Facelift surgery
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Transcript of Facelift surgery
FACELIFT
Dr Subhakanta MohapatraMch Plastic surgery , IPGME&R & SSKM Hospital,kolkata
Introduction
Facial aging is a panfacial phenomenon
Changes in all layers of face including bone
It converts inverted cone (heart shaped) of face in to rectangular shape
Facelift reposition the ptotic tissue
Age for facelift – in 40s
75% 15 % 10%
1- premasseter space 2 – prezygomatic space 3 – upper temporal space
Pre op
Uncontrolled hypertension is a C/I for Surgery
Smoking , NSAIDs , HRT , anticoagulants - to be stopped 3 wks prior to surgery
Photographic documentation of face. Pt’s youth time photograph can be helpful.
Clinical assessment of facial nerve function
Ptosis of sub-mandibular gland to be noted
Patient counselling
Types of facelift
Subcutaneous facelift SMAS plication MACS facelift Supraplatysmal plane facelift Lateral SMASectomy Deep plane facelift Dual plane facelift Subperiosteal facelift
Facelift incisions
Temporal hair incision Anterior hairline incision Incision in the hair + a transverse
extension at the base of sideburn Pretragal Tragal edge incision Short scar technique(limited to retro
auricular sulcus,no occipital incision)
Short scar incision
Incorrect submental Correct submental incision incision
Safe plane of dissection
Subcutaneous facelift
1st facelift Still used today Basis of other facelift techniques Subcutaneous dissection Leaving 2 mm of fat in dermis Large random pattern skin flap Shifted in superolateral direction
(perpendicular to nasolabial fold , along the line of zygomaticus major muscle)
Normal (long axis of lobule is 15 ° Posterior to long axis of ear)
Subcutaneous facelift
Adv
Relatively safe
Easy to do
Rapid recovery
Disadv
Ineffective in heavier patients with significant ptosis of deep tissue
Skin will stretch with time leading to a loss of effect
Distortion of facial shape
PSP(Platysma – SMAS plication)
Incision - vertical temporal +/- post auricular extension
Vector of traction - Postero – superior SMAS – SMAS fixation SMAS is sutured directly (no purse string fashion) Platysmaplasty – direct (infralobular
excision)
Incision & area of subcutaneous dissection in PSP
Anterior SMAS to PM fascia posterior platysma to(key suture) mastoid fascia
PSP (after completion)
PSP
ADV
Easy Safe Autologous
malar augmentation
DISADV
Cheese wire effect
No release of ligaments
Limited effect in heavy jowls
MACS Lift (Minimal access cranial suspension lift) – Loop sutures
Based on specialised suture suspension
Suture loops placed in purse string fashion
Anchoring point – Deep temporal fascia (SMAS – DTF) Vertical vector of traction
No dissection in neck.(Liposuction in >95%) Types – 1. basic 2. extended
Short scar incision for MACS lift
Temporal branch of facial nerve
Basic MACS Lift
Extended MACS Lift
Microimbrication
MACS lift
ADV
No deep plane dissection
Less dissection – faster recovery
No dissection over SCM muscle
Reversible during surgery
Easy to learn
DISADV
Loss of effect if sutures pull through
No ligament release Less effective for
heavy jowls Relative lack of
malar augmentation
Lateral SMASectomy
Resection of a portion of SMAS - at the interface of mobile & fixed SMAS
(directly overlying the anterior edge of parotid gland).
Extends from tail of parotid to lateral canthus
Lateral SMASectomy
ADV
No SMAS flap elevation , so lesser tearing of superficial fascia & better holding of suture fixation
Facial nerve injury is less , as majority of dissection carried over parotid gland
Rapid,safe,durable & with less complications
DISADV
Not applicable for thin face, where fat needs to be preserved
Extended SMAS technique
Also known as dual plane facelift
Subcutaneous facelift with separate SMAS flap
SMAS flap shifted more vertically than the skin flap
Extended SMAS technique
Adv 2 different
vector is more effective
No skin tension Excellent
mobilisation & advancement of SMAS (ligament release)
Disadv More time
consuming
More chance of damage to deep structures
Thin skin flap
Supraplatysmal plane facelift Deep subcutaneous dissection immediately
superficial to SMAS & platysma
Raising skin & superficial fat as a single layer
SMAS layer untouched
Adv Thick robust flap No facial nerve injury
Disadv Flap is unidirectional Skin tension at suture line
Foundation facelift
Formerly known as deep plane facelift
Composite musculo cutaneous flap
Dissection – deep to SMAS platysma plane (avascular plane so less hematoma)
Robust flap (so indicated in secondary facelift, in smokers )
Particularly effective for deep nasolabial fold & midface
Disadv- facial nerve injury, single vector
Subperiosteal facelift
For central oval of the face (forehead , periorbita , midface , chin )
Most suitable plane for implant placement
Biplanar ( subperiosteal + subcutaneous )
Midface gets maximum benefit
Open / endoscopic technique
One cosmetic unit Forehead & upper eye lid Lower eye lid & mid face Lower face & neck
Subperiosteal facelift
Adv en bloc mobilisation(no
tension on skin) Short incision Implant placement Better visibility & orientation Safe plane More durable More balanced & natural
rejuvenation (no windswept/ motorcyclist appearance)
Disadv
Additional equipments needed
Limited effect in lower face & neck
High SMAS technique
Flap along the superior border of zygomatic arch . (unlike traditional low cheek SMAS flap elevated below arch )
Extending the dissection medially to mobilise midface soft tissue
Improves midface , upper anterior cheek
Allows simultaneous lift of jaw line , cheek & mid face
Corset ( Feldman platysmaplasty )
Post op care
Light dressings Rest with head end of bed elevated No neck flexion (no pillow) Control of blood pressure (pain,
anxiety,urinary retention) Cool packs to face Drain removal on 1st post op morning Suture removal in 7-9th day Photographic documentation of result
– after 6 months of surgery.
Complications
Hematoma – most common Localised & worsening pain T/t – evacuation (rather than giving
analgesic ) Nerve injury(facial & great auricular) Skin slough (retro auricular area) Unsatisfactory scars Alopecia Infection(rare)
Secondary facelift
Goals- To relift the face & neck Remove primary facelift scars Preserve maximum temporal & sideburn
Less skin resection Time consuming, technically
demanding Intra op bleeding & postop
hematoma – less Risk of nerve injury is slightly higher
Conclusion
The worst of all outcomes is to look operated
Surgical disharmony compromises the result
Thank U