El lifting cervicofacial de plano profundo: Presentación de la técnica y resultados

Objetivo: El lifting cervicofacial es una técnica que busca devolver una apariencia juvenil y descansada al rostro del paciente. Originalmente, esta técnica se limitaba solamente a una disección en el plano cutáneo. El lifting de plano profundo o deep plane facelft, en cambio, utiliza un plano de disección anatómico por debajo del sistema musculoaponeurótico superficial (SMAS), permitiendo la lisis de los ligamentos de retención faciales y la máxima movilización de los tejidos superficiales, confiriéndole ventajas frente a otras técnicas. Se describe la técnica y se presenta nuestra experiencia. Material y Método: Serie de casos retrospectiva de pacientes sometidos a lifting de plano profundo en nuestro centro. Se describe la técnica quirúrgica, datos demográficos, antecedentes médico quirúrgicos y complicaciones post-operatorias. Resultados: Entre enero de 2021 y junio de 2023 se operaron 18 pacientes, todos de sexo femenino con un promedio de edad de 58,7 años. Solo 2 pacientes presentaron complicaciones (hematoma). Ningún paciente presentó lesión del nervio facial transitoria o permanente. Ningún paciente necesitó re-operación. Discusión y conclusión: La técnica de lifting de plano profundo o deep plane facelft es un método seguro y efectivo para tratar los signos del envejecimiento facial. Las complicaciones descritas por nuestro grupo son acordes a la literatura.

Aim: The facelift is a technique that aims to restore a more youthful and rested appearance to the aging face. Originally it was limited to a skin dissection only. The deep plane facelift, on the other hand, uses an anatomical dissection plane below the superficial muscular aponeurotic system (SMAS), allowing lysis of the facial retention ligaments and maximum mobilization of superficial tissues, with better outcomes than other techniques. The technique is described and our experience is presented. Material and Method: Retrospective case series of patients undergoing deep plane facelift. The surgical technique, demographic data, surgical medical history, and postoperative complications are described. Results: Between January 2021 and June 2023, 18 patients were operated, all female with an average age of 58,7 years old. Only 2 patients presented complications (hematoma). No patient presented facial nerve injury. No patient required re-operation. Discussion and Conclusion: The deep plane facelift is a safe and effective method to treat the signs of the aging face. The complications described are consistent with the literature.

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.

Robot-assisted submandibular gland excision via modified facelift incision / 대한악안면성형재건외과학회지

BACKGROUND: The conventional transcervical resection for submandibular gland disease has some risks and an unsatisfactory cosmetic result. Recently, robot-assisted surgery has been developed as a plausible substitute for conventional surgery which provides an excellent cosmetic outcome. CASE PRESENTATION: The authors performed robot-assisted sialadenectomy via modified facelift incision using the da Vinci Xi surgical system (Intuitive Surgical Inc., CA, USA) with two endowrist arms (monopolar curved scissors and Maryland bipolar forceps) successfully in a 44-year-old female patient who suffered from sialolith and severe atrophic submandibular gland. CONCLUSIONS: If similar studies are done in the future, this robot-assisted sialadenectomy may become established as an alternative to existing disadvantageous surgical methods.

Endoscopic facelift of the frontal and temporal areas in multiple planes

<p><b>INTRODUCTION</b>The detachment planes used in endoscopic facelifts play an important role in determining the results of facial rejuvenation. In this study, we introduced the use of multiple detachment planes for endoscopic facelifts of the frontal and temporal areas, and examined its outcome.</p><p><b>METHODS</b>This study included 47 patients (38 female, 9 male) who requested frontal and temporal facelifts from January 2009 to January 2014. The technique of dissection in multiple planes was used for all 47 patients. In this technique, the frontal dissection was first carried out in the subgaleal plane, before being changed to the subperiosteal plane about 2 cm above the eyebrow line. Temporal dissection was carried out in both the subcutaneous and subgaleal planes. After detachment, frontal and temporal fixations were achieved using nonabsorbable sutures, and the incisions were closed. During follow-up (ranging from 6-24 months after surgery), the patients were shown their pre- and postoperative images, and asked to rate their satisfaction with the procedure. Complications encountered were documented.</p><p><b>RESULTS</b>All 47 patients had complete recovery without any serious complications. The patient satisfaction rate was 93.6%. Minor complications included dimpling at the suture site, asymmetry, overcorrection, transitory paralysis, late oedema, haematoma, infection, scarring and hair loss. These complications resolved spontaneously and were negligible after complete recovery.</p><p><b>CONCLUSION</b>Dissection in multiple planes is valuable in frontal and temporal endoscopic facelifts. It may be worthwhile to introduce the use of this technique in frontal and temporal facelifts, as it may lead to improved outcomes.</p>

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.

Complicação tardia de preenchimento cutâneo após facelift: relato de caso / Late complication of cutaneous filling after a facelift: a case report

Os autores apresentam o caso de uma paciente submetida 7 anos após aplicação de polimetilmetacrilato (PMMA) a um facelift com implante de prótese mentoniana, o qual evoluiu com granuloma por corpo estranho em região distante da aplicação do preenchimento. Após quase um ano de tratamento, a paciente evoluiu com resolução do caso.

The authors present the case of a patient who underwent a facelift with a chin implant 7 years after polymethylmethacrylate (PMMA) implantation, which evolved with foreign body granuloma in a region distant from the filling application. After nearly a year of treatment, the patient evolved with resolution of the granuloma.

Endoscope-Assisted Trichophytic Anterior Hairline Brow Lift

BACKGROUND: The brow lift plays an essential role in upper face rejuvenation. The authors designed a new brow lift technique, the endoscope-assisted trichophytic anterior hairline brow lift. It combines the advantages of an endoscopic approach and an anterior hairline approach. This technique was applied to 13 patients with aesthetically excellent results. METHODS: A trichophytic incision line was designed within the fine hairs of the entire anterior hairline and the incision was extended to the temporal hair-bearing scalp. After the incision, most of the procedures were conducted in a similar way to the conventional endoscopic brow lift. Without direct visualization, the dissection was extended down onto the root of the nose and the forehead. An endoscope was used from 2 cm above the supraorbital notch to avoid supraorbital nerve injury. Scars were assessed with the Stony Brook Scar Evaluation Scale (SBSES) at the time the sutures were removed. The visual analogue scale (VAS) score was checked at postoperative 1-year follow-up. The surgical outcomes for brow position and subjective satisfaction were rated with the Global Aesthetic Improvement Scale (GAIS) at postoperative 1-month follow-up. The dermatome of the deep branch of the supraorbital nerve, especially around the hairline, was checked with a two-point discrimination test. RESULTS: From October 2012 through August 2015, 13 endoscope-assisted trichophytic anterior hairline brow lifts were performed. The GAIS score was 1.62 on average. The VAS score was 2.09 on average. No permanent nerve damage has been reported except for 2 cases of temporary paresthesia. These fully recovered at 1-month follow-up. CONCLUSIONS: Based on our results, we think our technique could be a safe and effective treatment option for brow ptosis patients with a high hairline.

Comparison of Modified Blair Incision and Modified Facelift Incision in Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Modified Blair incision (MBI) and Modified facelift incision (MFI) are mainly used for paroidectomy. MBI can provide a wide surgical view for parotidectomy. MFI was designed for better cosmesis by hiding the incision behind the auricle and hair line. This study was performed to evaluate surgical outcomes, functional and cosmetic results after parotidectomy using MBI and MFI. SUBJECTS AND METHOD: We retrospectively reviewed medical records of 120 patients who underwent parotidectomy from September 2005 to April 2012. Tumor characteristics, operative outcome, and cosmetic outcome according to incision method were investigated. Cosmetic satisfaction was assessed using a questionnaire 12-18 months after surgery. RESULTS: Tumor characteristics such as size, location and pathologic features did not differ between the two groups. The extent of parotidectomy, operation time, amout of drainage, and complications were also not different between the two groups. Cosmetic satisfaction was significantly supeior in the MFI group than that of the MBI group. CONCLUSION: MFI is superior to MBI for parotidectomy for having similar surgical outcome but better esthetical success compared to MBI.

Facelift incision and superficial musculoaponeurotic system advancement in parotidectomy: case reports / 대한악안면성형재건외과학회지

Surgical procedures for parotidectomy had been developed to gain adequate approach, prevent morbidity of nerve, and give esthetic satisfaction. We performed two cases of parotidectomy through facelift incision. One case was reconstructed with superficial musculoaponeurotic system (SMAS) flap and sternocleidomastoid (SCM) muscle rotated flap at the parotid bed. In second case, same procedures were performed, but collagen membrane was additionally implanted for prevention of Frey's syndrome. After surgery, two cases showed esthetic results without neck scar and hollow defect on parotid bed area.

Transmasseteric antero-parotid facelift approach for open reduction and internal fixation of condylar fractures

Surgical approaches to the condylar fracture include intraoral, preauricular, submandibular, and retromandibular approaches. Each approach has its own advantages and disadvantages. When a patient needs esthetic results and an intraoral approach is not feasible, the transmasseteric antero-parotid facelift approach is considered. This approach permits direct exposure and allow the surgeon to fixate the fractured unit tangentially. Tangential fixation is critical to osteosynthesis. Disadvantages of the transmasseteric antero-parotid facelift approach include damage to the facial nerve and a longer operation time. However, after the initial learning curve, facial nerve damage can be avoided and operation time may decrease. We report three cases of subcondylar fractures that were treated with a transmasseteric antero-parotid facelift approach. Among these, two cases had trivial complications that were easily overcome. Instead of dissecting through the parotid gland parenchyma, the transmasseteric antero-parotid facelift approach uses transmasseteric dissection and reduces facial nerve damage more than the retromandibular transparotid approach. The esthetic result is superior to that of other approaches.

A Multicenter Noncomparative Clinical Study on Midface Rejuvenation Using a Nonabsorbable Polypropylene Mesh: Evaluation of Efficacy and Safety

BACKGROUND: Facial rejuvenation can be achieved using a variety of techniques. Since minimally invasive procedures for face lifting have become popular because of their convenience and short operating time, numerous minimally invasive surgical procedures have been developed. In this study, a nonabsorbable polypropylene mesh is introduced as a new face lifting instrument, with the nasolabial fold as the main target area. In this paper, we report the efficacy and safety of a polypropylene mesh in midface rejuvenation. METHODS: Thirty-three subjects with moderate-to-severe nasolabial folds were enrolled from two medical institutions for a noncomparative single-sample study. A mesh was inserted above the superficial muscular aponeurotic system layer, reaching the nasolabial folds through a temporal scalp incision. After 3 weeks, the temporal end of the mesh was pulled to provide a lifting effect. Then, the mesh was fixed to the deep temporal fascia using nonabsorbable sutures. To evaluate efficacy, we compared the scores on the Wrinkle Severity Rating Scale and a visual analog scale for patient satisfaction between the baseline and 7 weeks postoperatively. In addition, we evaluated safety based on the incidence of adverse events. RESULTS: The treatment was deemed effective at improving wrinkles in 23 of 28 cases, and patient satisfaction improved significantly during the study period. There were seven cases of skin or subcutaneous tissue complications, including edema and erythema, but there were no suspected serious adverse events. CONCLUSIONS: Face lifting using a nonabsorbable mesh can improve nasolabial folds without serious adverse effects. Thus, this technique is safe and effective for midface rejuvenation.

Inversão da porção lateral do músculo orbicular para tratamento das rítides perioculares (pés-de-galinha) / Inversion of the lateral portion of the orbicularis oculi muscle for the treatment of periocular rhytides (crow's feet)

INTRODUÇÃO: A cirurgia plástica, sempre em busca de resultados cada vez mais expressivo, vem associando às técnicas já consagradas aos novos tempos intraoperatórios. Este trabalho descreve uma técnica cirúrgica para ser associada às ritidoplastias baseada na ressecção da porção lateral do músculo orbicular, seguida pela enxertia do próprio músculo, porém invertido, sobre a área ressecada. MÉTODO: Em um período de 5 anos, foram realizadas 54 ritidoplastias associadas a técnica descrita. RESULTADOS: O seguimento no pós-operatório tardio (5 anos) mostrou-se satisfatório com permanente desaparecimento das ritides perioculares por neutralizar as forças exercidas pelo músculo nesta área. Não houve insatisfação por parte dos pacientes. Logo, trata-se de um procedimento com excelentes resultados na resolução das ritides perioculares e na elevação da porção caudal da sobrancelha em relação a orbita. CONCLUSÃO: A técnica descrita gera resultados permanentes e satisfatórios.

INTRODUCTION:In the continued search for increasingly expressive results, plastic surgeons are combining established techniques with new intraoperative times. This article describes a surgical technique associated with rhytidoplasties based on the resection of the lateral portion of the orbicularis oculi muscle, followed by grafting the muscle itself, however inverted, on the resected area. METHOD: In a 5-year period, 54 rhytidoplasties associated with the described technique were performed. RESULTS: The follow-up in the late postoperative period (5 years) was satisfactory, with the permanent disappearance of periocular rhytides due to the neutralization of the forces exerted by the muscle in this area. There was no dissatisfaction on the part of the patients. Consequently, the procedure had excellent results in the resolution of periocular rhytides and in lifting the caudal part of the eyebrow in relation to the orbit. CONCLUSION: The technique described generates permanent and satisfactory results.

Treatment of Botulinum Toxin Type A in Parotid Fistula after Face Lifting

Botulinum toxin type A has an inhibitory action not only on neuromuscular junctions, but also postganglionic sympathetic and cholinergic autonomic parasympathetic acetylcholine release at the secretary end of the salivary gland. Use of botulinum toxin to treat sialorrhea was first reported in 1997 by Bushara. Parotid duct or gland injuries with parotid fistula are uncommon but troublesome complications of surgical trauma. Here, we report two patients with constant leakage of serous fluid and a swelling cheek after facelift surgery. Each patient underwent an amylase test, starch iodine test, and sialography. After diagnosis of parotid fistula, a total of 50 units botulinum toxin was injected into the parotid gland. Facial bandage, scopolamine, and minimizing temporomandibular joint motion were instructed. Leakage volume decreased gradually, and symptoms subsided within 2 weeks. Neither functional problems nor complications occurred. In conclusion, a parotid fistula after facial surgery can be treated effectively with botulinum toxin; this treatment option should be considered before proceeding with invasive surgical treatment.

Consideration of Facelift Methods and Facial Retaining Ligaments in Asians

BACKGROUND: The demand for facelifts is rapidly increasing in Asia because of economic development as well as the aging of the population. It is difficult to obtain satisfactory results, because of the facial characteristics of Asians. Various approaches, such as the extended superficial musculoaponeurotic system (SMAS) facelift, the finger-assisted malar fat elevation facelift, and the high SMAS facelift, were designed to improve facial sagging in the mid- and lower face with the development of advanced facial surgical procedures. METHODS: We reviewed facelift methods and surgical anatomy from the Asian viewpoint. RESULTS: In Asians, skin is fibrous and richer in collagen, and retaining ligaments are tougher and more rigid. Facial features are flat and wide, so achieving satisfactory facelift results is a challenge. The release of retaining ligaments in the sub-SMAS plane is the most important procedure in Asian facelifts to achieve satisfactory results. Supplementing the SMAS dissection above the upper border of the zygomatic arch and elevating the malar fat pad through the prezygomatic space achieve better results in Asian facelifts. CONCLUSIONS: The release of retaining ligaments in the sub-SMAS plane is the most important step during Asian facelifts for satisfactory results. The addition of SMAS dissection above the upper border of the zygomatic arch and malar fat pad elevation through the prezygomatic space help achieve better results for Asian facelifts.

Endoscopic assistance in a variety of complicated facelift and postoperative repair in frontal and temporal areas / 中华医学美学美容杂志

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

Procedimiento quirúrgico miniinvasivo para el rejuvenecimiento de la región frontal / Mini-invasive surgical procedure to reverse the aging process

La disminución del volumen de la estructura esquelética de la cara ocasiona flacidez de todos los elementos que se apoyan sobre ella y es una de las causas más importantes de su caída. Dado que no contamos con un recurso efectivo para lograr la recuperación del volumen óseo, lo indicado es restaurar la relación entre las partes blandas y el volumen óseo vigente. Ésta es la meta más importante de la ritidectomía subperióstica. Describimos la aplicación de este procedimiento miniinvasivo para la restauración de la región frontal. Se describen las metas y medios para realizarlo por vía frontal, transpalpebral y combinando ambas vías, así como los procedimientos auxiliares asociados, los detalles del manejo posoperatorio, las complicaciones, las observaciones resultantes de nuestra experiencia con este método a lo largo de 10 años y la razón de que actualmente sea nuestro procedimiento de elección.

Reduction of the bony structure of the face is the main reason for flabbiness and drooping of the facial soft tissues. Because we do not currently have recourse to restore the lost bony volume, a good possibility is to reestablish an optimal relationship between the soft tissues and the present bony volume. Based on this principle, we have developed the procedure of mini-invasive subperiosteal facial restoration. In this paper we describe the application of this procedure to restore the frontal region. The maneuvers and instrumentation used to perform this procedure through frontal, palpebral or the combination of both approaches are described. Based on the surgical anatomy, orientation and instructions for obtaining the goals of the procedure and to avoid complications are elucidated. Ancillary procedures that may be associated with this procedure are described, as well as detailed postoperative care. Observed complications are noted and a summary of the obtained results, which have shown a high degree of patient and surgeon satisfaction, are reported. Observations from our experience with this method during a 10-year period and the reasons for this being the procedure of our first choice are revealed.

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.

Application of superficial temporal fascia flap in reconstruction of temporal depression / 中华医学美学美容杂志

Objective To evaluate the effect of superficial temporal fascia flap for the reconstruction of temporal depression. Methods According to the degree of temporal depression, we applied folded superficial temporal fascia to reconstruct the temporal depression, combined with forehead and orbital subperiosteal facelift. Results Postoperative follow-up for 1~2 years showed that the method used in subperiosteal facelift combined with temporal depression, maintained a satisfactory long-term full contour. And it improved the facial contour.Conclusions Application of superficial temporal fascia flap in reconstructing the temporal depression combined with facelift for one-stage is a good method. It can get the purposes of tightening the skin and improving the facial contour together. Good results are achieved.