The S-Lift Facelift Featuring the U-Suture and O-Suture Combined with Skin Resurfacing

The lipo-facelift: merging the face-lift and liposculpture: eight years experience and a preliminary observational study

BACKGROUND

Since the introduction of the classic submucosal aponeurotic system (SMAS) face-lift, the surgical approach to improve the changes of an aging face has evolved, and significant technical improvements have been made. However, several problems still have not been solved satisfactorily. These problems include facial lipodystrophy and changes in skin and skin texture.

METHODS

The Lipo-Facelift procedure consists of facial liposculpturing performed simultaneously with a biplanar, bivectorial SMAS face-lift procedure. The authors analyzed pre- and postsurgical photographs of 12 patients with a Lipo-Facelift after 3 and 12 months and analyzed their charts for complications. Furthermore, O2C measurement was performed to assess improved microcirculation. The longest follow-up period was 8 years.

RESULTS

The Lipo-Facelift demonstrated very satisfying results. Initial swelling and bruising were seen as well as two cases of wound-healing disorders, but no surgical intervention or revision was needed. The findings show lasting improvement of skin quality and a youthful appearance.

CONCLUSION

The Lipo-Facelift corrects age-related skin and SMAS changes as well as age-related lipodystrophy, improves skin circulation and skin revitalization, and provides a lasting and natural result. The skin quality resulting from simultaneous lipofilling can be explained by improved angiogenesis due to transferred growth factors in the lipoaspirate. Also, differentiation of progenitor cells to fibroblasts and increased production of collagen contribute to firmer skin.

LEVEL OF EVIDENCE IV

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Rhytidectomy

The understanding of cervicofacial anatomy, and of the physiologic and anatomic changes that occur with the aging process, has vastly increased over the past three to four decades. This knowledge has led to more logical approaches to face-lift surgery. Vastly different than most other surgical domains, cervicofacial rhytidectomy is a cosmetic procedure. Face-lift surgery is driven not just by the ultimate result, but also by patient-driven economic factors of cost and recovery time. General resistance by patients to what they perceive as more invasive procedures often also plays a significant role in planning procedures.

Advances in facial rejuvenation surgery

There have been many important contributions to the literature on the subject of facial rejuvenation surgery. There has been a trend toward less invasive techniques that offer patients shorter recovery periods with levels of aesthetic satisfaction comparable to those of more invasive and complex procedures. Techniques reviewed in this article include midface suture meloplication, and purse-string suture suspension of the superficial musculoaponeurotic system to effect changes in the lower one third of the face. Another exciting area is the use of fibrin sealants and autologous platelet gels to enhance the adhesion of the tissue flaps at closure and reduce the amount of ecchymosis and edema in the recovery period. Their ability to decrease bruising, swelling, and lessen the frequency of complications has the potential of increasing patient satisfaction through a quicker return to normal activities.

Minimal access cranial suspension lift: a modified S-lift

There is a strong trend at hand toward less dramatic facial rejuvenation surgery. Most of the authors' patients want a cosmetic improvement but not at the cost of prolonged disfigurement or a high risk of complications. In 1999, a very simple but effective rhytidectomy technique, termed an S-lift, was described in the literature and was adopted by the authors. Its basic principle is the suspension of sagging facial features by a strong, permanent purse-string suture. The procedure is performed with the patient under local anesthesia. Significant modifications were applied to the incision, to the purse-string suture anchoring site, and to the direction and shape of the skin excision. The authors named the modified procedure the minimal access cranial suspension lift to specifically describe the concept of the technique. Through an inverted L-shaped preauricular incision with extension below the sideburn, a limited skin undermining is performed. Two strong, permanent purse-string sutures are woven into the superficial musculoaponeurotic system tissues in a vertical U and an oblique O shape, initiating from a strong anchorage in the deep temporal fascia at the level of the helical crus. Tying these sutures produces a very powerful vertical correction of descended facial features that acts mainly on the jowls and the upper neck. The procedure can be extended by continuing the dissection over the malar fat pad, placing a third vertical purse-string suture with strong action on the nasolabial groove, and vertically repositioning the midfacial volumes. During 20 months, pleasing results and a very low complication rate were obtained in 88 consecutive patients with a mean age of 551/2 years. In this article, the authors provide a detailed description of the anesthetic and surgical technique, a demonstration of the results in different patient age categories, and a discussion comparing the minimal access cranial suspension lift with other types of facial rejuvenation procedures.