Fig. 18 – 24. (16,17) The fat pads which have been excised following upper and lowe blepharoplasty. (18,19,20,21,22,23) Facelifting: the planned skin incision is marked. The anterior, inferior and posterior limits of the dissection are noted. (23) Local anaesthesia: Xylocaine 1%, 1:200,000 Adrenaline is infiltrated using spinal needle.
Fig. 18 – 25. (24) Lower facelifting: Dissection and undermining of skin is carried out, forward, downward, backward in all direction up to the noted dissection limits. The dissection is carried out by a straight blunt scissors just deeper than the hair follicles beween the skin and platisma. (25,26,27,28) SMAS management: The SMAS plane is entered with a blunt scissors superficial to the parorid capsule. The SMAS flap is elevated, then advanced and rotated superiorly. The excessive overlapped tissue is trimmed and then edge to edge suture repair is completed with 2/0 Ethibond. (29,30) Suspension rhytidectomy: SMAS plication in addition to the above SMAS management is recommended. The author adds six to eight sutures 2/0 Ethibond which is positioned anteroposteriorly from the anterior limit of the dissection at the junction between the skin and platisma then posteriorlyjusst one cm anterior to the skin incision. (31) Skin flap redistribution and closure: Closure is achieved with subcutaneous 4/0 Dexon. Hemovac is used.