Facelifting: The Treatment of the Lower 1/3 of the Face

Abstract

Background: The search for rejuvenation interests several branches of medicine and industry. For this reason, plastic surgeons had to develop various techniques and routines. The author, with 50 years of experience in plastic surgery and facelifting, after experiencing all different procedures (each one at each time), now intends from the top of his professional experience to present his current consolidated routine, where he takes advantage of his previous experiences seeking the maximum simplification of the surgical techniques, searching for the best cost-effectiveness result.

Methods: He presents his original technique of the closed platysmotomy that allows the platysma band deactivation without opening the submenton and demonstrates the elimination of these bands through lateral SMAS-platysma plication only, having abandoned the SMAS dissection. The technique prevents total undermining of the skin in the liposuction areas and, where there is no liposuction, undermines the skin with cannulas, preserving the neurovascular bundles between the skin and deep planes. Facial liposuction and fat grafting on indicated areas are also a major goal of the procedure, bringing a smooth facial contour.

Results: After 50 years of facelifting experience, all techniques have been practiced such as round lifts, deep plane undermining, and submenton open approach. The long-term results do not differ when compared to less invasive procedures with smaller undermining area and strong lateral plications associated or not to closed platysmotomy.

Conclusions: Less invasive techniques must be considered in facelift cases since it can achieve good results with a good cost-effectiveness ratio to the patient, avoiding large undermining areas and morbidity. It is up to the surgeon and his knowledge in medical literature to make good judgment and select the best techniques. The author intends, after his vast experience, to have selected the best, achieving a routine that is less aggressive and bringing maximum results for the patient.