Rejuvenation of facial contour for elderly women / 中华医学美学美容杂志

Objective Aged facial contour presents changing facial skeleton and sagging soft tissue.We performed reshaping the facial skeleton simultaneouly during the rhytidectomy to achieve a youthful facial contour.Methods It was a retrospective observational study based on 26 elderly women (42-60 years) that complained of aged face and boosing of the orbital rim,prominent zygoma and mandibular angle.All of them had undergone reduction boosing,malar and mandible combined with rhytidectomy from January 2010 to December 2015.Results The facial skeleton was reshaped with face-lift successfully.No fatal bleeding,respiratory obstruction,cardiovascular accident,severe facial edema,permanent facial nerve injury and other major complications occurred.All of the patients recovered safely.Follow-up for 3-24 months showed that the facial contour and aging were improved,and the youthful face form was preserved.Conclusions The face contour correction combined with face-lift is an effective technique to restore the youthful for elderly patients.

Use the technique of three layers suspension to lift the mid-low face / 中华医学美学美容杂志

Objective To explore an ideal surgical method for mid-low face lifting.Methods In this procedure,the first surgical step was subcutaneous undermining that was performed through the incision along temporal hairline,anteriorear,and mastoideae.It extended distally beyond the furthest skin fold and along the mandibular border or the midline of the neck if nacessary.Then three layers suspension were performed,which included three procedures:first,SMAS was purse string sutured in certain direction;secondly,the malar fat pad was suspended to tow directions backward and upward and anchored in the periosteum of zygoma and SMAS too;lastly,through traction suture of reducing tension step-by-step,lots of the tension was relieved from the incision;at the same time,new retaining ligaments between flap and SMAS were reestablished.And redundant skin was removed in incision at the end of the procedure.Results A total of 22 cases received this operation.16 cases were followed up from 3 months to 24 months after operation.The results of operation were divided into three degrees:excellent,acceptable and poor;and those were evaluated by patients themselves.14 cases obtained excellent result (87.5 ％),2 cases regarded that their results were acceptable (12.5 ％).The total satisfactory rate was 100 ％.None serious complication occurred in those eases except some slight complications,such as local edema,skin numbness and small hematoma which relieved in 3 to 6 months after operation.Scar was inconspicuous.Conclusions This technique can correct the posies of lower tow-third face better,especially for mitigating the nasolabial fold and enhancing the elastic of face skin.Simultaneously,it is an effective,safe and simple technique.

True retaining ligaments of face as surgical landmarks / Los verdaderos ligamentos de retención de la cara como marcadores quirúrgicos

The adherence of the overlying tissues to the underlying structures in the face is maintained by the retaining ligaments. True retaining ligaments named orbital, zygomatic and mandibular ligaments are a series of fibrous bands that run from periosteum to the dermis. The tethering effect of true retaining ligaments must be released for achieving a satisfactory movement of facial skin and Superficial Muscular Aponeurotic System (SMAS) during facial rejuvenation procedures. The aim of this study was to define the location of the true retaining ligaments of the face and to discuss their usability as surgical landmarks. The study was made on ten hemi-faces of formaline-fixed cadavers. Dissections resembling face-lift procedures were applied and ligaments were determined. The distances of the ligaments to lateral canthus, tragus and commissure and to the lines from tragus to lateral canthus and commissure were measured. Correlations were investigated statistically. The distances of the zygomatic and mandibular ligaments from the tragus were 66.50±10.78 mm and 114.80±9.76 mm respectively. The distances of the zygomatic ligament from the commissure and the commissure tragus line were 56.30±8.94 mm and 28.40±5.19 mm respectively. The distances of zygomatic and mandibular ligaments from the tragus were strongly correlated with a ratio of 3/5 and there was a strong correlation between the distances of the zygomatic ligament from the commissure and commissure- tragus line with a ratio of 2. The results of this study elucidated the possibility of the use of the true retaining ligaments as surgical landmarks for facial surgery.

La adherencia de los tejidos que recubren a las estructuras subyacentes en la cara se mantiene por los ligamentos de retención. Los ligamentos de retención verdaderos llamados ligamentos orbitales, cigomático y mandibular son una serie de bandas fibrosas que se extienden desde el periostio a la dermis. El efecto de la inmovilización de los verdaderos ligamentos de retención debe ser liberado para lograr un movimiento satisfactorio de la piel del rostro y del SMAS durante los procedimientos de estiramiento facial. El objetivo fue definir la ubicación de los verdaderos ligamentos de retención de la cara para discutir su utilidad como puntos de referencia quirúrgicos. El estudio se realizó sobre diez hemi-caras de cadáveres, fijadas con formalina. Las disecciones se asemejaron a los procedimientos de estiramiento facial, se aplicaron y determinaron los ligamentos. Se midieron las distancias de los ligamentos al canto lateral, trago, comisura y a las líneas de trago a canto lateral y comisura. Las correlaciones fueron analizadas estadísticamente. Las distancias de los ligamentos cigomático y mandibular desde el trago fueron 66,50±10,78 mm y 114,80±9,76 mm, respectivamente. Las distancias del ligamento cigomático a la comisura y la línea de comisura al trago fueron 56,30±8,94 mm y 28,40±5,19 mm, respectivamente. Las distancias de los ligamentos cigomático y mandibular desde el trago estaban correlacionadas de forma importante con una relación de 3/5 y había una fuerte correlación entre las distancias del ligamento cigomático desde la línea de comisura y el trago - con una relación de 2. Los resultados de este estudio han dilucidado la posibilidad de la utilización de los verdaderos ligamentos de retención como puntos de referencia quirúrgicos para la cirugía facial.

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.

Blepharoplasty and periorbital surgical rejuvenation.

The periorbital region forms the epicenter of facial aging changes and receives highest attention from physicians and patients. The concern about visual function, clubbed with the need for hidden incisions, makes the periocular region a highly specialized surgical area, most appropriately handled by an ophthalmic plastic surgeon. The article provides an overview of cosmetic eyelid and facial surgery in the periocular region. Common aesthetic surgical procedures as well as ocular side-effects of commonly performed periocular injections are discussed from the dermatologist's point of view.

Subcision: An Ancillary Procedure to Face-Lift Operation to Improve Prominent Nasolabial Folds

Face-lift operations have been performed to correct the stigma of aging of the lower face, and its techniques have been modified to obtain more favorable results. However, the lack of significant improvements in the appearance of nasolabial folds has been a problem in face-lift procedures, requiring surgeons to perform ancillary procedures such as fat strip, dermofat, and superficial musculoaponeurotic system (SMAS) grafting to address the issue. In this report, we describe a subcision technique using a wire scalpel or a thread as an ancillary procedure to a face-lift operation to improve the appearance of nasolabial folds. The procedure is simple, safe, easy, and effective with minimal complications.

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.

Midface Lift

Midface is one of the most important structures which impresses, combining with eyes and nose. Youthful midface shows the blending of lower eyelid and the anterior cheek, therefore the goals of midface rejuvenation is harmony between the lower eyelid and anterior cheek. The purpose of this article is to provide an overview of current concept of midface rejuvenation including preoperative patient assessment, surgical methods, postoperative management and complications. A critical understanding of patient expectation, anatomy and operative technique is important to achieve satisfactory results and to avoid complications.

Face and Neck Lift with Thread (Won V Lift)

During the facial aging, a series of physical and biochemical changes leads to tissue hypotrpphy, sagging and wrinkles not only at the level of the skin but also in the soft tissue structure. There has been a recent trend toward minimally invasive procedures for facial rejuvenation. This trend is keeping with a general demand toward more effective procedure with less tissue injury and less down time for the patient. Suspending thread technique is a new innovation in plastic surgery. Fifty patients underwent a threadlift procedure in combination with fat injection or filler injection to the midface, lowface, jowl and neck. We used anchoring point with deep temporal fascia in cheek and low face lift and mastoid fascia in neck lift without any incision. The procedure outcome was assessed in each case through patient interviews. All patients demonstrated improvement and youthful appearance in the midface, lowface, jowl and neck with minimal complications. Threadlift is a safe procedure with limited scarring, rapid recovery and low complication rates. The combination of the threadlift and fat injection or filler injection enables the increase of volume of mid or low face and prevents the complication with great patient satisfaction.

Lifting cervical gravitacional / Gravitational cervical lifting

Introdução: Os procedimentos cirúrgicos visando ao rejuvenescimento facial vêm evoluindo desde 1920. Os primeiros relatos descreviam pequenas ressecções de pele que se revelaram totalmente ineficazes. A exigência progressiva por melhores resultados ocasionou a busca por abordagens cirúrgicas mais eficazes, principalmente no que diz respeito ao tratamento do terço inferior da face e pescoço, onde as deformidades eram mal corrigidas ou apresentavam recidiva precoce. Objetivo: Apresentar uma nova abordagem para o tratamento do terço inferior da face, principalmente nos pacientes que apresentam grande flacidez de pele e dos músculos platismas, com ou sem excesso de gordura na região cervical, pois com as condutas atuais existe elevada taxa de resultados insatisfatórios. Método: Cento e oitenta pacientes foram operados, seguindo técnica proposta pelo autor sênior, e acompanhados durante cinco anos (janeiro de 2003 a maio de 2008) foram avaliados. Foram analisadas 172 (95,6%) pacientes do sexo feminino e 8 (4,4%) do masculino. A média de idade foi de 57,7 anos, tendo 41 anos e 1 mês o mais jovem e 81 anos e 5 meses o mais idoso. Na maioria dos casos, realiza-se extensa lipectomia com tesoura, completa dissecção das bandas platismais com posterior ressecção total da flacidez das bandas platismais e seu tracionamento vetorial inferior, além da tração oblíqua da pele na região cervical em sentido à linha de implantação do cabelo na região cervical. Conclusão: Os efeitos duradouro se o sucesso da técnica podem ser comprovados pelo crescente número de procedimentos realizados neste período e pela grande satisfação dos pacientes.

Background: The surgical procedures searching the anti aging face come evolving since 1920. The first stories described small resections of skin that if had disclosed inefficacious total. The gradual requirement for better resulted caused the search for more efficient surgical procedures mainly in what it says respect to the treatment of the cervical region of face and neck where the deformities were badly corrected or presented precocious return. Objective: The objective of this study was to introduce a new approach for treatment of the cervical region of face and neck, mainly in the patients who present great flaccidity of skin and the muscles platysma, with or without excess of fat in the cervical region, therefore with the current behaviors still we have resulted unsatisfactory. Method: One hundred and eighty patients had been operated, following the technique of gravitational cervical lifting, and followed during five years (January of 2003 to May of 2008). There were 172 (96.6%) women and 8 (4.4%) men. The average age was 57.7 years old, the young est was 41 years old and the oldest was 81 years old. Conclusions: In most cases is done extensive lipectomy using scissors, complete resection of the platysma bands and their traction vector lower. Besides, it made the skin traction in the cervical area in oblique sense to the line of hair implantation in the cervical area. The durable effect and the success of this technique can be proved by the increase in the procedure number performed in this period and by the great patient’s satisfaction.

Lower Blepharoplasty in Aged Persons

With increase in average life expectancy, more patients of an older demographics are undergoing periocular facial rejuvenation procedures. One of the most common procedures performed for periocular rejuvenation is the lower blepharoplasty. One of the most common and challenging postoperative complication after this procedure is lower lid retraction. The degree of lower lid retraction can be presented in a varying range from lateral canthal rounding and scleral show to cicatrical ectropion. Causes of lower eyelid retraction seem to be multifactorial and there are a variety of surgical approaches for correction of lower eyelid retraction. According to the cause and degree of lower lid retraction, the author must incorporate a customized approach for each deformity. Techniques used to correct lower lid retraction include midface lift, lateral canthopexy or canthoplasty, oculi muscle suspension, and a spacer graft. To effectively correct the retraction, the surgeon must have a sound understanding of the anatomy of lower eyelid. Technically, key essential fundamentals to correct lower lid retraction include: knowledge of elevating the mid face, anchoring the lateral canthal tendon securely, and proper insertion of the spacer graft. The author presents multiple techniques to correct significant postsurgical lower lid malposition without the use of skin grafts.

Limited Dissection Face Lift with PDS Quilting Suture

PURPOSE: Facial rejuvenating surgery has become a challenge to most plastic surgeons. Patients are demanding fewer complications, a prompt recovery, and more natural results. Current trend of the face lift surgery has been developed into less invasive procedures. Every aging patient in Asia wants to look younger without obvious evidence of surgical correction. METHODS: The authors performed the limited dissection face lift with PDS quilting suture on twenty five patients. These five quilting sutures consist of sutures at 1~2 cm posterior to the prominent point of zygoma to the periosteum of the zygomatic arch, at the lateral border of Bichat's fat pad area to the zygomatic arch, at the lateral border of the orbicularis oculi muscle to the deep temporal fascia, at the upper lateral border of the platysma to the periosteum of the mastoid, and at the anterior lower margin of the earlobe to the deep temporal fascia by quilting suture technique to achieve rejuvenation. RESULTS: These procedures could produce a balanced volumetric rejuvenation. This method gave considerable benefit of stable and satisfactory results. It provides reduced operative time, well corrected nasolabial fold and neck wrinkle, and swift recovery with minimal complications. CONCLUSION: Although it could not replace the classic facelift, this technique can be recommended as an option for patients who do not present with advanced facial aging or not want a more extensive procedure.

Intraoral Reduction Malarplasty with Simultaneous Zygomatic Soft Tissue Lifting: Prevention of the Mid-Face Sag

No abstract available.

Combined Approach for Rejuvenation of the Lower Third of the Face and the Neck in the Male Patient

Most men develop deep crease in the nasolabial area and visible redundant tissue in the anterior neck with aging. The ideal operation for those patients seeking facial rejuvenation because of prominent nasolabial folds and neck soft-tissue laxity is the cervicofacial rhytidectomy. If the patient doesn't wish to have a conventional face/neck lift under general anesthesia, a combined approach based on summation of partially effective modalities is a good option. We present our experience with combined subcutaneous neck lift, platysmaplasty, mentoplasty, and platysma graft in the treatment of the lower third of the face and the neck, and obtained good results without complications using this comprehensive approach. In terms of morbidity, the procedure left inconspicuous scars. The platysma grafts remained in place and were not palpable and/or perceptible after insertion. Finally, postoperative recovery occurred uneventfully and no patients presented complications or the need for complementary treatment modalities. The incorporation of this innovative technique will provide us with more choices for addressing this controversial issue with a combined approach. The combination of proven methods may have better results than each one alone. It is a simple, safe, and inexpensive procedure that leaves no visible scars and has long-term adequate outcome. In conclusion, the presented procedure offers an additional technique of rejuvenating the lower third of the face and the neck with excellent results in the male patients.

One-stage Reconstruction after Partial Removal of Paraffinoma in Face with Dermofat Graft and Face Lift

Paraffin injection for aesthetic purpose by unauthorized people has many problems. One of the most common complication is the paraffinoma. Because of problems after paraffinoma removal, such as flap necrosis and facial nerve injury, the treatment of the choice is only partial removal. But there can be some depression and sagging of the cheek left after paraffinoma removal. So we have treated 8 patients who have suffered from paraffinoma in forehead and cheek by partial removal of paraffinoma and correction of the depression and the sagging of the cheek with dermofat graft and face lift. Through the extended preauricular incision, after skin flap elevation we removed paraffinoma as much as possible. Dermofat graft from the gluteal area was performed at paraffinoma removed site. And we prevented the sagging of the cheek skin by the suspension pull through suture. The follow up period was from 2 to 26 months(mean, 12 months). All the patients were satisfied with the reduction of the paraffinoma and they did not complain any deformity. One patient had flap necrosis on nasal dorsum and postauricular area, but they healed with dressing only in two weeks. We concluded that one-stage reconstruction with dermofat graft and face lift after partial removal of paraffinoma is reliable method in treating of paraffinoma in forehead and cheek.

Clinical Experiences of Face Lift: A Marginal Tragal Incision and Two Point Anchor

There is one problematic part of the facialplasty procedure that has been addressed with relative infrequency in the plastic surgery literature. Hypertrophic scar, deformed tragus and "pixie ear" deformity, the problems associated with the design and closure of the periauricular incisions, are still recognized. Prevention of these undesirable results of facialplasty is the surgical challenge about which this article is concerned. In facelift, pretragal incision leaves long scar formation on preauricular area and retrotragal incision occasionally makes the unnatural tragus. Since the marginal tragal incision consists of several short segments, it can prevent tragal deformity caused by scar contracture and preserve shape of the tragus. Putting 2 anchoring key sutures on just above the ear and at the mastoid area minimizes the tension on the incision line and minimizes postoperative ear deformity. We experienced 42 face lifting procedures in patients with aging face during the last 6 years(from Dec 1999 to May. 2005). Complications were hematoma in four cases(9.5%) and focal wound dehiscence in two cases(4.8%). The patients with the complications completely recovered 3 months later.

Mid-face Lift with Preauricular Pre-excision Technique

PURPOSE: Facial nerve injury is a rare but feared complication of face lift. Uncertainty as to the depth and vulnerability of the facial nerve in face lift dissection causes some surgeon, particularly novices, to dissect slowly. Excessively thin flaps can be made because of fear of nerve injury, contributing to skin slough. METHODS: From September 1998 to February 2003, the authors operated on 34 aging face patients using classical face-lift. We had analysed about quantity of skin removal and degree of elevated flap. The authors have found quantity of skin removal was 1.5-2.0cm, degree of elevated flap was 40-45 degree on average. RESULTS: The authors performed preauricular pre-excision face-lift technique on 12 aging face patients from July 2003 to Feburary 2005 based on experienced surgery. This technique reduced fear of dissecting skin flap necrosis and facial nerve injury because of firmly attached pre-auricular skin removed in advance. CONCLUSIONS: We easily dissected SMAS without visual field disturbance, nerve damage and reduced operation time and bleeding loss compared to classical face-lift.

Combined Facial Rejuvenation Using Endoscopic Face Lift and Laser Resurfacing

Facial aging is a complex process of gravity-induced soft tissue ptosis and photoaging. In the standpoint of ideal rejuvenation, face lifting combined with laser resurfacing offers significant improvement in aesthetic outcome unachievable by either procedure alone and has many advantages. Neverthless, the simultaneous combination has never been popularized due to the non-specific thermal effects of the laser and risks of skin necrosis in Korea. This report documents the safety and effectivness of combined procedures when using systematic consideration and modified techniques in orientals. This study included 26 Fitzpatrick type III, IV orientals who didn't complaint lower face aging. A dramatic rejuvenation in soft tissue reposition and skin quality was produced in combined endoscopic forehead and midface lift with laser resurfacing cases. The standard forehead lift using endoscopic subperiosteal deep plane seldom interfere flap resurfacing. An endoscopic subperiosteal and subcutaneous midface lift repositions the midface tissue effectively without preauricular incision. Newer variable pulse Er:YAG lasers allow precise ablation and coagulation separately. The minimal excessive thermal injury from variable Er:YAG lasers, modified techniques for flap and skin care program would make it possible to safely perform laser resurfacing with surgical facial rejuvenations on non smokers. There were no incidents of persistent erythema or pigmentation abnormality, scar, full thickness flap necrosis. By following the considerations suggested in this report, the combination of controlled skin resurfacing with face lifting may be safe and effective in orientals.

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).

Multiple suspension of superficial musclo-aponeurofic system for complete face lift / 中华医学美学美容杂志

Objective To find a procedure for facial rejuvenation w hi ch is simple, safe with lasting aesthetic results and to make it popularized eas ily. Method We performed complete face lifting first by extens ive subcutaneous detatchment. Secondly we plicated the superficial musclo-apon eurofic system (SMAS), including the superficial temporal fascia and the SMAS su perior to the parotid fascia, 1 cm anterior to the incision line by No.1 silk su tures. The distance of plication was about 1-2 cm. Interval of suture was 1 cm. After dissection under the platysma for 1-2 cm, we pulled the posterior edge of platysma postlaterally, and sutured it to the sternocleiodomasoid fascia. The n we suspended the obiculoris oculi and the SMAS lateral to the nasoalar and com issura oris by 4-0 absorbable surtures. If necessary, we plicated the platysma near the anterior border of the detachment. Results We performe d rhytidectomy on 48 patients by extesive subcutaneous detachment and multiple S MAS suspension in the past two years. The results were satisfactory after 3-16 months follow -up. There were no serious complications (including injury of fa cial nerve and skin necrosis and severe bleeding which needed another operation to clean up the hematoma). The aesthetic results were lasting. Complications in cluded temporal hair loss in 3 cases, in which one patient accepted hair transpl antation, and in another two patients alopecia zone were incised and sutured pri marily. Two cases had scar hyperplasia behind the ear, who required revision. Tw o cases had temporary asymmetry which were given no treatment and recovered 3 mo nths after operation. Conclusion This procedure overcomes the s hortcoming caused by simple subcutaneous rhytidectomy, in which improvement is t emporary. The SMAS is well perserved to avoid the facial nerve injury, the most severe complication of rhytidectomy. Therefore, rhytidectomy by extensive subcu taneous detachment and multiple SMAS suspension is a simple and safe procedure w ith lasting aesthetic results.