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.     

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.     

The lip lift

Attention is brought to a seldom-considered sign of aging--the lengthening of the upper lip. It is easily corrected by excising a wavy ellipse of lip skin and hiding the scar up under the nose. A vertical midline component may be added. The scars are minimal, and the results have been excellent in 83 patients.     

The subcutaneous forehead lift

A limited experience (27 patients, all female) is presented utilizing the subcutaneous approach to forehead lifting. This approach has been little utilized and has been condemned in the literature for being dangerous. However, no difficulties in wound healing or alopecia have been encountered, and the procedure has the advantages of more effectively removing the vertical and transverse wrinkles in the glabellar region, raising the brows, and preserving sensation to the scalp posterior to the incision.     

Transblepharoplasty endoscopic subperiosteal midface lift

The use of endoscopy in the transblepharoplasty midface lift is essential for preventing the complications of facial nerve injury and bleeding. Complete observation allows precise dissection and release of all structures in the composite flap. This technique fully preserves the zygo-orbicular nerve plexus and prevents denervation of the orbicularis oculi and zygomaticus muscles. Blind dissection has a significant probability of denervation of the entire zygo-orbital muscle complex, and avulsion of the zygomaticofacial vessels, with associated postoperative bleeding complications. The modification involving suturing of the "vest" of the combined lateral orbital periosteal and superficial layers of the deep temporal fascia over the elevated "pants" of the orbicularis periosteal flap provides very secure fixation for suspension of the lower eyelid and midface. The use of slowly absorbable polydioxanone sutures for this technique prevents the problems caused by permanent sutures beneath the very thin skin of the lateral canthal area. Careful trimming of the prominent roll of the orbicularis muscle that often develops with suspension eliminates the uneven contour and yields a smooth lower lid appearance. The details and modifications described should decrease the complications and morbidity that can occur with this procedure and provide for a more precise and reliable procedure for rejuvenation of the lower eyelid and midface.     

Amphibians: lungs' lift lost

The reduction or loss of lungs in some amphibian species is a rare evolutionary occurrence. The discovery of the first lungless frog sheds further light on the physiological, morphological and behavioral changes that allowed sufficient external respiration in the absence of lungs.