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Approaches to Facelifting

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Oculofacial, Orbital, and Lacrimal Surgery

Abstract

The evolution of the cervicofacial rhytidectomy spans more than 110 years, witnessing many successes and failures along the way and yielding the variety of facelift techniques available today. In this chapter, we review the key features and differences between the most common and well-established techniques in facelifting, including conventional SMAS (superficial musculoaponeurotic system) techniques such as the lateral-SMASectomy and extended-SMAS procedures such as the deep plane and high-SMAS rhytidectomy techniques. At the core of understanding the differences between these varied facelift types lies a comprehensive understanding of facial anatomy and the facial aging process. In this chapter, the history of facelifting, surgical approaches, and complications pertaining to this iconic surgery are discussed.

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Abbreviations

RSTLs:

Relaxed skin tension lines SMAS Superficial Musculoaponeurotic System

References

  1. Leal Silva HG. Facial laxity rating scale validation study. Dermatol Sure. 2016;42(12):1370–9.

    Article  CAS  Google Scholar 

  2. Pessa JE, Zadoo VP, Yuan C, Ayedelotte JD, Cuellar FJ, Cochran CS, et al. Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps. Infants Have Jowls Plast Reconstr Surg. 1999;103(2):635–44.

    Article  CAS  PubMed  Google Scholar 

  3. Mendelson B, Wong C-H. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthet Plast Surg. 2012;36(4):753–60.

    Article  Google Scholar 

  4. Shaw RB Jr, Katzel EB, Koltz PF, Kahn DM, Girotto JA, Langstein HN. Aging of the mandible and its aesthetic implications. Plast Reconstr Surg. 2010;125(1):332–42.

    Article  CAS  PubMed  Google Scholar 

  5. Donofrio LM. Fat distribution: a morphologic study of the aging face. Dermatol Surg. 2000;26(12):1107–12.

    Article  CAS  PubMed  Google Scholar 

  6. Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg. 2007;120(5):1367–76.

    Article  CAS  PubMed  Google Scholar 

  7. Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219–27.

    Article  CAS  PubMed  Google Scholar 

  8. Ascher B, Coleman S, Alster T, Bauer U, Burgess C, Butterwick K, et al. Full scope of effect of facial lipoatrophy: a framework of disease understanding. Dermatol Surg. 2006;32(8):1058–69.

    CAS  PubMed  Google Scholar 

  9. Pallua N, Wolter T. The Lipo-facelift: merging the face-lift and Liposculpture: eight years experience and a preliminary observational study. Aesthet Plast Surg. 2013;37(6):1107–13.

    Article  CAS  Google Scholar 

  10. Glogau RG. Aesthetic and anatomic analysis of the aging skin. Semin Cutan Med Surg. 1996;15(3):134–8.

    Article  CAS  PubMed  Google Scholar 

  11. Lexer E. In: Barth JA, editor. Die gesamte Wiederherslellung schiurgie, vol. 2. Leipzig; 1931. p. 548.

    Google Scholar 

  12. Hollander E. Cosmetic surgery. In: Joseph M, editor. Handbuch der Kosmetik. Leipzig: Veriag von Velt; 1912. p. 688.

    Google Scholar 

  13. Joseph J. Hangewangenplastik (melomioplastik). Dtsch Med Wochenschr. 1921;47:287.

    Article  Google Scholar 

  14. Bourget J. La disparitionchiurgicale des rides etplis du visage. Bull Acad Med Paris. 1919;82:183.

    Google Scholar 

  15. Passot R. La chirurgieesthetique des rides du visages. Presse Med. 1919;27:258.

    Google Scholar 

  16. Noel A. La Chirurgieesthetique: Son Role Social. Paris: Masson et Cite; 1926.

    Google Scholar 

  17. Bames OH. Truth and fallacies of face peeling and face lifting. Med J Rec. 1927:126–86.

    Google Scholar 

  18. Burian F. Zur Technik der Gesichtshautspannung. Med Welt. 1936;10:930.

    Google Scholar 

  19. Seltzer AP. Reconstructive surgery for the elderly. Geriatrics. 1952;7(3):185–8.

    CAS  PubMed  Google Scholar 

  20. Johnson JB. The problem of the aging face. Plast Reconstr Surg. 1955;15(2):117–21.

    Article  CAS  Google Scholar 

  21. Gonzales-Ulloa M. The creation of aesthetic plastic surgery [book on the internet]. New York: Springer; 1985. Chapter 3: The history of rhytidectomy; p. 46–90. Available from: SpringerLink.

    Book  Google Scholar 

  22. Skoog T. “Chapter XIII: The Aging Face”. Plastic surgery: new methods. Saunders: Philadelphia; 1974. p. 328–9.

    Google Scholar 

  23. Webster RC, Smith RC, Papsidero MJ, Karolow WW, Smith KF. Comparison of SMAS plication with smas imbrication in face lifting. Laryngoscope. 1982;92(8 Pt 1):901–12.

    CAS  PubMed  Google Scholar 

  24. Barton FE Jr. The SMAS and the nasolabial fold. Plast Reconstr Surg. 1992;89(6):1054–7; discussion 1058–9.

    Article  PubMed  Google Scholar 

  25. Hamra ST. The deep-plane Rhytidectomy. Plast Reconstr Surg. 1990;86(1):53–61; discussion 62–3.

    Article  CAS  PubMed  Google Scholar 

  26. Hamra ST. The tri-plane face lift dissection. Ann Plast Surg. 1984;12(3):268–74.

    Article  CAS  PubMed  Google Scholar 

  27. Hamra ST. Commentary on: total composite flap facelift and the deep-plane transition zone: a critical consideration in SMAS-release midface lifting. Aesthet Surg J. 2016;36(5):546–9.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Barton FE. The “high SMAS” facelift technique. Aesthet Surg J. 2002;22(5):481–6.

    Article  PubMed  Google Scholar 

  29. Tessier P. Le lifting facial sous-perioste. Ann Chir Plast Esthet. 1989;34(3):193–7. French.

    CAS  PubMed  Google Scholar 

  30. Psillakis JM, Rumley TO, Camargos A. Subperiosteal approach on an improved concept for correction of the aging face. Plast Reconstr Surg. 1988;82(3):383–92.

    Article  CAS  PubMed  Google Scholar 

  31. Santana PM. Craniofacial methods in rhytidectomy. Cir Plast Iberolatinoamer. 1984;10:322–8.

    Google Scholar 

  32. Ramirez OM, Maillard GF, Musolas A. The extended subperiosteal face lift: a definitive soft tissue remodeling for facial rejuvenation. Plast Reconstr Surg. 1991;88(2):227–36.

    Article  CAS  PubMed  Google Scholar 

  33. de Saint Cyr BC, Maillard GC, Scheflan M, Ramirez O. The subperiosteal lift. Aesth Plast Surg. 1993;17(2):151–5.

    Article  Google Scholar 

  34. Quatela VC, Jacono AA. The extended centrolateral endoscopic midface lift. Facial Plast Surg. 2003;19(2):199–208.

    Article  PubMed  Google Scholar 

  35. Hamra ST. Composite Rhytidectomy. St. Louis: Quality Medical Publishing; 1993.

    Google Scholar 

  36. Marten TJ. High SMAS facelift: combined single flap lifting of the jawline, cheek, and midface. Clin Plast Surg. 2008;35(4):569–603.

    Article  PubMed  Google Scholar 

  37. Marten TJ. Lamellar high SMAS face and mid-face lift. In: Nahai F, editor. The art of aesthetic surgery. St. Louis: Quality Medical Publishing; 2005. p. 1110–93.

    Google Scholar 

  38. Maliniak JW. Is the surgical restoration of the aged face justified? Med J Rec. 1932;135:321–4.

    Google Scholar 

  39. Millard DR, Garst WP, Beck RL. Submental and submandibular lipectomy in conjunction with a face-lift in the female and male. Plast Reconstr Surg. 1972;49(4):385–91.

    Article  PubMed  Google Scholar 

  40. Guerrero-Santos J, Espaillat L, Morales F. Muscular lift in cervical rhytidoplasty. Plast Reconstr Surg. 1974;54(2):127–30.

    Article  CAS  PubMed  Google Scholar 

  41. Connell BF. Contouring the neck in rhytidectomy by lipectomy and muscle sling. Plast Reconstr Surg. 1978;61(3):376–83.

    Article  CAS  PubMed  Google Scholar 

  42. Aston SJ. Platysma muscle in rhytidoplasty. Annals Plast Surg. 1979;3(6):529–39.

    Article  CAS  Google Scholar 

  43. Connell BC. Cervical lifts: the value of platysma muscle flaps. Ann Plast Surg. 1978;1(1):32–43.

    Article  CAS  PubMed  Google Scholar 

  44. Feldman JJ. Corset platysmaplasty. Plast Reconstr Surg. 1990;85(3):333–43.

    Article  CAS  PubMed  Google Scholar 

  45. Mittelman H, Spencer JR, Chrzanowski DS. Chin region: management of grooves & mandibular hypoplasia with alloplastic implant. Facial Plast Surg Clin North Am. 2007;15(4):445–60.

    Article  PubMed  Google Scholar 

  46. Grover R, Jones BM, Waterhouse N. The prevention of haematoma following rhytidectomy: a review of 1078 consecutive facelifts. Br J Plast Surg. 2001;54(6):481–6.

    Article  CAS  PubMed  Google Scholar 

  47. Baker DC, Stefani WA, Chiu ES. Reducing the incidence of hematoma requiring surgical evacuation following male rhytidectomy: a 30-year review of 985 cases. Plast Reconstr Surg. 2005;116(7):1973–85; discussion 1986–7.

    Article  CAS  PubMed  Google Scholar 

  48. Kamer FM, Song AU. Hematoma formation in deep plane rhytidectomy. Arch Facial Plast Surg. 2000;2(4):240–2.

    Article  CAS  PubMed  Google Scholar 

  49. Berner RE, Morain WD, Noe JM. Postoperative hypertension as an etiological factor in hematoma after rhytidectomy. Prevention with chlorpromazine. Plast Reconstr Surg. 1976;57(3):314–9.

    Article  CAS  PubMed  Google Scholar 

  50. Spotnitz WD. Efficacy and safety of fibrin sealant for tissue adherence in facial rhytidectomy. Clin Cosmet Investig Dermatol. 2012;5:43–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Weissman O, Farber N, Remer E, Tessone A, Trivizki O, Bank J, et al. Post-facelift flap necrosis treatment using charged polystyrene microspheres. Can J Plast Surg. 2013;21(1):45–7.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Rees A, Aston SJ. Complications of rhytidectomy. Clin Plast Surg. 1978;5(1):109–19.

    CAS  PubMed  Google Scholar 

  53. Kruper GJ, VandeGriend ZP, Lin H-S, Zuliani GF. Salvage of failed local and regional flaps with porcine urinary bladder extracellular matrix aided tissue regeneration. Case Rep Otolaryngol. 2013;2013:917183.

    PubMed  PubMed Central  Google Scholar 

  54. Kimmel H, Rahn M, Gilbert TW. The clinical effectiveness in wound healing with extracellular matrix derived from porcine urinary bladder matrix: a case series on severe chronic wounds. J Am Col Certif Wound Spec. 2010;2(3):55–9.

    PubMed  PubMed Central  Google Scholar 

  55. Robertson SA, Jeevaratnam JA, Agrawal A, Cutress RI. Mastectomy skin flap necrosis: challenges and solutions. Breast Cancer (Dove Med Press). 2017;9:141–52.

    Google Scholar 

  56. Francis A, Baynosa RC. Hyperbaric oxygen therapy for the compromised graft or flap. Adv Wound Care (New Rochelle). 2017;6(1):23–32.

    Article  Google Scholar 

  57. Payne DL. Facial nerve deficits following face lift surgery. Am J Otol. 1992;13(1):91–2.

    CAS  PubMed  Google Scholar 

  58. Liebman EP, Webster RC, Gaul JR, Griffin T. The marginal mandibular nerve in rhytidectomy and liposuction surgery. Arch Otolaryngol Head Neck Surg. 1988;114(2):179–81.

    Article  CAS  PubMed  Google Scholar 

  59. Kamer FM. One hundred consecutive deep plane face lifts. Arch Otol Head Neck Surg. 1996;122(1):17–22.

    Article  CAS  Google Scholar 

  60. Clark RP, Berris CE. Botulinum toxin: a treatment for facial asymmetry caused by facial nerve paralysis. Plast Reconstr Surg. 1989;84(2):353–5.

    Article  CAS  PubMed  Google Scholar 

  61. LeRoy JL Jr, Rees TD, Nolan WB III. Infections requiring hospital readmission following face lift surgery: incidence, treatment, and sequelae. Plast Reconstr Surg. 1994;93(3):533–6.

    Article  PubMed  Google Scholar 

  62. Shah VV, Aldahan AS, Mlacker S, Alsaidan M, Samarkandy S, Nouri K. 5-fluorouracil in the treatment of keloids and hypertrophic scars: a comprehensive review of the literature. Dermatol Ther (Heidelb). 2016;6(2):169–83.

    Article  Google Scholar 

  63. Tholen RH. Pulsed dye laser treatment of hypertrophic scars. Aesthetic Surgery Journal. 1996;16(2):92.

    Article  Google Scholar 

  64. Kono T, Erçöçen A, Nakazawa H, Nozaki M. Treatment of hypertrophic scars using a long-pulsed dye laser with cryogen-spray cooling. Ann Plast Surg. 2005;54(5):487–93.

    Article  CAS  PubMed  Google Scholar 

  65. Drost BH, van de Langenberg R, Manusama OR, Janssens AS, Sikorska K, Zuur CL, et al. Dermatography (medical tattooing) for scars and skin grafts in head and neck patients to improve appearance and quality of life. JAMA Facial Plast Surg. 2017;19(1):16–22.

    Article  PubMed  Google Scholar 

  66. Perez CF, Gaball CW. Functional and aesthetic tragal reconstruction in the age of mobile electronic devices. Case Rep Otolaryngol. 2016;2016:2591705.

    PubMed  PubMed Central  Google Scholar 

  67. Choucair RJ, Hamra ST. Extended superficial musculaponeurotic system dissection and composite rhytidectomy. Clin Plastics Surg. 2008;35(4):607–22.

    Article  Google Scholar 

  68. Lambros V, Stuzin JM. The cross-cheek depression: surgical cause and effect in the development of the “joker line” and its treatment. Plast Reconstr Surg. 2008;122(5):1543–52.

    Article  CAS  PubMed  Google Scholar 

  69. Hoefflin SM. Simple repair of pixie earlobe. Plast Reconstr Surg. 2001;107(6):1623–4.

    Article  CAS  PubMed  Google Scholar 

  70. Gonzales-Ulloa M. The history of rhytidectomy. Aesthet Plast Surg. 1980;4(1):1–45.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, University of Central Florida College of Medicine, Orlando, FL, USA

    Danny J. Soares

  2. Mesos Plastic and Laser Surgery, Lady Lake, FL, USA

    Danny J. Soares

  3. Department of Otolaryngology, Head and Neck Surgery, Emory University, Atlanta, GA, USA

    William E. Silver

  4. Atlanta Institute for Facial Aesthetic Surgery, Atlanta, GA, USA

    William E. Silver

Authors
  1. Danny J. Soares
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  2. William E. Silver
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Corresponding author

Correspondence to Danny J. Soares .

Editor information

Editors and Affiliations

  1. Eyelid and Facial Plastic and Reconstructive Surgery and MediSpa, Diseases and Surgery of the Orbit & Lacrimal System Neuro-ophthalmology, Glenview/Chicago, IL, USA

    Adam J. Cohen

  2. Oculoplastics, Orbital, and Cosmetic Facial Surgery, University of Wisconsin, Madison Department of Ophthalmology and Visual Sciences, Madison, WI, USA

    Cat Nguyen Burkat

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Soares, D.J., Silver, W.E. (2019). Approaches to Facelifting. In: Cohen, A., Burkat, C. (eds) Oculofacial, Orbital, and Lacrimal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-14092-2_33

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  • DOI: https://doi.org/10.1007/978-3-030-14092-2_33

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-14092-2

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