Naranjargalan.N M.SJuly 15, 2015

15th presentation

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Preoperative evaluationExplore patient’s desires and motivations SAFE

Self-image Anxiety Fear Expectation

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Potential contraindications Diabetes Smoking Collagen-vascular disease Psychiatric history Steroid use

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Clinical Evaluation“Face-lift”

Chin/neck liftNasolabial foldFine or deep rhytids

Ideal patientElastic and not too

much skinLittle fatGood bone structure

(hyoid)

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Clinical EvaluationLess than ideal

candidatesDiscuss

expectations in detail

Need for other procedures

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Clinical EvaluationImportant to

assess hyoid positionHigh hyoid is ideal

for cervicomental angle

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Clinical EvaluationAdjunctive

TechniquesLaser peelDermabrasionChemical peelNeck treatmentImplantsBlepharoplastyForehead liftRhinoplasty

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Anatomy (SMAS)Superficial Musculoaponeurotic System

SMASFacial nerve lies deep to the SMASPosteriorly, the SMAS fuses with the fascia

overlying the sternocleidomastoid muscle, but it is a distinct layer superficial to the parotid fascia

Anterosuperiorly, the SMAS invests the facial mimetic muscles of the mid-face (i.e., orbicularis oculi, zygomatic major/minor, levator labii superioris) the melolabial crease and upper lip

Scalp galea

Upper face continuous with frontalis and

orbicularis oculi Temporal region

temporoparietal fascia (superficial temporal fascia)

Parotid region dense fibrous layer overlying

parotid gland Cheek

thin layer invests superficial mimetic muscles

Lower face continuous with platysma

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Facial Artery and Nerve

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The most dangerous places

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Temporal branch is most superficialCrosses junction of

anterior 1/3 and posterior 2/3 of zygomatic arch

Above the arch it travels in the temporoparietal fascia to innervate frontalis and orbicularis oculi

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PlatysmaOrigin: clavicles and

1st rib and 5 cm below the angle of the mandible

Insertion: blends with the SMAS and lip depressors

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TechniquesSubcutaneous liftSMAS liftDeep-plane liftComposite liftSubperiosteal lift

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Incisions

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Incision technique

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Subcutaneous lift (full tickness skin graft)

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Subcutaneous lift

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Subcutaneous lift

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Subcutaneous lift

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Subcutaneous lift

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Subcutaneous lift

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Subcutaneous lift

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Subcutaneous lift

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SMAS Facelift

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SMAS Facelift Rotation of the SMAS-platysma flap

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SMAS Facelift

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SMAS Facelift

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SMAS Facelift

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SMAS FaceliftUsually with

liposuction and submental incision

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SMAS Facelift

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SMAS incision

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Differences

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Skin reduction and platysma muscle repositioning

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Deep plane rhytidectomy

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Deep Plane FaceliftSkin reduction,

platysma muscle repositioning and cheek fat repositioning

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Composite Face Lift

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Composite Face Lift

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Elevates and repositions the m.orbicular, the cheek fat and platysma muscle

MACS lift Minimal access cranial suspension Insicion is including skin fold of front of the

ear and following hairline

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Suturing First suture is going from deep temporalis

fascia to angle between the mandible and the neck.

Second suture is going from deep temporalis fascia to cyrcle between the cheek . It is parallel with nasolabial fold.

Third suture lift the lower eyelid and malar.

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Complications Hematoma Skin flap necrosis Nerve injury

Greater auricular Frontal

Pixie earHairline changes Hypertrophic scar and widening of scarAlopecia Infection

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