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Stein MJ, Shah N, Harrast J, Zins JE, Matarasso A, Gosain AK. Clinical Practice Patterns in Facelift Surgery: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery. Aesthetic Plast Surg 2024; 48:793-802. [PMID: 38302713 DOI: 10.1007/s00266-023-03841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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 61 years. 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). CONCLUSIONS 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. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- Michael J Stein
- Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Nikhil Shah
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital of Northwestern Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA
| | | | - James E Zins
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Alan Matarasso
- Department of Plastic and Reconstructive Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Ann and Robert H. Lurie Children's Hospital of Northwestern Feinberg School of Medicine, 225 E. Chicago Ave., Box 93, Chicago, IL, 60611, USA.
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Han CH. Rotation of a Part of the Composite Flap for Simultaneous Gonion Reduction and Malar Augmentation During Rhytidectomy in Asians. Ann Plast Surg 2024; 92:267-273. [PMID: 38394266 DOI: 10.1097/sap.0000000000003739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND The desired facial shape that Asians aim to achieve through plastic surgery differs from that of westerners. OBJECTIVES The author facilitates facial volume deflation by using the rotation of a part of the composite flap to the malar area resulting in volumetric augmentation during rhytidectomy; simultaneously, a volumetric reduction was implemented in the gonion. METHODS Extended deep plane rhytidectomy with the rotation of a part of the composite flap was performed in 49 patients, whereas extended deep plane rhytidectomy without the rotation of a part of the composite flap was performed in 20 patients. For the results, the satisfaction survey of the surgery was conducted in all patients and by 2 surgeons during a follow-up visit 12 months later. To assess the surgical outcome objectively, the author used the Allergan photometric midface volume deficit scale to measure the midface volume. The midface contour and degree of projection were analyzed using lateral view photographs of the patients. The measurement of segment CM (distance between the lateral canthus and mouth corner) and segment MA (distance from segment CM to the most protruding malar area) was performed. RESULTS The patients who underwent extended deep plane rhytidectomy with the rotation of a part of the composite flap reported higher overall satisfaction and achieved more favorable results, as evaluated by the 2 aesthetic surgeons (P < 0.05). The scores on the Allergan photometric midface volume deficit scale showed a significant increase before and after the surgery in both groups (P < 0.05), also as evaluated by the 2 aesthetic surgeons. However, the change in scores was found to be higher in the extended deep plane rhytidectomy with the rotation of a part of the composite flap group. The midface contour and degree of projection showed an increase of 20.6% on the right face and 22.7% on the left face, respectively (P < 0.001). CONCLUSION Using the rotation of a part of the composite flap during rhytidectomy resulted in overall satisfactory outcomes for all patients. Based on these findings, it can be concluded that the use of this surgical method is beneficial and effective.
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Affiliation(s)
- Chung Hee Han
- From the Decade Renewal Aesthetic Surgery Clinic, Seoul, South Korea
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Kucukguven A, Galandarova A, Bitik O. A Systematic Review and Meta-Analysis of Early Relapse After Facelift. Aesthetic Plast Surg 2023; 47:144-155. [PMID: 35534779 DOI: 10.1007/s00266-022-02894-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/27/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early relapse is an adverse outcome of facelift surgery. The rate of early relapse is an indirect measure of the longevity and efficacy of facelift techniques. However, early relapse after facelift is ill-defined, under-evaluated, and under-reported, and literature data on the subject are dispersed. In this systematic review, we aimed to analyze facelift studies using relapse-related outcomes (RROs). Our secondary aim was to highlight the importance of early relapse as an essential outcome measure. METHODS The study design was a systematic review of the English literature and meta-analysis of RROs after facelift surgery. RROs that occurred within the first 2 years after surgery were considered "early". Performance, analysis, and reporting were performed in accordance with the PRISMA guidelines. The systematic search was conducted using the PubMed database as of February 2020. Initial screening was performed using the keywords "facelift", "rhytidectomy", "surgical rejuvenation", "face lift", "rhytidoplasty", and "facial rejuvenation". Articles were excluded by using a set of inclusion and exclusion criteria. RESULTS RROs were reported only in 4.4% (19/433) of the papers that underwent full-text review. The frequency of RROs ranged between 0.2 and 50% among facelift papers. The weighted median rate of RROs after facelift surgery was found to be 2.4% in the meta-analysis. CONCLUSIONS Future research on preventive measures will be successful upon acknowledgment of the actual prevalence of this problem. Consensus on its definition and objective criteria for its diagnosis are required for further progress. LEVEL OF EVIDENCE III 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 .
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Affiliation(s)
- Arda Kucukguven
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Zhao R, Wang G, Xie H. Subcutaneous Face and Neck Lift With Prefabricated Skin Excision: A Practical Technique With Favorable Results in Young and Middle-Aged Chinese Patients. Dermatol Surg 2022; 48:1317-1323. [PMID: 36449874 DOI: 10.1097/dss.0000000000003631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Subcutaneous face and neck lift is a popular procedure in Chinese face and neck rejuvenation. However, there are limited studies focusing on the details and evaluation of this technique. OBJECTIVE To introduce our subcutaneous face and neck lift technique with prefabricated skin excision, evaluating the efficacy with patient reported FACE-Q Scale. In addition, to investigate on skin excision and patient's satisfaction under different circumstances. MATERIALS AND METHODS One hundred forty-five consecutive patients were identified who underwent subcutaneous face and neck lift with our technique. Online FACE-Q Scale was assessed for patients' satisfaction 6 months postoperatively. The skin excision and FACE-Q Scale were compared among different subgroups. RESULTS Fifty-eight patients completed the FACE-Q. Patients demonstrated high satisfaction overall and felt 8.8 years younger than their actual age. Intraoperative skin excision data verified the practicality of the prefabricated technique. There was a constant trend with patients' satisfaction among different age groups. The preliminary comparison between the facial bone reduction group and the general group revealed no significant difference. CONCLUSION The subcutaneous face and neck lift technique with prefabricated skin excision is an effective technique with favorable results in young and middle-aged Chinese patients. LEVEL OF EVIDENCE IV. Evidence obtained from a retrospective cohort analytic study.
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Affiliation(s)
- Runlei Zhao
- All authors are affiliated with the Department of Plastic Surgery, Peking University Third Hospital, Beijing, China
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Face Lift Practice Patterns: An American Society of Plastic Surgeons Member Survey, 2000 and 2020. How Much Have We Changed? Plast Reconstr Surg 2022; 149:1096e-1105e. [PMID: 35383689 DOI: 10.1097/prs.0000000000009097] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2000, Matarasso et al. performed a survey of American Society of Plastic Surgeons members' face lift practice patterns. Since that publication, the aesthetic marketplace has changed dramatically, as have ancillary face lift techniques. In an attempt to detail these changes, we repeated that original survey, adding questions to address more recent technical issues and advances. The goal of this report was to define current face lift practice patterns, compare current patterns to the previous ones, and define recent advances. METHODS A 38-question survey assessing face lift techniques, perioperative management, complications, and concomitant procedures was electronically distributed to a random cohort of American Society of Plastic Surgeons members. Data were recorded and statistically analyzed utilizing the Pearson chi-square test. RESULTS A total of 251 forms were returned and analyzed. Details of demographics, face lift techniques, ancillary procedures, perioperative care, and complications are presented. Current results were compared to the previously published society member practice patterns delineated in the 2000 Plastic and Reconstructive Surgery publication. CONCLUSIONS The basic approach of American Society of Plastic Surgeons members to the face lift operation has not changed dramatically over the past 20 years. The development of operative adjuncts, however, has been positive, including fat grafting techniques, concomitant use of skin resurfacing, and means of minimizing blood loss with tranexamic acid. In certain instances, respondents do not follow evidence-based guidelines for perioperative care. Finally, common complications of practicing members appear to coincide with published retrospective reviews.
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Easy and Safe Simultaneous Zygoma Reduction and Facelift by Single incision through Subcutaneous Approach. J Plast Reconstr Aesthet Surg 2022; 75:3513-3520. [DOI: 10.1016/j.bjps.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/23/2022] [Accepted: 05/27/2022] [Indexed: 11/21/2022]
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Botti C, Botti G, Pascali M. Facial Aging Surgery: Healing Time, Duration Over the Years, and the Right Time to Perform a Facelift. Aesthet Surg J 2021; 41:NP1408-NP1420. [PMID: 34337655 DOI: 10.1093/asj/sjab304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The "time variable" assumes paramount importance, especially regarding facial rejuvenation procedures. Questions regarding the length of recovery time before returning to work, how long the results will last, and the ideal time (age) to undergo this particular type of surgery are the most commonly asked by patients during the initial consultation. OBJECTIVES The authors endeavored to determine the healing time, optimal age to perform the surgery, and duration of the results after cosmetic face surgery. METHODS A 35-year observational study of 9313 patients who underwent facial surgeries was analyzed. The principal facial rejuvenation interventions were divided into 2 subgroups: (1) eyelid and periorbital surgery, including eyebrow lift, blepharoplasty, and its variants and midface lift; and (2) face and neck lift. Significant follow-ups were conducted after 5, 10, and 20 years. To evaluate the course of convalescence, the degree of satisfaction with the intervention, and the stability of the results, a questionnaire survey was administered to a sample of 200 patients who underwent face and neck lifts. RESULTS The answers given indicated that surgery performed according to rigorous standards allowed for a relatively rapid recovery, and the positive results were stable up to 10 years after surgery. The level of patient satisfaction also remained high even after 20 years. CONCLUSIONS The "right time" for a facelift, taking into account age, recovery time, and the longevity of the results, is an important consideration for both the patient and the cosmetic surgeon. LEVEL OF EVIDENCE: 4
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Hashem AM, Couto RA, Surek C, Swanson M, Zins JE. Facelift Part II: Surgical Techniques and Complications. Aesthet Surg J 2021; 41:NP1276-NP1294. [PMID: 33558887 DOI: 10.1093/asj/sjab081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although previous publications have reviewed face and necklift anatomy and technique from different perspectives, seldom were the most relevant anatomical details and widely practiced techniques comprehensively summarized in a single work. As a result, the beginner is left with a plethora of varied publications that require sorting, rearrangement, and critical reading. A recent survey of US plastic surgery residents and program directors disclosed less facility with facelift surgery compared with aesthetic surgery of the breast and trunk. To this end, 4 of the widely practiced facelift techniques (ie, minimal access cranial suspension-lift, lateral-SMASectomy, extended-SMAS, and composite rhytidectomy) are described in an easy review format. The highlights of each are formatted followed by a summary of complications. Finally, the merits and limitations of these individual techniques are thoroughly compared and discussed. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ahmed M Hashem
- Department of Plastic Surgery at Cairo University, Cairo, Egypt
| | | | | | - Marco Swanson
- Department of Plastic Surgery at Case Western University, Cleveland, OH, USA
| | - James E Zins
- Department of Plastic Surgery at Cleveland Clinic Foundation, Cleveland, OH, USA
- Facial Surgery co-section editor for Aesthetic Surgery Journal
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Shauly O, Stone GL, Shin R, Grant Stevens W, Gould DJ. Evaluating Facelift Complications and the Effectiveness of the SMASectomy Technique: A Single Center's 15-Year Experience. Aesthet Surg J Open Forum 2021; 3:ojab030. [PMID: 34617012 PMCID: PMC8489308 DOI: 10.1093/asjof/ojab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Facelift continues to be one of the most common aesthetic procedures performed in the United States. Although there exist many techniques and variations, superficial musculoaponeurotic system (SMAS) manipulation, by way of plication, overlap, or SMASectomy, is common and has been shown to result in favorable cosmesis and durability. However, there is a lack of current complications data in the discussion of this technique. OBJECTIVES To assess the benefits and risks of the SMASectomy technique. METHODS The records of all patients who underwent a facelift procedure between December 2004 and March 2019 were reviewed for this study. All procedures were performed at an American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)-accredited outpatient facility in Marina Del Rey, California. This represents data on 241 total patients. Retrospective chart review was performed to include data on patient characteristics, operative technique, and complications. RESULTS Average operative time of 152.68 ± 51.50 minutes and anesthesia time of 175.00 ± 54.07 minutes were observed among those patients who underwent SMASectomy. This was significantly lower (P < 0.000001) than those who did not undergo SMASectomy (average operative time of 265.25 ± 85.25 minutes and anesthesia time of 294.22 ± 85.31 minutes). There were no observed facial nerve injuries among patients who underwent SMASectomy. No deep vein thrombosis (DVT) events were observed in this patient population. CONCLUSIONS In the hands of an experienced surgeon, the SMASectomy facelift technique offers the unique advantage of significantly reducing operating time and anesthesia time and can provide extremely favorable and long-lasting aesthetic results. LEVEL OF EVIDENCE 3
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Affiliation(s)
| | | | | | | | - Daniel J Gould
- Corresponding Author: Dr Daniel J. Gould, 1510 San Pablo Street, Suite 415, Los Angeles, CA, 90033, USA. E-mail: ; Twitter: @Danjgould
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Gasperoni C, Gasperoni P, Pino V. Conservative Neck Rejuvenation. Facial Plast Surg 2021; 37:400-406. [PMID: 33706387 DOI: 10.1055/s-0041-1725167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In the field of facial rejuvenation, among the recurrent topics, one of the most discussed is the return to less invasive techniques. Lower face rejuvenation is best achieved acting on the platysma muscle. Many techniques are used and usually include platysma section, redundancy reduction, and redraping. Platysma plication is also used especially in secondary cases because of the increased risk of nerve injury due to possible anatomical damage caused by previous operations. A technique that preserves the deep planes based on a new plication method is proposed (conservative neck rejuvenation). In this technique, the dissection plane is only subcutaneous to reduce the risk of nerve injuries. An effective neck contouring is possible using a simpler technique with very good results and a lower rate of morbidity.
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Affiliation(s)
| | - Paolo Gasperoni
- Plastic Surgery Center Center, Quisisana Clinic, Rome, Italy
| | - Valentina Pino
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
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SMAS Advancement with Fat Enhancement (SAFE) Lift. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3364. [PMID: 33680641 PMCID: PMC7929536 DOI: 10.1097/gox.0000000000003364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
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Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2791. [PMID: 33133889 PMCID: PMC7572151 DOI: 10.1097/gox.0000000000002791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/28/2020] [Indexed: 11/26/2022]
Abstract
Any face/neck lift operation has a natural flow of slower and speedier portions; slower when dissecting under the superficial musculoaponeurotic system and around nerves while faster during opening, undermining, defatting, and closing. Surgeons can maximize efficiency with these simple maneuvers.
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Namin A, Shokri T, Vincent A, Saman M, Ducic Y. Complications in Facial Esthetic Surgery. Semin Plast Surg 2020; 34:272-276. [PMID: 33380913 PMCID: PMC7759431 DOI: 10.1055/s-0040-1721764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Esthetic surgery continues to become increasingly popular both in the United States and globally. Facial esthetic procedures in particular account for a large proportion of procedures performed. This increase in popularity will inevitably result in the number of potential complications associated with these procedures. In this review, the authors describe common complications encountered with frequently performed cosmetic facial procedures and their associated management. This article is meant as a general overview and introduction to potential complications surgeons may encounter, interested readers are encouraged to further review comprehensive subspecialty literature for more detailed discussion.
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Affiliation(s)
- Arya Namin
- Department of Otolaryngology – Head and Neck Surgery, University of Missouri, Columbia, Missouri
| | - Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Aurora Vincent
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Masoud Saman
- Saman Center for Facial Plastic Surgery, Plano, Texas
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Refinements in Tailoring the Lift-and-fill Facelift. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2827. [PMID: 32766031 PMCID: PMC7339365 DOI: 10.1097/gox.0000000000002827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/18/2020] [Indexed: 11/28/2022]
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Skin Excursion with Cannula Lipodissection and the Anatomical Implications of Superficial Musculoaponeurotic System Movement in the Tumescent Face Lift. Plast Reconstr Surg 2020; 146:269-276. [PMID: 32740573 DOI: 10.1097/prs.0000000000006977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The tumescent face lift uses the concept of subcutaneous cannula lipodissection of the neck, as opposed to wide skin undermining. Lipodissection mobilizes soft tissue while preserving perforating neurovascular branches. The purpose of this study is two-fold: (1) to compare the skin recruitment with subcutaneous lipodissection of the neck alone versus wide undermining and (2) to examine the effect of superiorly oriented superficial musculoaponeurotic system (SMAS) movement on jowl excursion in the tumescent face lift. METHODS A cadaveric study was performed on five fresh tissue cadavers. Postauricular skin excursion was measured following subcutaneous lipodissection and then measured again after traditional, wide undermining of the neck skin. Jowl excursion (in reference to the mandibular border) was measured following superiorly oriented SMAS excursion. An electronic force gauge was used to measure force application during measurements. RESULTS Cannula lipodissection resulted in a mean skin excursion of 41.9 mm. There was no significant difference in skin excursion compared to wide undermining (41.9 mm versus 42.1 mm; p = 0.785). Jowl position, in reference to the mandibular border, moved superiorly by a mean distance of 18.3 mm with vertical SMAS excursion. CONCLUSIONS Subcutaneous cannula lipodissection results in equivalent skin recruitment in comparison to wide undermining of the neck. A superior vector of pull on the SMAS results in vertical excursion of the jowl in reference to the mandibular border.
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Bertossi D, Nocini PF, Rahman E, Heydenrych I, Kapoor KM, de Maio M. Non surgical facial reshaping using MD Codes. J Cosmet Dermatol 2020; 19:2219-2228. [PMID: 32623790 DOI: 10.1111/jocd.13596] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Both age-related and congenital volume deficiencies may be addressed through the injection of hyaluronic acid (HA) fillers. Deep injection provides structural support, more superficial fat-tissue injection mediates contouring, and superficial intradermal use of HA filler and/or onabotulinumtoxinA may be used for refinement. AIMS To evaluate the clinical efficacy, patient satisfaction, and safety of the MD Codes approach as a proposed standardized methodology for full-face rejuvenation. METHODS This was a retrospective, single-center study of 250 consecutive adult patients undergoing full-face rejuvenation with HA fillers (Vycross) and onabotulinumtoxinA based on the MD Codes approach. RESULTS The mean age was 39.4 ± 11.6 years, and 80.4% were female. All patients were treated with HA filler in the midface; 89.6% were also treated in the upper face, and 63.2% in the lower face. The mean number of syringes used was 14 ± 4 (range 4-25), with more syringes typically required in older versus younger patients. All patients received onabotulinumtoxinA treatment. Mean FACE-Q Appearance-Related Psychosocial Distress score decreased from 54.3 ± 9.3 pretreatment to 36.1 ± 8.9 at 3 months post-treatment (P < .05). The most common complications were bruising (35.2%), transient soft-tissue edema (14.0%), and prolonged periorbital edema (3.6%). CONCLUSIONS Full-face rejuvenation based on the MD Codes approach provides significant esthetic improvements, with no major safety issues observed.
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Affiliation(s)
- Dario Bertossi
- Department of Oral and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Verona, Italy
| | - Pier Francesco Nocini
- Department of Oral and Maxillofacial Surgery, Policlinico G.B. Rossi, University of Verona, Verona, Italy
| | - Eqram Rahman
- Professor of Practice, University College London, London, UK
| | - Izolda Heydenrych
- Cape Town Cosmetic Dermatology Centre, Central Park on Esplanade, Cape Town, South Africa.,Division of Dermatology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Getting Better Results in Facelifting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2270. [PMID: 31624678 PMCID: PMC6635200 DOI: 10.1097/gox.0000000000002270] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/02/2019] [Indexed: 11/25/2022]
Abstract
The facelift has significantly evolved over the past several decades. What was once considered a skin only operation is now a sophisticated, elegant procedure that requires meticulous preoperative analysis, understanding of underlying anatomically based aging changes, and extreme attention to detail. According to the American Society of Plastic Surgeons, 125,697 facelifts were performed in 2017. It is not surprising that given these advances that facial rejuvenation surgery is still a very common procedure with a high degree of patient satisfaction despite the increase in nonsurgical facial aging treatments. With an improved understanding of facial anatomy including the facial retaining ligaments and intervening superficial and deep fat compartments, the modern facelift requires an anatomically targeted approach. Furthermore, the modern facelift surgeon must achieve consistently excellent results with reasonably little downtime while being aware of methods to improve the safety of this popular elective procedure. Hematoma is the most common complication after rhytidectomy with an incidence between 0.9% and 9%, with a higher incidence in males. Other potential complications include seroma, nerve injury, skin flap necrosis, siaolocele as a consequence of submandibular gland debulking, and skin flap rhytid and hairline distortion. This review aims to discuss safe, consistent, and reproducible methods to achieve success with facelift.
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Role of Ancillary Procedures in Facial Rejuvenation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2075. [PMID: 31624657 PMCID: PMC6635208 DOI: 10.1097/gox.0000000000002075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/19/2018] [Indexed: 11/26/2022]
Abstract
Face-lift techniques have evolved beyond the concept of lifting and now include incorporating superficial and deep filling of facial fat compartments to address volume deflation and aging. In addition to traditional face-lift methods involving the excision and tightening of skin and the underlying soft tissues, the following ancillary procedures have become paramount in achieving an optimal result: blending the lid-cheek junction; chin augmentation; lobule augmentation; hand rejuvenation; perioral rejuvenation; chemical peels; and laser resurfacing. We presented a summary of these integral techniques.
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Moris V, Bensa P, Gerenton B, Rizzi P, Cristofari S, Zwetyenga N, Guilier D. The cervicofacial lift under pure local anaesthesia diminishes the incidence of post-operative haematoma. J Plast Reconstr Aesthet Surg 2019; 72:821-829. [DOI: 10.1016/j.bjps.2018.10.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/06/2018] [Accepted: 10/28/2018] [Indexed: 11/25/2022]
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Wang R, Yang J, Guo K, Zhong A, Tong J, Xiong L, Sun J. Periauricular Purse-String Reinforced with SMAS plication and Malaria Fat Pad Elevation for Mid-and Lower Facial Rejuvenation. Ann Plast Surg 2018; 81:S59-S65. [DOI: 10.1097/sap.0000000000001496] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
After massive weight loss, deflation of the tissues and loss of skin elasticity in the face and neck can result in the appearance of accelerated facial aging. Surgical facial rejuvenation can be successfully performed with several modifications. Proper preoperative counseling and expectation management regarding staged or ancillary procedures is recommended. Wide undermining of the face and neck, and extended postauricular incisions are required to allow for mobilization of excess skin and access to the mobile superficial musculoaponeurotic system (SMAS). Fat transfer into the deep malar compartment for midface volumizing is helpful. Treatment of the SMAS and platysma are universally necessary.
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Affiliation(s)
- Joshua T Waltzman
- Private Practice, Waltzman Plastic and Reconstructive Surgery, 3828 Schaufele Avenue, #360, Long Beach, CA 90808, USA.
| | - James E Zins
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA
| | - Rafael A Couto
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA
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The Individualized Facelift Technique in Improving Facial Asymmetry for Asian Patients. Ophthalmic Plast Reconstr Surg 2018; 34:516-521. [DOI: 10.1097/iop.0000000000001072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cotofana S, Gotkin RH, Ascher B, Morozov SP, Gombolevsky VA, Laipan AS, Pyatintsky IA, Movsisyan TV, Koban KC, Hladik C, Frank K. Calvarial Volume Loss and Facial Aging: A Computed Tomographic (CT)-Based Study. Aesthet Surg J 2018; 38:1043-1051. [PMID: 29635393 DOI: 10.1093/asj/sjy096] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Our understanding of the aging changes involving the cranium and its impact on the overlying soft tissues is limited. OBJECTIVES This study was designed to look at the changes that occur in the cranium with aging and to propose an additional mechanism for loss of support for overlying soft tissues. METHODS One hundred and fifty-seven white individuals (10 males and 10 females in each decade: 20-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, 80-89 years, and 8 males and 9 females aged 90-98 years) were investigated. Computed tomographic (CT) multiplanar scans with standardized measurements of cranial thickness were performed for the frontal bone, nasion, vertex, pterion, lambda, calvarial and midfacial height, and sagittal and transverse diameter. RESULTS Increasing age correlated with a decrease in sagittal diameter in both males (rp = -0.201) and females (rp = -0.055) but with an increase in transverse diameter in both males (rp = 0.233) and females (rp = 0.207). Frontal bone thickness decreased in males -1.57mm/-18.14%, whereas it increased slightly in females +0.26mm/+3.04%. At the pterion, bone thickness increased significantly in both genders. Calvarial volume decreased with increased age in both males and females: -70.2 ml/-5.35% and -61.4 ml/-5.10%, respectively. CONCLUSIONS The lateral expansion of the skull may favor a skeletonized appearance of the face in elderly individuals. The computed volume of the calvaria decreased with advancing age in both genders, providing an additional element in the multifactorial model for facial soft-tissue laxity. LEVEL OF EVIDENCE 2
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Affiliation(s)
- Sebastian Cotofana
- Department of Medical Education, Albany Medical College, Albany, NY, USA
| | | | - Benjamin Ascher
- Plastic and Reconstructive Surgeon, Iena Plastic Surgery Clinic, Paris, France
| | - Sergey P Morozov
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Victor A Gombolevsky
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Albina S Laipan
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Ilya A Pyatintsky
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Tigran V Movsisyan
- Research and Practical Center of Medical Radiology, Department of Health Care of Moscow, Moscow, Russia
| | - Konstantin C Koban
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig, Germany and Maximilian University Munich, Munich, Germany
| | - Casey Hladik
- Department of Medical Education, Albany Medical College, Albany, NY, USA
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig, Germany and Maximilian University Munich, Munich, Germany
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Hodgkinson DJ. The Fate of Fogli's Lore's Fascial Platysma Fixation Optimalising the Results of Fogli's Neck Lift Procedure. Aesthetic Plast Surg 2018; 42:1002-1012. [PMID: 29770861 DOI: 10.1007/s00266-018-1147-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/28/2018] [Indexed: 10/16/2022]
Abstract
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 3 cm 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 .
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Innovative Surgical Approach Using a Mesh Sling for the Aging Neck. Plast Reconstr Surg 2018; 141:1386-1391. [PMID: 29794700 DOI: 10.1097/prs.0000000000004422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rejuvenation of the neck is essential to achieve a young facade. Different approaches for aging neck rejuvenation have been developed throughout the years. Most of them focus on specific elements that contribute to the aging neck. The main drawbacks of these techniques are recurrence of the platysma bands, malposition, deformations, salivary problems, and defatting. These disadvantages and limitations have led the author to create a novel surgical approach to improve the aging neck that would be suitable for most patients. Instead of dealing with each of the elements of the aging neck, the author's approach involves use of a sling to elevate all the descending elements as a whole to create a natural and longstanding result. METHODS Since March of 2014, 10 patients have been operated on for neck lifting with this new approach. Four different types of material have been used: absorbable synthetic braided (Vicryl) in five patients, semiabsorbable synthetic braided and monofilament (Vypro) in one patient, absorbable synthetic matrix (TIGR) in three patients, and biological mesh-allograft material (AlloDerm) in one patient. Follow-up visits were made after 10 days, 3 months, 6 months, and annually. RESULTS In all cases, the operations were uneventful. There were no major complications. Minor complication occurred in one patient with the Vypro mesh. The mesh caused stiffness and was replaced. Final aesthetic results were satisfactory in all cases. CONCLUSIONS Current approaches for improvement of the aging neck do not fit all aging neck cases and are suitable for only a specific dominant element. The aging neck tends to reappear faster than expected because of recurrence or dominance of another element. The author's novel approach is more predictable and is suitable for most cases regardless of the dominant part causing the aging. More experience and longer follow-up are needed to choose the most appropriate material for the mesh. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Abstract
The neck is an aesthetic unit for which a rejuvenation request is sometimes very targeted or ore often encompassed in a global surgical project of face-lift. To obtain a long lasting outcome, the plastic surgeon has to make a full, detailed, and exhaustive analysis of the neck in order to choose the best indication within the multiple surgical tools. A full clinical examination is the key point, every aspects are outlined. The numerous surgical choices are described, illustrated, and sometimes revisited in the light of targeted anatomical studies. A didactic and graduated way is used to explain the recent evolutions of the surgical tools of the cervical lifting. Complications and insufficiencies in outcomes must be identified and explained. Finally, we illustrate this development by clinical cases. The surgical improvement of the cervical region is, for us, centered on the reconstruction of a cervical retaining structure: the Cervico-Mandibular Angle Suspensor (CMAS) ligament. This element makes it possible to understand and integrate the large number of technical proposals for cervical lifting.
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Abstract
OBJECTIVE The proposal is to demonstrate that facelift surgery is particularly suitable for the care in ambulatory. METHODS Between 2010 and 2016, 246 patients were operated for a facelift in ambulatory. RESULTS No major complication arose in this series (241). Among the patients, 98% expressed their satisfaction and would accept again this intervention in ambulatory. CONCLUSION The facelift can be realized in ambulatory with complete safety. The rate of satisfaction shows a very strong support of the patients for the ambulatory care.
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