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.     

Unsatisfactory forehead scar following face lift

The W-plasty scar revision technique has been found to be effective in the repair of the difficult and cosmetically unsatisfactory hairline scar following the ill-advised face lift technique that excises forehead skin.     

Sideburn relationship in the male face lift.

The importance of preserving the non-hairbearing preauricular skin in a male face-life is described and illustrated.     

Depth of the facial nerve in face lift dissections

Facial nerve depth was measured in 12 cadaver face halves after bilateral face lift dissections. The main nerve trunk emerged anterior to the midearlobe and was 20.1 +/- 3.1 mm deep. Nerve exit from the parotid edge also was deep, averaging 9.1 +/- 2.8 mm for temporal, 9.2 +/- 2.2 mm for zygomatic, 9.6 +/- 2.0 mm for buccal, and 10.6 +/- 2.7 mm for mandibular branches. Distal to the parotid gland, danger areas where nerve branches became superficial were distal temporal, lower buccal, and upper mandibular branches over the masseter muscle and marginal mandibular as it crossed the facial artery. Some protection in these danger areas was provided by fascia, especially superficial temporal and masseteric, while platysma provided some protection for the mandibular branch. Fascial and muscle protection was less in thin cadavers. Face lift dissection can be rapid in areas where facial nerve branches are deep or absent, such as postauricular, inferior to the zygomatic prominence, and near the earlobe.     

Do growth chart centiles need a face lift?

European height and weight growth charts commonly extend from the 3rd to the 97th centile, whereas in North America the extremes are usually the 5th and 95th centiles. There is no good reason for the difference, and neither chart is particularly useful for screening owing to the high false positive rate associated with a cut off based on the lowest centile. The World Health Organisation''s international growth reference uses cut offs based on standard deviation scores rather than centiles, which are more suitable for the extremes of growth status seen in the developing world. This chart, however, is incompatible with charts based on centiles. Here a unified growth chart is proposed: it has nine rather than seven centiles, and they are spaced two thirds of a standard deviation score apart rather than the more usual unit spacing. This gives a set of curves very like the conventional 3rd to 97th centiles, but with additional curves at 2.67 standard deviation below and above the mean (roughly the 0.4th and 99.6th centiles). The 0.4th centile is a more practical cut off for screening purposes than the 3rd or 5th centile.     

Effect of face lift on earlobe ptosis and pseudoptosis

The authors have previously described a classification system for earlobe ptosis and established criteria for earlobe pseudoptosis. Earlobe heights were characterized on the basis of anatomic landmarks, including the intertragal notch, the otobasion inferius (the most caudal anterior attachment of the earlobe to the cheek skin), and the subaurale (the most caudal extension of the earlobe free margin). The classification system was derived from earlobe height preferences as determined by a survey of North American Caucasians and identified the ideal free caudal segment (otobasion inferius to subaurale distance) measuring 1 to 5 mm (grade I ptosis). Also, earlobe pseudoptosis was defined by an attached cephalic segment (intertragal notch to otobasion inferius distance) measuring greater than 15 mm. In this study, the authors evaluated the effects of standard face lift surgery on earlobe ptosis and pseudoptosis by comparing the preoperative and postoperative earlobe height measurements from life-size photographs of 44 patients who underwent rhytidectomy performed by the senior author. The postoperative attached cephalic segment (intertragal notch to otobasion inferius distance, 12.22 +/- 0.364 mm) increased over its preoperative attached cephalic segment (intertragal notch to otobasion inferius distance, 11.10 +/- 0.406 mm) (p = 0.041). The postoperative free caudal segment (otobasion inferius to subaurale distance, 6.32 +/- 0.438 mm) demonstrated only a trend toward decreased heights when compared with the preoperative free caudal segment (otobasion inferius to subaurale distance, 7.15 +/- 0.489 mm) (p = 0.210). The incidence of pseudoptosis, defined by an attached segment (intertragal notch to otobasion inferius distance) greater than 15 mm, increased from 12.3 percent of preoperative patient earlobes to 17.3 percent of postoperative patient earlobes. An ideal free caudal segment (otobasion inferius to subaurale distance), defined by a range of 1 to 5 mm, was observed in only 37.0 percent of postoperative earlobes versus 22.2 percent of preoperative earlobes. Significant increases in the attached cephalic segments (intertragal notch to otobasion inferius distance) following rhytidectomies correlated with increased incidence of earlobe pseudoptosis, as observed in 17.3 percent of postoperative patient earlobes. Because the free caudal segment was negligibly affected by rhytidectomy, a majority of earlobes (63.0 percent) demonstrated persistent nonoptimal free caudal segment heights (otobasion inferius to subaurale distance > 5 mm). Earlobe height changes can result from either age-related lobule ptosis (increase in free caudal segment) as previously described or in patients undergoing rhytidectomy (increase in attached cephalic segment). Therefore, ideal lobule distances along with the effects of aging and rhytidectomy surgery on the lobule should be discussed with patients who are seeking a more youthful facial appearance, so that the aging ear may be addressed concurrently with the aging face.     

Multiplane face lift with the subperiosteal dissection for orientals

A subperiosteal face lift rejuvenates the midface and periorbital region by restoring facial muscle tone. Since 1993, the authors have performed this procedure on Oriental patients who have their own distinct facial contours: the brachycephalic cranium and a prominent zygoma and mandibular angle. Although it was thought that these protuberances might disturb the subperiosteal procedure, especially in the anterior midface, the procedure could be performed easily by adopting the ancillary upper buccovestibular and subciliary incisions; the authors found that the protuberances actually act as fulcrums to keep up the lifting vectors reliably. For older patients, the procedure was combined with a deep subcutaneous dissection. A simple lift of the periosteum would not improve a severe nasolabial fold deformity and prominent wrinkles adequately because of "lag-lifting" of the superficial layer. It was concluded that the multiplane face lift, consisting of the subperiosteal and the deep subcutaneous approaches, achieves a natural-appearing rejuvenation of the Oriental aging face.