The McCollough Facial Rejuvenation System: expanding the scope of a condition-specific algorithm.

The ideal facial rejuvenation algorithm is comprised of an appropriate combination of procedures, thoughtfully chosen from an assortment of reliable alternatives, that when skillfully performed provide both short- and long-term enhancement to the undesirable conditions of aging that exists at the time of treatment. In 2010, the senior author published the first scientific article in which a condition-specific classification system and a treatment plan algorithm were applied to the discipline of facial rejuvenation. In the landmark article, the senior author reviewed his surgical experience of more than 5000 face-lifts and grouped patients into five major categories (or stages), based upon the extent of aging identified in various regions of the face and neck and the procedures performed to correct them. The criteria (that have now been suggested on a facial aging worksheet) were recorded in a data blank comprised of a first-generation worksheet. Once the data were collected--and using algorithmic charts for each region and/or facial feature--the most appropriate plan of action for a given patient was created. The sole objective in sharing the senior author's methodology was to launch a scholarly discussion among physicians and surgeons involved in the various disciplines that provide rejuvenation procedures on the face, head, and neck. From such a debate would, hopefully, emerge a definitive algorithmic system--one based squarely on the venerable ethics of medicine, coupled with the appropriate application of and skillful performance of the fundamental principles of surgery. A single, science-based system would restore order to a noble discipline, currently being challenged by narcissism, gimmickry, and commercialization. The implementation of a system rooted in universal truths would require its advocates to agree upon a common "language," the implementation of which allows aesthetically focused surgeons to share both new ideas and time-tested experiences. More importantly, a condition-specific system matches each potential patient's problems--at every age--with the appropriate facial rejuvenation treatment plan, restoring the ideals of science and art to the profession. Initially provided in a consumer information book devised to assist patients with understanding the advantages of personalized treatment plans, the senior author later shared his practices and evolving system with colleagues attending conventions, seminars, and courses. Only after he was convinced that his system could be of benefit to physicians and surgeons from a variety of backgrounds was it offered to the peer-reviewed medical literature. Clearly, a plethora of techniques and materials are available for facial rejuvenation; however, only the ones deemed to be worthy of consideration were included. In practice--and in this presentation--the authors expanded the scope of the previously published article and offer a user-friendly, condition-specific worksheet and algorithmic tables designed to make it easier for surgeons to select the right combinations of procedures--at the right time in a patient's life. Although imitations potentiate an environment of disharmony, the authors remain committed to enabling the evolution of a single facial rejuvenation classification system, one that--with the input of like-minded scholars--could restore needed order to a branch of the medical profession that, in recent years, seems to have lost its focus.

The McCollough Facial Rejuvenation System: a condition-specific classification algorithm.

The search for the holy grail in facial rejuvenation is an ongoing quest. Perhaps the reason the "ideal" face-lift has yet to be discovered is a result of three factors. First, the term FACE-LIFT has never been adequately defined. Second, fads and trends play a role in how the operation is taught and performed. Third, surgeons searching for the prototypic technique have not had a way to index the physical signs of facial aging. After 37 years of practicing facial plastic surgery and performing more than 5000 face-lifts, the author determined that replacing chaos with order is long overdue. To achieve this goal, he developed a classification system that is designed to match each potential patient's problems with the most appropriate facial rejuvenation treatment plan and a "language" by which facial rejuvenation surgeons can communicate. Five progressive stages of aging have been identified and matched with recommended courses of face-lifting, blepharoplasty, volume augmentation, and skin resurfacing techniques. Ancillary procedures have also been included when indicated. It is the author's hope that a new classification system will bring order to mounting confusion within the aesthetic surgery professions as well as within the public sector.

Development and validation of a 6-point grading scale in patients undergoing correction of nasolabial folds with a collagen implant.

BACKGROUND: Various scoring techniques prone to subjective interpretation have been used to evaluate soft tissue augmentation of nasolabial folds (NLFs). OBJECTIVE: To design and validate a reliable wrinkle assessment scoring scale. MATERIALS AND METHODS: Six photographed wrinkles of varying severity were electronically copied onto the same facial image to become a 6-point grading scale (GGS). A pilot training program (13 investigators) determined reliability, and a 12-week multicenter survey study validated the GGS scoring method. RESULTS: Pilot study inter- and intrarater scoring reliability were high (weighted kappa scores of 0.85 and 0.86, respectively). Seventy-five percent of survey investigators and independent review panel (IRP) members considered a GGS score difference of 0.5 to be a minimally perceivable difference. Interrater weighted kappa scores were 0.91 for the IRP and 0.80 for investigators. Intrarater agreements after repeat testing were 0.91 and 0.89, respectively. The baseline "live" assessment GGS mean score was 3.34, and the baseline blinded photographic assessment GGS mean score was 2.00 for the IRP and 2.16 for the investigators. CONCLUSIONS: The GGS is a reproducible method of grading the severity of NLF wrinkles. Treatment effectiveness of a dermal filler can be reliably evaluated using the GGS by comparing "live" assessments with the standard GGS photographic panel.

Short incision, short flap face-lift surgery versus deep plane face-lift surgery.

Face-lift surgery is becoming very common. The number of techniques and the expected results from those techniques vary greatly. Often it is confusing to patients and surgeons what is meant when the term FACE-LIFT is used. This article then analyzes two specific face-lift techniques, noting differences in patient selection, technique, result, and healing time.

Vantagens da ritidoplastia cérvico-facial com descolamento subcutâneo amplo / Advantages of facial and neck rhytidectomy with ample subcutaneous displacement

Considerando-se que, a maior parte da literatura sobre o tratamento de envelhecimento facial, referiase à técnica com SMAS (Sistema Músculo Aponeurótico Superficial), o autor realizou 31 cirurgias com a “ritidoplastia cérvico-facial com descolamento subcutâneo amplo” e a propõe como uma opção de recurso a ser utilizado. Essa técnica tem se revelado segura e simples e com menores riscos de lesões nervosas. Pode ser utilizada pelo cirurgião iniciante, pela facilidade de execução, e pelo cirurgião experiente como técnica alternativa. Houve redução do tempo cirúrgico e, em conseqüência, menos hematomas e edemas e um maior tempo para ocupar-se com vetores de tração, cicatrizes resultantes e demais estigmas da face operada. As complicações foram incomuns, os resul- tados satisfatórios e prolongados, tanto em pacientes jovens como em idosos.

Achieving the "natural look" in rhytidectomy.

Achieving the "natural look" in rhytidectomy and satisfying my aging face patient population are the primary motivating factors that have guided me to develop my personal philosophy and technique for facelifting. The following article will consider how to achieve the "natural look" in rhytidectomy using the modified deep plane-extended SMAS rhytidectomy technique, including the benefits derived from this efficient face-lift technique. It outlines how to give proper individualized consideration to each patient from the initial consultation, through the preoperative evaluation and workup, as well as anatomic indications for the type of face lift to be performed. In addition, the article covers possible postoperative complications and how to determine when secondary rhytidectomies or tuck-ups are indicated.

The central oval of the face: tridimensional endoscopic rejuvenation.

The central oval of the face is a distinct anatomic and aesthetic unit. Early signs of aging and advanced features of aging are manifested primarily in this unit. Standard face lift techniques are ineffective in treating this area. Intermediate layer (sub-SMAS, [superior musculo-aponeurotic system], intermuscular, etc.) and deep layer (subperiosteal) techniques were developed to treat this rather difficult part of the face. All variations of the intermediate layer technique have negative features, primarily safety issues related to potential nerve-muscle injury and protracted facial edema. Early described subperiosteal techniques (open, first generation endoscopic) were also associated with these types of complications. The author has outlined 14 principles of the ideal technique for the rejuvenation of the central oval. The advances and modifications to the first and second generation endoscopic central oval rejuvenation method comply with these principles. There are several principles that distinctly separate it from all other techniques: (1) direct approach to the central oval; (2) interconnected subperiosteal plane of dissection to the upper and midface; (3) use of small hidden slit incisions; (4) absence of eyelid incisions; (5) use of endoscopic techniques; and (6) absence of traction on skin or SMAS from the peripheral hemicircle. Another important advance made in this approach is the manipulation of soft tissues in the brow, glabella, cheek, and chin to provide a tridimensional rejuvenation. This was lacking in all previously described procedures. This method has been used with several modifications in over 500 patients. Aesthetic results have been excellent, with minimal sequela and a low complication rate. The subset of patients in whom this third generation endoscopic subperiosteal approach has been used have also had a three-dimensional remodeling and enhancement. The aesthetic results and safety factors surpass all other previously described techniques done at the intermediate or deep layers of the face.

[Current systematic definition and terminology of the face lifting technique]. / Aktuelle Systematik und Terminologie der Face Lifting-Technik.

OBJECTIVE: A more precise definition of the term "face lifting" appears to be necessary. The development of new techniques and modifications in the last decade has been the main reason for the proliferation of definitions. Nearly every author has his own terminology for describing his procedures. METHODS: Three criteria are helpful in achieving an overview. 1. The selection according to the anatomical areas of the face and the neck which have to be rejuvenated 2. The selection according to procedures, involving resection of soft tissues as opposed to techniques that solely involve soft tissue reposition, modification of facial bones, and combinations of these principles. 3. The selection according to the different layers of soft tissue or to the combination of different layers which are to be lifted. CONCLUSIONS: The terms "face lifting" and "lifting" are used synonymously in international literature. They refer to those surgical procedures which aim a achieve facial rejuvenation and a younger appearance of the neck. Definitions that refer only to a lifting of the facial skin do not correspond to the actual techniques, which often involve the surgical treatment of different soft tissue layers and sometimes facial bone. A classification is possible because some terms are used more often.

Face lift without preauricular scars.

A subperiosteal rhytidectomy is described that corrects aging of the forehead, the orbital region, the nasolabial fold, and the cheeks. It substantially improves muscular tone, consistency of subcutaneous tissue, and projection of malar volume. Its use with proper preoperative evaluation of the grade of facial aging reduces the indication for preauricular incision.