Cervicofacial rhytidoplasty in Ehlers-Danlos syndrome: hazards on healing

Ehlers-Danlos syndrome is an uncommon autosomal-dominantly inherited connective tissue disorder marked by excessive skin and joint laxity and easy bruising and ecchymotic tendency that poses a formidable threat to achieving face lift surgery in its normal perspective. Since this surgery is often sought by these patients as a result of premature excessive skin wrinkling of the face, one has to be aware of its possibility during the preoperative examination of the patient. All the possible complications and their management are described to the patient with a case history actually presenting these complications.     

Incidence of cervical branch injury with "marginal mandibular nerve pseudo-paralysis" in patients undergoing face lift

The anatomy of the cervical and marginal mandibular branches of the facial nerve is reviewed. In the senior author's practice, "pseudoparalysis of the marginal mandibular nerve" due to cervical branch injury occurred in 34 of 2002 superficial musculoaponeurotic system-platysma face lifts (1.7 percent) and was associated with a full recovery in 100 percent of cases within a time period ranging from 3 weeks to 6 months. Cervical branch injury can be distinguished from marginal mandibular nerve injury by the fact that the patient will be able to evert the lower lip because of a functioning mentalis muscle.     

Face lift

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Identify and describe the anatomy of and changes to the aging face, including changes in bone mass and structure and changes to the skin, tissue, and muscles. 2. Assess each individual's unique anatomy before embarking on face-lift surgery and incorporate various surgical techniques, including fat grafting and other corrective procedures in addition to shifting existing fat to a higher position on the face, into discussions with patients. 3. Identify risk factors and potential complications in prospective patients. 4. Describe the benefits and risks of various techniques. SUMMARY: The ability to surgically rejuvenate the aging face has progressed in parallel with plastic surgeons' understanding of facial anatomy. In turn, a more clear explanation now exists for the visible changes seen in the aging face. This article and its associated video content review the current understanding of facial anatomy as it relates to facial aging. The standard face-lift techniques are explained and their various features, both good and bad, are reviewed. The objective is for surgeons to make a better aesthetic diagnosis before embarking on face-lift surgery, and to have the ability to use the appropriate technique depending on the clinical situation.     

Muscular contraction

A molecular theory of muscular contraction, based on the trigger action of the cross bridge between actin and myosin, is postulated. The formation of the cross bridge is followed by a transconformation in contractile protein producing work and liberating heat. The process possesses a mechanochemical character and utilizes the energy liberated by dephosphorylation of ATP. The equation of for tension dependence of muscle power is derived from the theory of reaction rates. The equation of is meaningful after elementary treatment; the physical meaning of the constants in these equations is explained. Quantitative analyses are corroborated by the experimental data.     

SMAS-platysma face lift

Correction of laxity in the submental area and of hypertrophic neck cords has been enhanced with the SMAS-platysma face life over that which was achieved with a standard skin face lift. Evaluation of a 6-year experience with the SMAS-platysma face lift reveals that the operation can be safely performed with an acceptably low incidence of complications. The incidence of hematoma and associated complications is less than that which occurs when cervical and submental defatting is performed in conjunction with a skin face lift.