An Evidence-Based and Case-Based Comparison of Modern Face Lift Techniques.

BACKGROUND: Facial aging is a multifactorial process that affects each component of facial anatomy. The two general groups of face lift techniques are superficial musculoaponeurotic system (SMAS) elevation and SMAS manipulation. The purpose of this article is to describe and compare the advantages, disadvantages, and limitations of face lift techniques. METHODS: A systematic review was performed to describe current outcomes evidence for face lift techniques. A subcohort of articles was selected for case-based analysis based on designated facial assessment criteria. Analysis was performed to determine the advantages, disadvantages, and limitations of each respective technique. RESULTS: A total of 65 articles were selected for systematic review, of which 15 met criteria for case-based review. Patient satisfaction was found to be equivocal for various face lift techniques. Specific advantages and disadvantages for each face lift technique were dependent on the techniques' approach to skin shift vector along with its degree of mobilizing superficial facial fat. Facial fat grafting was universally applicable for restoration of deep malar volume. Facial fat grafting was also used differently depending on the SMAS technique to address its specific limitations. CONCLUSIONS: The authors' review confirms that there are many methods to obtain excellent outcomes in facial rejuvenation. Experienced surgeons are able to obtain consistent results through a variety of techniques based on understanding the aesthetic needs of the individual patient, the quality of the soft tissues being manipulated, and how to vary a specific technique to reach desired aesthetic end points.

A personal tribute to a great educator: how Henry Kawamoto influenced my interest in facial soft tissue anatomy and changed my plastic surgery career.

Henry Kawamoto remains one of the most influential craniofacial surgeons of the 20th century. A Tessier-trained craniofacial surgeon, Dr. Kawamoto has personally influenced not only the lives of his patients, but significantly also the lives of those craniofacial fellows he educated, passing on the Tessier methodology to future generations. This article serves as an anecdote as to how Dr. Kawamoto's mentoring influenced a personal understanding of facial soft tissue anatomy, leading to improved technical approaches for surgical rejuvenation of the aging face.

The Role of the Buccal Fat Pad in Facial Aesthetic Surgery.

SUMMARY: Social media have triggered a buccal fat pad excision frenzy. Not surprisingly, there is tremendous appeal of having a slimmer lower face and more defined jawline after undergoing a small intraoral procedure under local anesthesia. Although this procedure is great for social media and seemingly beneficial for jawline aesthetics, the evidence remains limited as to whether or not this is an effective long-term solution. How much the buccal fat pad persists or diminishes as we age is an area of debate. However, the possibility of causing premature aging and midface distortion in the long run is disconcerting.

Facial Nerve Danger Zones.

Facial nerve injury is one of the most feared complications in surgical rejuvenation of the aging face. Understanding the three-dimensional architecture of the facial soft tissue, the fascial planes that exist within this architectural arrangement, and the danger zones where the facial nerve is situated superficial and adjacent to the planes of dissection commonly used in face-lift techniques, are the keys to safety in preventing motor branch injury. The two-dimensional branching patterns of the marginal and cervical branches of the facial nerve are variable, making it difficult to ascertain exact nerve location when dissecting within the cheek and neck. On a three-dimensional basis, the position and depth of the marginal and cervical branches are constant and predictable. Understanding the three-dimensional anatomy in terms of planes of dissection, and the danger zones where these nerve branches are vulnerable to injury, provides protection against iatrogenic injury when performing surgical rejuvenation of the aging face. These video vignettes provide an overview of the fascial anatomy of the cheek in relation to the facial nerve branches and delineate the regions of the face in which nerve branches are most likely to be injured. Methods to prevent injury are discussed. Furthermore, the vignette defines these danger zones and delineates methods to protect the nerve branches.

PRS Global Open: A Dream Turning to Reality.

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The Facial Fat Compartments Revisited: Clinical Relevance to Subcutaneous Dissection and Facial Deflation in Face Lifting.

The facial fat compartments were described over a decade ago, but their clinical relevance to both deflation and techniques in facial rejuvenation is underappreciated. Although much of the literature following their description has focused on further anatomical elucidation of compartment anatomy, clinical relevance has focused on volumetric compartment augmentation. From the authors' perspective, understanding compartmentalization of facial fat provides an anatomical roadmap of the facial subcutaneous plane and a patient-specific guide for the degree of skin flap dissection in facial rejuvenation. The compartmentalization of facial fat also explains the regional development of cheek deflation in aging. An individualized treatment plan to restore facial shape can be achieved with deep compartment volume augmentation and repositioning of superficial facial fat using the superficial musculoaponeurotic system.

Tissue-Based Planning and Technique for Breast Augmentation with Anatomical Implants.

Breast augmentation with anatomical implants offers several potential advantages. Tissue-based planning is patient specific and essential in choosing the correct dimensions of an implant, thereby providing greater control in breast shape following augmentation. This video vignette demonstrates tissue-based planning in a patient with a constricted breast, allowing the surgeon to accurately choose the proper implant dimensions, which correct the constriction while providing aesthetic control of breast shape. Operative techniques of precise pocket formation, prospective hemostasis, and judging the aesthetic contour following implant insertion are demonstrated.

Gluteal Augmentation and Enhancement of the Female Silhouette: Analysis and Technique.

Dr. Constantino Mendieta demonstrates and details his personal technique for gluteal augmentation. The video demonstration is divided into three parts: Part I, Aesthetic Analysis and Preoperative Marking; Part II, Creating the Female Silhouette with Circumferential Lipoplasty; and Part III, Autogenous Gluteal Augmentation. Artistic concepts for gluteal augmentation and contouring the female silhouette and technical considerations for patient safety are emphasized. This Master Series Video article is the first in a planned series of video vignettes.

Female Cosmetic Genital Surgery.

Female cosmetic genital surgery is rapidly gaining popularity. Patient demand is increasing, and female cosmetic genital surgery is becoming a subspecialty of plastic surgery. Two predominant techniques exist in labia minora reduction: edge trim and wedge resection. Dr. Hamori prefers the wedge resection for most clinical situations. This video vignette clearly describes aesthetic analysis, marking, and technical execution for an extended wedge procedure. Patient safety and the management of patient expectations are emphasized.

The Modern Male Rhytidectomy: Lessons Learned.

BACKGROUND: Cosmetic surgery among male patients has become increasingly popular. The face-lift technique is different in male patients, specifically regarding preservation of hair follicles, restoration of a youthful and well appearance, and reduction of the risk of hematoma. METHODS: A retrospective review of a single surgeon's past 20 years of consecutive male rhytidectomies revealed a cohort of 83 patients. A control group was created by random selection of 83 age-matched female rhytidectomy patients during the same period. Data were collected and analyzed critically for factors contributing to complications, including hematoma, seroma, skin sloughing, alopecia, infection, and nerve injury. The evolution in the senior author's technique in male rhytidectomy is described. RESULTS: Differences in facial analysis and rhytidectomy technique in male patients and female patients are highlighted. Five male patients (6.0 percent) and no female patients in the control group developed postoperative hematoma (p = 0.0587). No other complications occurred. CONCLUSION: Respecting the patterns of hair growth in incision design, avoiding damage to follicles during dissection, and exercising standard of care (especially avoidance of hypotensive anesthesia) in prevention of postoperative hematoma have delivered safe and consistently reproducible aesthetic outcomes and acceptable complication rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Celebrating the Fiftieth Baker Gordon Symposium on Cosmetic Surgery: The Legacy of Thomas J. Baker, M.D.

The Baker Gordon Symposium on Cosmetic Surgery celebrates its fiftieth year. A review of its history mirrors the evolution of aesthetic surgery in terms of advancements in techniques, and the acceptance of cosmetic surgery as a credible subspecialty of plastic surgery. Beginning in 1967, the Baker Gordon Symposium was the first live surgery symposium that focused on aesthetic surgery, and set a precedent for aesthetic surgery education over the ensuing decades. Historically, the pioneers in aesthetic techniques first presented their innovations at the Baker Gordon Symposium, helping to educate and train their peers to perform cosmetic procedures. The legacy of Thomas Baker is intertwined with the history of the Baker Gordon Symposium, both in terms of his contributions to plastic surgery education, and to the acceptance of the subspecialty of aesthetic surgery.

Anatomical considerations to prevent facial nerve injury.

Injury to the facial nerve during a face lift is a relatively rare but serious complication. A large body of literature has been dedicated toward bettering the understanding of the anatomical course of the facial nerve and the relative danger zones. Most of these prior reports, however, have focused on identifying the location of facial nerve branches based on their trajectory mostly in two dimensions and rarely in three dimensions. Unfortunately, the exact location of the facial nerve relative to palpable or visible facial landmarks is quite variable. Although the precise location of facial nerve branches is variable, its relationship to soft-tissue planes is relatively constant. The focus of this report is to improve understanding of facial soft-tissue anatomy so that safe planes of dissection during surgical undermining may be identified for each branch of the facial nerve. Certain anatomical locations more prone to injury and high-risk patient parameters are further emphasized to help minimize the risk of facial nerve injury during rhytidectomy.

Current Trends in Facial Rejuvenation: An Assessment of ASPS Members' Use of Fat Grafting during Face Lifting.

BACKGROUND: Fat grafting can be used to improve the results of face lifting. The extent to which plastic surgeons use fat grafting in their face-lift practices is unknown. The goals of this study were to understand the current use of fat grafting during facial rejuvenation surgery and identify the most common techniques used. METHODS: A 28-item questionnaire was formulated for distribution to a randomized cohort of American Society of Plastic Surgeons members. Data were collected and statistically analyzed using Pearson chi-square and Fisher's exact tests. RESULTS: A total of 309 questionnaires were collected. The questionnaire revealed that 85.2 percent of respondents use fat grafting during face lifts. Currently, the most common techniques used include abdominal harvest, centrifuge processing, blunt cannula injection without pretunneling, and placing less than 0.1 cc per pass. The deep central malar, lower lid cheek junction, and nasolabial folds are the most commonly injected areas. CONCLUSIONS: Combining surgical repositioning of fat with fat grafting offers surgeons a greater degree of aesthetic control for correcting contour in the aging face. Although there is controversy regarding the best method to surgically reposition fat, there is a growing consensus that volume augmentation is preferred by most face-lift surgeons.

Infection in face-lift surgery: an evidence-based approach to infection prevention.

BACKGROUND: Complications in face-lift surgery are rare but can present a difficult experience for the patient and surgeon. It is the objective of this review to evaluate the clinical efficacy of routine perioperative safety measures in preventing surgical-site infection in face-lift surgery. METHODS: A review of the literature was performed to assess the correlation of preoperative decolonization, prophylactic antibiotic use, perioperative hypothermia, body mass index, and smoking status with the incidence of surgical-site infection in cosmetic surgery, especially pertaining to face-lift surgery. RESULTS: Studies supporting safe practice in cosmetic surgery and "clean" procedures are analyzed and discussed. CONCLUSION: This article provides the current evidence on perioperative safety measures and recommendations regarding the prevention of infection in cosmetic surgery, especially in face-lift surgery.