ABSTRACT
Introdução: Os procedimentos aplicados nos problemas de envelhecimento facial devem ficar restritos aos tecidos brandos e às relações com o volume prévio do esqueleto. Eles podem ser realizados mediante diversas técnicas: dissecção ampla e aberta, endoscópica e mini-invasiva. O objetivo é apresentar nossa concepção de ritidoplastias mini-invasivas e ritidoplastias completas através de mini-incisões, após 18 anos de experiência. Métodos: A ritidoplastia mini-invasiva é realizada através de mini-incisões localizadas na linha do cabelo da região frontal, região temporal, na fossa triangular da orelha, no sulco submentoniano e nas pálpebras. Ampla dissecção é realizada para liberar a fáscia parietal do arco zigomático para elevar em continuidade com o SMAS e o platisma num único plano. Essas estruturas são seletivamente fixadas em posições mais elevadas, restaurando a posição dos tecidos brandos e o contorno da face. Resultados: Nossa experiência se apoia em 672 pacientes, operados durante 19 anos, com mínimo de complicações a serem registradas, tendo sido evitadas as incisões pré-auriculares em 89% dos pacientes. Estão registrados os detalhes e táticas de como realizar cirurgias com segurança e a qualidade dos resultados. Conclusões: Diferentes procedimentos são descritos para mostrar como realizamos as ritidoplastias com minivias de acesso, de acordo com as regiões tratadas e sem cicatrizes pré-auriculares em 89% dos casos operados.
Introduction: A restoring procedure of the ageing process of the face should consider the conditions of the soft tissues and the relationship between them and the existing skeletal volume. This could be done through different approaches: open, endoscopic or mini-invasive. To present our concept of mini-invasive facelift, a full facelift through minimal incisions, product of eighteen years of experience. Methods: The mini-invasive facelift is done through minimal incisions located on the frontal hairline, temporal area, triangular fossae of the auricle, submentalis sulcus and eyelids. A wide dissection is performed to liberate the parieto-temporal fascia from the zigomatic arch, to pull it up in continuity with the SMAS and the platysma as one continuous layer or composite flap. These structures are selectively fixed to a higher position restoring the location of the soft tissues and the contour of the face. Results: We have done this procedure to 672 patients, along 19 years, with minimal complications (described also), and avoiding the pre-auricular incisions in 89% of our patients. In this paper details and tips to perform this procedure in a safer way and to get the most natural results are presented. Conclusions: Different approaches are described to perform a face lift with specific mini access views according to the regions to be treated , without periauricular scar round 89% of the operated cases.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , History, 21st Century , Surgery, Plastic , Case Reports , Aging , Comparative Study , Rhytidoplasty , Evaluation Study , Dissection , Esthetics , Face , Facial Bones , Surgical Wound , Surgery, Plastic/adverse effects , Surgery, Plastic/methods , Aging/pathology , Rhytidoplasty/adverse effects , Rhytidoplasty/methods , Dissection/adverse effects , Dissection/methods , Face/surgery , Facial Bones/surgery , Surgical Wound/surgery , Surgical Wound/therapyABSTRACT
BACKGROUND: The mestizo patient usually has a small nose with a wide base, round nostrils, and a convex dorsum. The alar cartilages are weak, thin, and short, providing deficient structural support and poor definition of the nasal tip. Cartilage grafts in the nasal tip are very often used to correct this condition, but a common problem of this procedure is the cephalic or lateral rotation of these grafts. OBJECTIVE: We used an angulated extended columellar graft to give columellar support and projection to nasal tip grafts for better control and prediction of the position and effect of these grafts. METHODS: The surgical protocol included a medical history, development of a surgical plan by analysis of the deformity, and the use of pre- and postoperative photographs taken at both intermediate and long-term follow-up visits for evaluation of the results. RESULTS: Sixty-seven patients underwent surgery using this procedure, 56 with an open technique and 11 with a closed technique. Follow-up ranged from 6 months to 4 years. The results obtained were satisfactory, showing better control and prediction of the shape of the nasal tip. CONCLUSIONS: The angulated extended columellar graft provides better control of the projection and angularity of cartilage grafts placed in the nasal tip.
Subject(s)
Cartilage/transplantation , Nose Deformities, Acquired/prevention & control , Rhinoplasty/methods , Torsion Abnormality/prevention & control , Adolescent , Adult , Female , Follow-Up Studies , Humans , Male , Mexico/ethnology , Middle Aged , Nasal Bone/surgery , Nasal Septum/surgery , Nose/abnormalities , Nose/anatomy & histology , Nose/surgery , Suture Techniques , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: The aging face is characterized by loss of skin elasticity, fat resorption, loss of muscle tone and volume, and loss of bone volume. Restorative procedures should be based on the condition of the soft tissues and the relationship between these tissues and the existing skeletal volume and can be performed through open, endoscopic, or minimally invasive approaches. OBJECTIVE: A minimally invasive approach to the face lift is presented, updated with useful details that the author has incorporated into his clinical technique on the basis of 15 years of experience. METHODS: The minimally invasive face lift is not a mini-lift but a full face lift performed through minimal incisions located in the frontal hairline, temporal area, triangular fossae of the auricle, submentalis, and eyelids. A wide dissection was performed to liberate the parietotemporal fascia from the zygomatic arch and to pull it up in continuity with the superficial musculoaponeurotic system and the platysma as one continuous layer or composite flap. These structures were selectively secured in a higher position, restoring the contour of the face and the consistency of the soft tissues. RESULTS: The described procedures, or combinations of these procedures, were performed in 539 patients during a 9-year period. Preauricular incisions were avoided in 83% of cases. Complications were minimal and included temporary hypoesthesia of the forehead or cheek and temporary palsy of the frontotemporal branch of the facial nerve that resolved after 2 to 4 weeks. There were few problems with hematomas. CONCLUSIONS: The minimally invasive face lift technique described here can reduce morbidity, achieve more durable results, and give a greater degree of satisfaction to patients. The procedures are relatively simple and easy to carry out but require somewhat of a learning curve to achieve optimal results.
