Longevity of SMAS facial rejuvenation and support.

BACKGROUND: One of the most common questions asked by patients when they present for face lift surgery is "How long will this last?" The answer to this question is not clear from the literature. METHODS: The purpose of the study was to review a series of secondary face lifts performed between 2001 and 2008 with both the primary and secondary face lift performed by a single surgeon. There were 42 patients with full records available for review. Data were collected with regard to timing, surgical technique, complications, and reasons for early revision. RESULTS: The average age at the primary face lift was 50.2 years (range, 34.9 to 69.9 years) and the average age at the secondary face lift was 61.9 years (range, 43.6 to 77.2 years). The average length of time from the primary to secondary face lift was 11.9 years. Nine patients required a secondary face lift before it had been 5 years since the primary face lift (21.4 percent). Reasons for early secondary face lift (within 5 years of the primary) included loss of skin elasticity in five patients and increase in subplatysmal fat and skin neck folds due to weight gain, loss of elasticity secondary to protease inhibitors for human immunodeficiency virus infection, loss of skin elasticity due to corticosteroid use, and residual fullness of digastric and residual submental fat in one patient each. CONCLUSIONS: On average, a well-performed superficial musculoaponeurotic system flap face lift will last 12 years. Those patients who present with very poor skin elasticity secondary to sun damage may require an earlier secondary face lift.

Long-term outcomes after primary breast reconstruction using a vertical skin pattern for skin-sparing mastectomy.

BACKGROUND: Preservation of the breast skin envelope in skin-sparing mastectomy is the key component for superior aesthetic results. Breast mound disproportions in primary breast reconstruction caused by a mismatch between retained skin envelope and donor-tissue volume provokes breast shape asymmetries. A skin-sparing mastectomy using a vertical pattern can address these breast mound imperfections by adjusting this mismatch in a vertical direction. METHODS: A retrospective chart review was conducted over a 10-year period for patients who underwent skin-sparing mastectomy using a vertical pattern for malignant, premalignant, benign, and deformational disease of the breast. Reconstruction was performed primarily with free muscle-sparing transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flaps. RESULTS: Seventy-two patients, aged 31 to 69 years (mean, 51.5 years), underwent 106 skin-sparing mastectomies using a vertical pattern and primary reconstruction with 38 unilateral and 34 bilateral free flaps (muscle-sparing transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flaps). The mean follow-up period was 42 months, without any local or systemic recurrences of the breast cancer. The complication rates of 8.49 percent at the donor site and 6.60 percent at the flap site show a direct correlation to smoking but no correlation to body mass index, cancer stage, or diabetes. CONCLUSIONS: Skin-sparing mastectomy using a vertical pattern improves the aesthetic outcome in primary breast reconstruction without compromising oncologic safety and demonstrates low morbidity. Elimination of the disharmony between skin flap and breast volume in the vertical direction while respecting the inframammary crease produces a youthful, symmetrical conical breast shape with medial fullness.