strip of SMAS has been resected (lateral SMASectomy) and a blunt Coleman needle is penetrating the lateral portion of the SMAS. (Center) A barbed suture passed through the needle from cephalic to caudal and is grasped by an Adson forceps. (Below) The barbed suture has secured both edges of the SMASectomy, closing the 3-cm gap. Traction of the SMAS is accomplished with two barbed sutures and the SMAS is gathered with elevation of the corner of the mouth.In this study, absorbable barbed sutures were used to close and advance the lower SMASectomy flap, facilitating its superomedial fixation and the suspension of the platysma, and this effect is transmitted to the neck. In primary face lifts with a weak SMAS, two or three barbed sutures act as a “stick over a crooked tree trunk” and make the structure firmer to pull on to. In secondary face lifts, it was also useful when the SMAS ripped with the sutures. The use of absorbable barbed sutures in plastic surgery is very new; they are made of polydioxanone, a monofilament polymer that hydrolyzes between 8 and 10 months, with a degradation of strength that is inverse to the increase of strength of the healing process of the wound. This delayed absorption could create more healing connective tissue over the barbed spines, and this would theoretically strengthen the SMAS with time. With this premise in mind, SMAS suspension-contraction could eventually lift the face structures continuously over time, carrying the entire subcutaneous cheek mass as a unit. Science has shown that absorbable barbed sutures can increase wound strength in soft tissues,4,5 but it still must be established that its slow period of absorption will be adequate to achieve satisfactory results in face lifts in the long run and also be able to preclude concerns about adverse effects, such as possible migration, extrusion, foreign body reactions, local infection, neuromas, nerve damage, palpable beads, and pain. Creating an internal grid basement with barbed sutures is a stimulating concept for use with the SMAS as a monobloc unit that, when suspended, will lift the entire subcutaneous malar and mandibular mass of the middle face in a vertical direction. Arturo Prado, M.D. Patricio Andrades, M.D. Patricio Fuentes, M.D. Alex Eulufi, M.D. Alvaro Cuadra, M.D. School of Medicine Postgraduate School Plastic Surgery Clinical Hospital J. J. Aguirre University of Chile Santiago, Chile DISCLOSURE None of the authors has any financial interests to declare or any relation to the manufacturer of absorbable barbed sutures.

Évaluation de 50 liftings cervicofaciaux monobloc avec suspension

To evaluate the efficacy, while performing a face-lift, of a monobloc suspension, by a wide loop of Prolene 2/0, of the deep tissues of the face and the neck. Fifty patients have been operated, 48 women and two men, mostly thin patients and often, it was a secondary face-lift. In favorable cases, a limited undermining has been performed followed by a strong pull on the deep layers by the loop of 2/0 Prolene. An acceptable social appearance at eight days post operatory has been obtained in over 50% of the cases. A slight recurrence of ptosis is observed between 1 and 6 months, but at 1 year, the results were very satisfactory for 36 patients out of 50. This simple and fast technique is mostly suitable for moderate ptosis in thin patients and especially for secondary face-lifts.

Histologic and Ultrastructural Evaluation of Sutures Used for Surgical Fixation of the SMAS

In extensive SMAS face-lift surgery, retaining ligaments are released, and the SMAS is resutured to the deep fascia to maintain the advanced position. The suture used to reattach the SMAS should replicate the quality of support provided by the original ligaments. Nonabsorbable sutures (monofilament and braided) retrieved intraoperatively from 22 patients undergoing secondary face-lift procedures were examined by light microscopy and transmission electronmicroscopy. A distinctive enclosure of dense collagen and elastin formed around both types of suture. Based on the presence of inflammatory cells, fibroblasts, collagen, and elastin, the tissue reaction to monofilament suture was less than with the braided suture. The collagen and elastin were thicker around the braided suture, and, additionally the collagen matrix infiltrated between the individual filaments. Ultrastructural analysis of the braided suture showed significant collagen binding around each individual filament. The greater quantity of connective tissue around the thread which continued into the interstices of the braided suture has the characteristics of a ligament. This suggests a stronger and more lasting tissue fixation.

Revisional neck surgery

Dr. Pitman: The first patient is a 61-year-old woman who is seeking rejuvenation of her face and neck (Figure 1). Fourteen years ago she underwent a superficial musculoaponeurotic system (SMAS)–platysma face and neck lift and lipoplasty of the neck. Dr. Aston, how would you treat this patient? Figure 1 This 61-year-old woman is seeking rejuvenation of the face and neck. Fourteen years ago she underwent neck lipoplasty and SMAS-platysma face and neck lift. Gerald Pitman, MD Dr. Aston: I see laxity in the lower portion of her face. In the front view, I see prominent labiomandibular folds and platysma laxity under the chin that does not appear to extend down to the first cervical crease. In the three-quarter and profile views, I see some laxity along the jawline and in the jowl area, so she would benefit from a secondary face lift. Sherell J. Aston, MD In the grimace view, there is some weakness of lower lip depressor function on the left evidenced by diminished pull down of the left lower lip and less dental show on the patient's left side. We do not know what work was initially done to her face. However, work on the anterior neck surface with platysma plication, or dissection in that area, could obviously damage the marginal mandibular branch. The damage could have occurred with a lateral platysma SMAS dissection. Dr. Pitman: She had lipoplasty of the anterior neck and lateral SMAS elevation. Dr. Aston: Then I suspect the damage was connected with undermining of the SMAS platysma flap. Dr. Pitman: Would the past injury influence your present approach? Dr. Aston: Not really. I would counsel her, pointing out that she has lower lip weakness along with platysma laxity, making absolutely sure she understood. I would be aware of the weakness when dissecting, but it would …

Age-based comparisons of patients undergoing secondary rhytidectomy

Background: Statistics published by The American Society for Aesthetic Plastic Surgery report a 48% increase in cosmetic procedures for 2000-2001 and a 14% increase for rhytidectomies alone. Patients aged 35 to 50 account for 30.2% of all rhytidectomies performed. Many of these patients undergo secondary rhytidectomy. Objective: We investigated differences between patients undergoing secondary rhytidectomy and those undergoing a primary rhytidectomy, and between older (more than 60 years) and younger (60 years or less) patients undergoing secondary rhytidectomy. Methods: A retrospective descriptive research design with the computer cross-filing system of the senior author (A.M.) was reviewed for patients undergoing secondary or more (ie, tertiary, quaternary, etc) rhytidectomy. A total of 113 consecutive patients were identified; charts from 98 female patients and 3 male patients, were available for review. Ages at the time of surgery ranged from 40 to 81 years, with an average of 60. Results: Among patients older than 60 undergoing secondary face lift, 41 of 53 patients (77%) had combined procedures with their most recent face lift; 39 of 53 (74%) of these patients had at least one comorbid medical condition. Among patients aged 60 or younger undergoing secondary face lift, 37 of 48 patients (77%) underwent multiple procedures along with their most recent face lift, and 16 of 48 patients (33%) had at least one comorbid medical condition. The overall complication rate was 2/101 (2%). Conclusions: There is a statistically significant increase in the number of comorbid medical conditions in older patients. The overall complication rate in patients undergoing secondary rhytidectomy compares favorably to that traditionally quoted for patients undergoing primary rhytidectomy, who on average are younger at the time of surgery. This suggests that in properly screened patients, even in older patients with combined ancillary procedures, secondary face lifting is both common and safe. (Aesthetic Surg J 2002;22:526-530.)

Secondary face lift

Robert W. Bernard, MD Sherrell J. Aston, MD Phillip R. Casson, MD Stanley A. Klatsky, MD Dr. Bernard: The first patient is a 70-year-old nonsmoker who underwent a deep plane face lift about 10 years ago (Figure 1). She wants to see improvement in the jowls, cheek, neck, and jaw line. You will notice that there is some asymmetry of her face. She has had no nerve damage. She has what appears to be a pretragal incision. Given that this is a secondary face lift, how would you approach treating this patient? Figure 1. This 70-year-old woman is a nonsmoker who underwent a “deep plane” face lift about 10 years ago. Dr. Klatsky: She does have facial asymmetry and upper eyelid ptosis. She also looks as if she has some orbital dystopia where the right side of the nasojugal groove is lower than the left. Her asymmetry also reflects into the modiolus, the right corner of her mouth is lower than the left, and she shows more relaxation, at least in the frontal view, on the right. She has either a relaxed platysma or it could possibly be a ptotic submaxillary gland. I am not really concerned with what plane has been dissected. Sometimes we may be fortunate enough to have this information, but many times we simply have no way of knowing. I am concerned, however, with the placement of the incision. The photograph shows an incision anterior to the tragus that is hypopigmented, as well as a little dart near the earlobe that is also white. Most likely, I would approach this patient with a retrotragal incision. If I believed that the hairline would be shifted significantly, I might consider a pre-tricheal (anterior hairline) incision. I cannot tell from this photograph whether the patient's previous incision was within the hairline …

The S-lift: Less Is More

Ziya Saylan, MD, Dusseldorf, Germany The typical superficial musculoaponeurotic system (SMAS) face lift of today involves extensive undermining of facial skin, a potentially lengthy healing time, and risk of complications. The newly repopularized S-lift technique, originally developed in the 1960s, is a more conservative procedure that carries fewer risks of complications. Ideal for both beginning and experienced surgeons who desire natural-looking results with minimal recovery time, the S-lift technique consists of a skin excision at the midface and a modified SMAS plication. A smaller excision of skin (Figure 1) and a new suspension technique developed by the author can lead to results similar or even superior to those associated with the traditional face lift in the lower face and neck. The S-lift technique offers many advantages, including a short duration of surgery, a rapid recovery period, more natural results, minimal scarring and hair loss behind the ears and temporal region (Figure 2), and less danger of facial nerve injury. Figure 1 Undemining of the skin during various face lifts. A , skin lift. B , S-lift. C , Face lift with extensive undermining. Figure 2 An S-formed area of skin is excised. The scar that results from this surgery is acceptable. Although the S-lift is ideally suited for the younger patient with early laxity of the lower face, it can be used in secondary face lifts and in older patients with lower-face laxity. One hundred fifty to 250 mL of tumescent solution is …

The pre-sideburn incision preserves the sideburn

Bernard L. Kaye, MD, Jacksonville, FL , is a board-certified plastic surgeon and an ASAPS member. I perform a large number of secondary face lifts on women and have seen their sideburns climb higher and higher until the lower temporal region becomes barren of hair. I initially used the pre-hairline incision only for the secondary face lifts of patients who had a sideburn at the root of the helix or higher, going around the sideburn and then directly upward—not anteriorly—and leaving the sideburn width about 3 cm anterior to the ear. Thus, the sideburn is not elevated and is not a part of the dissection. From that point the dissection is subcutaneous. I now use this incision almost exclusively unless a woman has a low sideburn to begin with, in which case I use a conventional incision. Thus a woman can retain her sideburns regardless of how many …