Application of double plication suspension utilizing barbed sutures on SMAS in middle and lower face lift / 中华整形外科杂志

Objective@#This paper describes a technique of facelift that utilizes bidirectional barbed sutures for superficial musculoaponeurotic system (SMAS) double plication. It corrects the facial aging of middle and lower part.@*Methods@#An extensive skin flap was undermined subcutaneously, and the sagging tissue of SMAS was lifted latero-superiorly by a secured barbed suture in two oval-shaped areas, with double plication, and without the need for knots, in order to correct the nasolabial groove and descended jowls, repositioning the midfacial volumes.@*Results@#A very high patient satisfaction was obtained in 76 patients. One patient had a small hematoma, and one patient had a temporary contour irregularity in the cheek. All resolved without any treatment.@*Conclusions@#The double plication facelift utilizing barbed sutures, mainly affects the middle and lower third of the face. Its advantages are: quick procedure, pleasant results, low complication rate, and short recovery period. It also eliminates the possibility of knot visibility, palpability, or extrusion.

The application of minimally invasive suspension and bury guidance technique in facial rejuvenation / 中华整形外科杂志

Objective@#This paper discusses a surgical method to improve the middle part of face and the temporal surface by using the patented technology of embedding guidance technology.@*Methods@#On the basis of not removing the skin, the application of embedding guidance technology was applied to achieve the effect of facial lifting by placing a 2-0 polyester knitting line under the scalp with a minimally invasive incision(3-5 mm) , paving up to the skull periosteum and down to the hairline edge for compound fixation.@*Results@#Among the 200 patients, 197 were female and 3 were male. Aging from 23-62 years old, all of the patients suffered from mild to moderate problem of saggy skin.Post-operation follow-up was kept from 3 months to 5 years after the treatment, which demonstrated that all of the patients showed different degrees of facial lifting after edema subsided at 3 months, including improvedfacial skin condition, shallower nasolabial groove, lifting of the lateral canthus and tightening of facial skin. The patients were satisfied with the effect.@*Conclusions@#The surgical method is an effective method to solve the problem of facial aging with advantages, such as simple execution, minimized wound, fast recovery, no post-operation bandage requirement and showing great result towards patients suffering from mild and moderate saggy facial skin problem.

Clinical study of therapeutic effect in eyebrow lifting with different incisions / 中华整形外科杂志

Objective@#To evaluate the therapeutic effect of choosing different surgical incisions in eyebrow lifting.@*Methods@#This research recruited 87 female who underwent eyebrow lifting in our hospital from January 2015 to December 2017, with the mean age of 52.4 years ranging from 25 to 71 years. According to the degree of the upper eyelid soft tissue laxity the level of eyebrow drooping and cosmetic patients personal requirements, we performed different surgical incisions respectively. Therefore, there were 39 cases upper-eyebrow incision, 31 cases under-eyebrow incision and 17 cases combined with upper and lower eyebrow incision.@*Results@#87 women who had undergone the 3 months to 4 years follow-up (average period, 6.3-month), are pleased with their eyebrow and rejuvenation after eyebrow lifting, with 90.8% (79 of 87) satisfaction, 6.9% (6 of 87) satisfaction basically and 2.3% (2 of 87) dissatisfaction. And only 2 patients had secondary surgery for unacceptable brow shape.@*Conclusions@#By choosing different eyebrow incisions and removing skin around the eyebrow, there were efficient ways to rectify the upper eyelid skin relaxation and eyebrow drooping, widen the double eyelid line as well as to improve crow′s-feet. We firmly believe that it is essential for surgeons to sufficiently get to know patients′ requirements and design a personalized treatment scheme according to the relaxation degree of the upper eyelid soft tissue and the shape of eye-brow.

Key points of high SMAS facelift / 中华整形外科杂志

Objective@#To summarize the key points of high SMAS facelift.@*Methods@#Forty-six patients who had received high SMAS facelift were included in this study. All the patients had subcutaneous dissection by classic facelift incision. The temporal region dissection was performed superficial to middle temporal fascia to avoid temporal branches injury. The zygomatic ligaments were released by sharp and blunt dissection at malar prominence and zygomatic arch. After sub-SMAS dissection, a complete SMAS-platysma flap was raised including temporal, malar, lower face, neck, and one third or half of the midface.@*Results@#Forty patients had postoprative follow-up for more than one year. Twenty patients showed " excellent" results, eighteen patients had " good" results , two patients " common" . The good and excellent rate was 95%.@*Conclusions@#The key points of high SMAS facelift to achieve ideal outcome depend on the safe dissection of superficial temporal fascia and the release of zygomatic ligaments.

Clinical investigation on skin changes after face lift based on extended subcutaneous and sub-SMAS undermining and multiple accurate plication of SMAS system / 中华整形外科杂志

Objective@#To explore the skin condition and histological changes after face lift based on extended subcutaneous and sub-SMAS undermining and multiple accurate plication of SMAS system.@*Methods@#Eighteen patients that underwent face lift were enrolled according to the inclusion and exclusion criterion. Objective, subjective and histological evaluations were performed to study the skin changes.@*Results@#Nine patients completed the study and skin condition improved significantly after face lift from the objective and subjective results. Histological evaluation revealed that epidermal thickness increased along with dermal collagen content. Collagen and elastic fibers were more condensed after surgery than before, suggesting the dermal regeneration after face lift.@*Conclusions@#Skin regeneration after face lift can help maintain the postoperative result. Extensive subcutaneous dissection along with removal of lax skin as much as possible are the key points of face lift.

Temporal and cheek face lift combined with fat grafting in facial rejuvenation / 中华整形外科杂志

Objective@#To observe the safety and efficiency of face-lift combined with fat grafting in facial rejuvenation.@*Methods@#We performed a retrospective study, which included 23 patients. SMAS suspension and multi-site suspension were combined to correct the nasolabial fold, mid-cheek aging and malar mounds. Structural fat grafting was performed to treat the volume loss in mid-face.@*Results@#All patients demonstrated a significant improvement in midfacial appearance. No infection or nerve injury were found in this study. Only three patients did not get primary healing in temple region, which led to temporal hair loss from secondary healing.@*Conclusions@#This study demonstrates that fat grafting and multiple layers face-lift are efficient method for facial rejuvenation. These approaches appear to be very promising for facial anti-aging techniques.

Evaluation of Elastic Lift for Facial Rejuvenation

BACKGROUND: Thread lift is a minimally invasive procedure for facial rejuvenation, but complications of thread lift have been reported. The purpose of this study was to evaluate outcomes and safety associated with elastic lift in relation to midface and upper mandibular region lifting. METHODS: Thirty-eight patients with sagging and laxity of the facial skin treated with elastic lift from September 2015 to October 2015 were enrolled in this study. Treatment was performed following the manufacturer's recommended protocol that called for 300 treatment lines. To evaluate elastic lift safety, a retrospective chart review was conducted. We used an automatic skin diagnosis system to evaluate the efficacy of elastic lift. RESULTS: Thirty-seven patients were female, and one patient was male. The mean age of the patients was 40.4 years, and their mean follow-up period was 3 months. There were no major complications manifesting in removal of the elastic thread during the follow-up period. The median skin laxity grade score was 5 (3-6) before surgery; the median skin laxity grade score was 3 (2-4) 3 months post-surgery, resulting in a statistically significant difference in skin grade score (P<0.01). CONCLUSIONS: Facial rejuvenation using elastic lift is an effective and safe procedure in select patients with midface ptosis and moderate jowls.

Evaluation of Elastic Lift for Neck Rejuvenation

BACKGROUND: The neck is not only the first area to show aging but it also represents the persona of the individual. The understanding of the aging process of the neck is essential for neck rejuvenation. The purpose of this study was to evaluate the outcomes and safety of elastic lift in relation to neck region lifting. METHODS: Forty-seven patients with sagging and laxity of the neck skin treated by elastic lift were enrolled in this study from November 2015 to February 2016. To evaluate the safety of elastic lift, a retrospective chart review was conducted. We used an automatic skin diagnosis system to evaluate the efficacy of elastic lift. RESULTS: Forty-five patients were female and 2 patients were male. The mean age of the patients was 45.3 years and their mean follow-up period was 3 months. There were no major complications requiring the removal of the elastic thread during the follow-up period. The median skin laxity grade score was 5 (4-5) preoperatively; the median skin laxity grade score was 3 at 3 months postoperatively. In comparing the skin grade score at these two points in time, there was a statistically significant difference (P < 0.01). CONCLUSIONS: Neck rejuvenation using elastic lift is a safe and effective procedure in selected patients with moderate sagging and laxity of the neck skin.

Evaluation of Micro-focused Ultrasound for Lifting and Tightening the Face

BACKGROUND: Micro-focused ultrasound (MFU) has developed as an effective, noninvasive, skin-tightening method. However, certain factors have limited its replacement of invasive surgical procedures, including a relative lack of efficacy, persistence, and reliability. The purpose of this study was to evaluate the efficacy and safety of MFU for noninvasive skin tightening and to determine how long the skin tightening can be maintained. METHODS: Between October 2013 and November 2014, 41 patients with sagging and laxity of the facial skin were treated with MFU. The treatment was performed following the manufacturer's recommended protocol that called for 300 treatment lines. We evaluated the patients using an automatic skin diagnosis system at pretreatment, and 2 and 4 months after treatment. RESULTS: Of the 41 patients treated using MFU, 3 patients were lost to follow-up for non-study-related reasons. In our study, 38 patients (1 male and 37 female) were evaluated and ranged in age from 37 to 52 years. The median skin grade scores were 5 at pretreatment, 3 at 2 months posttreatment and 3 at 4 months posttreatment. After comparing pretreatment and 2 months posttreatment, pretreatment and 4 months posttreatment, and both 2 and 4 months posttreatment, there were statistically significant differences (P<0.01). CONCLUSIONS: This study suggests that the aging face, with wrinkling and sagging, can be improved using MFU, while minimizing injury to the epidermis and dermis.

Nonexcisional, Minimally Invasive Rejuvenation of the Neck Using Radiofrequency Tissue Tightening (FaceTite(TM))

BACKGROUND: Noninvasive radiofrequency (RF) and lasers have been used for skin tightening and body contouring since the 1990s. The safety, efficacy, and patient satisfaction with the procedure using a novel RF device (BodyTite(TM); Invasix Ltd, Yokneam Ilit, Israel) were evaluated. METHODS: We retrospectively included 13 patients who were treated with the BodyTite(TM) to rejuvenate neck skin from May 2012 to May 2014. The power of the device was set between 10 and 15 W. The target temperature was set at 38degrees C. Three independent evaluators were asked to grade baseline and 6- to 12-month follow-up photographs using a comprehensive quantitative 4-point laxity grading scale. All patients were asked to rate their satisfaction with the aesthetic outcome and quality of life after treatment. RESULTS: Grading results of baseline and follow-up photographs of patients were statistically significant with an average grade improvement of 1.01 points on the 4 point scale. Using a patient satisfaction scale, patients were also significantly more satisfied (poor, 0%; fair, 15%; good, 46%; and excellent, 39%). There were transient complications, such as minimal erythema, mild edema, and focal hardness, which resolved spontaneously within 1 week. There were no significant adverse effects or complications. CONCLUSIONS: The BodyTite(TM) is a minimally invasive, RF treatment that was demonstrated to improve skin laxity without significant adverse effects or complications. The BodyTite(TM) provides a nonsurgical option for the safe and effective rejuvenation of neck skin under local anesthesia.

Clinical efficacy of modified rhytidectomy with hidden temporal and buccal incision / 中华医学美学美容杂志

Objective To explore the clinical effect of the modified rhytidectomy technique with hidden temporal and buccal incision.Methods 26 cases of aging face were collected.The operation was performed with modified preauricular incision which was the leading edge of the cartilage of helix and hair line.Preauricular remporal fascia was modified as suspended vertically and SMAS superficial to parotic gland was suspended vertically to nasolabial sulcus.Results All the patients reported fine rejuvenescent effects,the satisfaction rate was 100％ without any severe complications,such as scar,hair loss on temperal incision.Conclusions This surgical technique may maintain natural configuration of preauricular area,result in invisable incision scar with no obvious baldness,and avoid important nerves or vessel injury.

Combined, Minimally Invasive, Thread-based Facelift

BACKGROUND: As society changes, patients have high expectations of plastic surgery and rapid recovery after surgery. A thread-based facelift meets these requirements and is growing in popularity. METHODS: Former thread lifts were either floating or fixed types. The authors used both types. Using a vertical line from the lateral orbital rim as the center, the anterior face was lifted with floating-type threads and the lateral face was lifted with fixed-type threads. The Blue RoseTM thread was used for the combined-type facelift, as it is stronger than other threads. Improvements were measured using the Global Aesthetic Improvement Scale (GAIS). RESULTS: Eighteen patients out of 28 were followed over 3 months. Five patients (28%) reported a GAIS score of 2, 10 patients (55%) had a GAIS score of 3, 2 patients (11%) had a GAIS score of 4, and one patient was unsatisfied with the surgical results. Results showed improvements in 83% of the patients. CONCLUSIONS: The combined, minimally invasive, thread-based facelift has some benefits. First, the functional anatomy of the face is considered. Second, the pulling force of the threads is stronger than formerly used threads. Third, especially in Asian patients, the postoperative broadening of the malar area can be minimized. Thus, a combined thread lift using Blue Rose threads can provide a natural-looking and strong facelift.

Understanding of the Aging Face

Facial aging is a natural and unavoidable process for everyone. During the third decade of life and beyond, there is a gradual change in facial structure. Recently, the demand for facial rejuvenation has grown given the growth of an aging population that is in pursuit of a younger and fresher appearance that is more in line with their concept of aging. Facial plastic surgeons should understand the anatomical changes of the aging face and must be able to guide a patient through an appropriate rejuvenation strategy ranging from noninvasive, nonsurgical, and minimally invasive procedures to major surgical procedures.

Autologous granular fat transplantation in facial rejuvenation / 中华医学美学美容杂志

Objective To investigate methods and experience of autologous granular fat transplantation by correction of aging face. Methods 178 cases of aging face subjects were treated by liposuction. Then autologous granular fat was harvested by liposuction,centrifuged and purified, and injected into marked areas of aging face. The injection process should be controled by multilevel and multiple tennel, in order to supplement the loss of facial soft tissue volume and improve the aging face. Results The follow-up period ranged from 3 months to 3 years. All the subjects had a satisfactory results with no obvious complications such as fat liquefaction, infection and ulceration. The effect of autologous granular fat transplantation was obvious and permanent. Conclusions Autologous granular fat transplantation is a safe and effective surgical technique for facial soft tissue augmentation that can effectively improve aging face and worthy of clinical application.

Extended SMAS Facelift

In order to solve the problems related to aging faces, new techniques, including various kinds of barbed suture technique, are developing in present time. Although these several kinds of noninvasive or minimal invasive method for aging face have their own indication and barely complications, these procedures would be less effective than the extended SMAS technique used on those of Oriental person. In the face, there are some retaining ligaments, which support facial soft tissue against gravitational change. With aging, the cheek soft tissue anterior to the zygomatic ligament and posterior to the mandibular ligament descends into the plane between the superficial and deep fascia. However, the attached area by the zygomatic and mandibular retaining ligaments are almost unchanged because the ligaments that support facial soft tissue in normal anatomic position i.e, ligaments retain their integrity while the soft tissue around it relaxes. These changes lead to the formation of a nasolabial fold and jowl. I think the most important consideration factor before choosing a certain procedure is to decide which procedure could bring more predictable results, make longer lasting effect, and has minimal risk and morbidity. In my opinion, it is rationally impossible to say that one technique is better than the other. I always try to keep in mind that no two patients are the same, so whenever I do my technique, I try to adjust and adapt my technique according to individual specifications. Among the multiple problems related to aging, there are three distinctive features, which are wrinkles, volume loss, and drooping facial soft tissue. There is no single method for removing these problems. If the wrinkles are the main problem, we can get the best result by facial resurfacing. If somebody has deep wrinkles, fold, and drooping facial soft tissue, I usually perform the extended SMAS facelift. I always do it with local anesthesia. Under the intravenous sedation with ketamine, midazolam, and propofol, I infiltrate 2% lidocaine with 1:80,000 epinephrine along the proposed incision line. Next, the tumescent solution is infiltrated into the face and neck dissection area. A total of 300-400ml of tumescent solution is infiltrated on the both sides of the face and neck. After infiltration, I begin working on the neck area first and then try to solve the facial problems. Different problems require different amount of subcutaneous and SMAS dissection. If the patient's main problem is wrinkle and one has a thin skin, one requires wide skin dissection and extended SMAS technique. If the patient's main problem is wrinkle and one has a thick skin, one requires narrow skin dissection and extended SMAS technique. If the patient's main problem is drooping and one has a thin skin, one requires narrow skin dissection and extended SMAS technique. If the patient's main problem is drooping and one has a thick skin, one requires wide skin dissection and extended SMAS technique. If somebody receives foreign body injection or secondary facelift, I do my procedure in case by case.

Extended SMAS Facelift

In order to solve the problems related to aging faces, new techniques, including various kinds of barbed suture technique, are developing in present time. Although these several kinds of noninvasive or minimal invasive method for aging face have their own indication and barely complications, these procedures would be less effective than the extended SMAS technique used on those of Oriental person. In the face, there are some retaining ligaments, which support facial soft tissue against gravitational change. With aging, the cheek soft tissue anterior to the zygomatic ligament and posterior to the mandibular ligament descends into the plane between the superficial and deep fascia. However, the attached area by the zygomatic and mandibular retaining ligaments are almost unchanged because the ligaments that support facial soft tissue in normal anatomic position i.e, ligaments retain their integrity while the soft tissue around it relaxes. These changes lead to the formation of a nasolabial fold and jowl. I think the most important consideration factor before choosing a certain procedure is to decide which procedure could bring more predictable results, make longer lasting effect, and has minimal risk and morbidity. In my opinion, it is rationally impossible to say that one technique is better than the other. I always try to keep in mind that no two patients are the same, so whenever I do my technique, I try to adjust and adapt my technique according to individual specifications. Among the multiple problems related to aging, there are three distinctive features, which are wrinkles, volume loss, and drooping facial soft tissue. There is no single method for removing these problems. If the wrinkles are the main problem, we can get the best result by facial resurfacing. If somebody has deep wrinkles, fold, and drooping facial soft tissue, I usually perform the extended SMAS facelift. I always do it with local anesthesia. Under the intravenous sedation with ketamine, midazolam, and propofol, I infiltrate 2% lidocaine with 1:80,000 epinephrine along the proposed incision line. Next, the tumescent solution is infiltrated into the face and neck dissection area. A total of 300-400ml of tumescent solution is infiltrated on the both sides of the face and neck. After infiltration, I begin working on the neck area first and then try to solve the facial problems. Different problems require different amount of subcutaneous and SMAS dissection. If the patient has thick facial skin and his or her main problem is drooping, wide skin area and SMAS undermining beyond the retaining ligaments is required. If the patient has thick facial skin and the main problem is wrinkles, less skin area and wide SMAS dissection is needed.

Facial Rejuvenation Surgery Combined with Malarplasty or Angleplasty

In general, Oriental people have thicker facial skin with more subcutaneous adipose tissues than Caucacian people. These differences result in characteristic Oriental aging face combined with squared facial contours. Conventional face lift essentially consists of facial wrinklinges and reducing flaccidity of facial skin but squared facial contouring is not considered. Flat and squared face can be improved by reduction malarplasty and mandibular angleplasty, thoses are the common facial bone contouring surgeries performed in the Orient. If patients, who have aging face, also have flat and squared face, it is necessary to be performed face lift and facial bone contouring surgery simultaneously. We have experienced 18 cases of patients with aging face and squared face who were operated face lifting procedures combined with maloplasty or angleplasty(from Apr.1997 to Mar. 2001). And We have satisfactory results on most patients(16 cases of patients were satisfied with results).

Facial rthytidectomy combined with lower blepharoplasty / 中华医学美学美容杂志

Objective To investigate the combination of blepharoplasty with rhytidectomy for correction of the aging face. Methods In addition to conventional rhytidectomy, the operation included transection of lower orbicularis palpebrorum ligament ,excision of the herniated orbital fat, suspension of lower obicularis palpebuorum muscle. Results The method has produced a satisfied result in 25 cases since 1999. Conclusion On the base of conventional rhytidectomy, we transect the lower orbicularis palpebrorum ligament to elevate and stabilize the orbicularis muscle to the periosteum above the level of lateral canthus, which improves nasopalpebromalar groove and obtains more youthful appearance of the mid face.