Facelifting procedures will be discussed purely from a practical angle, including the particular techniques which the author finds more straight forward, sharp, less complicated and invasive.
The features and signs of an aging face result mainly from the following major factors:
1. Atrophy of the cutaneous fat.
2. Loss of elasticity of the skin.
3. Facial skeleton bone absorption including periodental.
4. Overactive facial and neck muscles.
Common features of an aging face are:
– Skin wrinkles, rhytids, creases, furrows, fissures, folds and deep lines of facial expressions.
– Eyes sagging, eyebags, bulging, fullness, redundant eyelid skin and fat herniation and prolapse.
– Fat deposits in submandibular and submentum.
– Redundant skin and ptosis of the lateral neck, anterior neck, cheek, submandibular, submentum and postcervical neck.
– Ptosis of the nose and chin.
– Vertical platisma muscle folds and binding submentum.
– ‘Gaunt’ appearance due to fat atrophy.
– Acquired pigmentation and skin lesions.
– Loss of hair pigmentation, sparse and coarse hair.
The goals of lower facelifting are to achieve the following:
– Natural, satisfactory and safe results.
– Avoiding unwanted postoperative problems.
– Short hospital stay and early mobilization (day case).
– Early return to work.
The technique of lower facelifting that the author has been using for the last seven years is based on a combination of:
– Suspension rhytidectomy (superficial musculoaponeurotic system plication).
– Superficial musculoaponeurotic system management: limited superficial musculoaponeurotic system flap, elevation and advancement, trimming, rotation and suture imbrication.
The main advantages of combined suspension rhytidectomy and superficial musculoaponeurotic system flap techniques are:
– Limited dissection that reduces bruises, echymosis, tension cones and dog ear formation.
– Reduction of subcutaneous dead space that limits and reduces the haematoma, infection, abscess
formation and leads for rapid wound healing.
– The branches of the facial nerves are usually safe.
– Procedure is easily performed under local anaesthesia and sedation as a day case.
– Preserve the hair pattern.
– Good healing resulting in invisible scars.
– Return to work usually in five days time.
|Fig. 18 – 9. A 65-year-old patient was presented with redundant skin of the lateral neck, anterior neck and submandibular regions with skin wrinkles, rhytids, creases and eyes sagging.
Postoperative photos showed the results of facelifting, forehead lifting with upper and lower blepharoplasty.
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