Facelift: panel discussion, controversies, and techniques.

This article is a panel discussion with questions and answers on face-lift technique.

The McCollough Facial Rejuvenation System: expanding the scope of a condition-specific algorithm.

The ideal facial rejuvenation algorithm is comprised of an appropriate combination of procedures, thoughtfully chosen from an assortment of reliable alternatives, that when skillfully performed provide both short- and long-term enhancement to the undesirable conditions of aging that exists at the time of treatment. In 2010, the senior author published the first scientific article in which a condition-specific classification system and a treatment plan algorithm were applied to the discipline of facial rejuvenation. In the landmark article, the senior author reviewed his surgical experience of more than 5000 face-lifts and grouped patients into five major categories (or stages), based upon the extent of aging identified in various regions of the face and neck and the procedures performed to correct them. The criteria (that have now been suggested on a facial aging worksheet) were recorded in a data blank comprised of a first-generation worksheet. Once the data were collected--and using algorithmic charts for each region and/or facial feature--the most appropriate plan of action for a given patient was created. The sole objective in sharing the senior author's methodology was to launch a scholarly discussion among physicians and surgeons involved in the various disciplines that provide rejuvenation procedures on the face, head, and neck. From such a debate would, hopefully, emerge a definitive algorithmic system--one based squarely on the venerable ethics of medicine, coupled with the appropriate application of and skillful performance of the fundamental principles of surgery. A single, science-based system would restore order to a noble discipline, currently being challenged by narcissism, gimmickry, and commercialization. The implementation of a system rooted in universal truths would require its advocates to agree upon a common "language," the implementation of which allows aesthetically focused surgeons to share both new ideas and time-tested experiences. More importantly, a condition-specific system matches each potential patient's problems--at every age--with the appropriate facial rejuvenation treatment plan, restoring the ideals of science and art to the profession. Initially provided in a consumer information book devised to assist patients with understanding the advantages of personalized treatment plans, the senior author later shared his practices and evolving system with colleagues attending conventions, seminars, and courses. Only after he was convinced that his system could be of benefit to physicians and surgeons from a variety of backgrounds was it offered to the peer-reviewed medical literature. Clearly, a plethora of techniques and materials are available for facial rejuvenation; however, only the ones deemed to be worthy of consideration were included. In practice--and in this presentation--the authors expanded the scope of the previously published article and offer a user-friendly, condition-specific worksheet and algorithmic tables designed to make it easier for surgeons to select the right combinations of procedures--at the right time in a patient's life. Although imitations potentiate an environment of disharmony, the authors remain committed to enabling the evolution of a single facial rejuvenation classification system, one that--with the input of like-minded scholars--could restore needed order to a branch of the medical profession that, in recent years, seems to have lost its focus.

The McCollough Facial Rejuvenation System: a condition-specific classification algorithm.

The search for the holy grail in facial rejuvenation is an ongoing quest. Perhaps the reason the "ideal" face-lift has yet to be discovered is a result of three factors. First, the term FACE-LIFT has never been adequately defined. Second, fads and trends play a role in how the operation is taught and performed. Third, surgeons searching for the prototypic technique have not had a way to index the physical signs of facial aging. After 37 years of practicing facial plastic surgery and performing more than 5000 face-lifts, the author determined that replacing chaos with order is long overdue. To achieve this goal, he developed a classification system that is designed to match each potential patient's problems with the most appropriate facial rejuvenation treatment plan and a "language" by which facial rejuvenation surgeons can communicate. Five progressive stages of aging have been identified and matched with recommended courses of face-lifting, blepharoplasty, volume augmentation, and skin resurfacing techniques. Ancillary procedures have also been included when indicated. It is the author's hope that a new classification system will bring order to mounting confusion within the aesthetic surgery professions as well as within the public sector.

Comparison of lip enhancement using autologous superficial musculoaponeurotic system tissue and postauricular fascia in conjunction with lip advancement.

OBJECTIVE: To evaluate and compare the short- and long-term aesthetic results of surgical lip enhancement using the superficial musculoaponeurotic system (SMAS) and postauricular fascia graft implantation with and without vermilion border advancement. METHODS: A single-blinded cohort study was performed using 39 patients who underwent surgical lip enhancement at a private facial plastic surgery practice between 2005 and 2007. The cohort was grouped as follows: 14 patients underwent lip augmentation using SMAS grafting; 10 patients underwent lip augmentation using postauricular fascia grafting; and 15 patients underwent combined lip augmentation and lip advancement (SMAS grafting was used in 8 of the procedures, and postauricular fascial tissue was used in 7). All procedures were performed in a controlled setting by a single surgeon (E.G.M.). Patients who had undergone previous lip augmentation of any kind were excluded from the study. Preoperative and postoperative photographs were analyzed by 3 blinded physician observers using the Lip Fullness Grading Scale. Postoperative photographs were evaluated at approximately 6 months and 1 year after the procedure. RESULTS: Reviewers noted a significant improvement in aesthetic scoring for each of the methods of lip augmentation examined at 6 months after surgery. This result was sustained at 12 months after surgery. Postauricular fascia graft lip augmentation and combined lip advancement and postauricular fascia augmentation recorded the highest scores after surgery. The largest mean scoring increases of 1.459 (t = -9.5049; P < .001) at 6 months and 1.584 (t = -9.0308; P < .001) at 1 year were found in the lip advancement and SMAS lip augmentation study group. CONCLUSIONS: Youthful, natural-appearing lips tend to enhance an individual's appearance. Surgical lip augmentation using SMAS or postauricular fascia, with or without vermilion border advancement, is a straightforward, safe, potentially long-lasting treatment for hypoplastic lips, with little to no morbidity.

The "midface-lift" as a misnomer for correctly identifying procedures designed to lift and rejuvenate the cheeks and malar regions of the face.

OBJECTIVE: To demonstrate that a classic temporal cheek rhytidectomy results in substantial and acceptable rejuvenation of the so-called midface and that additional surgery is not necessary to improve a sagging cheek, the melolabial fold, and the position of the corner of the mouth and the lateral corner of the eye. DESIGN: A retrospective observational study of 53 patients seen at the McCollough Plastic Surgery Clinic between 2005 and 2007. Each patient underwent temporal and cheek face-lifting surgery for various indications. All procedures were performed by the same surgeon, and the surgical technique was identical in all cases. Patient photographs were evaluated by 3 unbiased plastic surgeons who were asked to compare preoperative and postoperative elevation of the cheek mound, melolabial fold, oral commissure, and lateral canthus. Each anatomic area was appraised for improvement by each reviewer using a 4-point scale. RESULTS: The average patient age was 57 years, and the average patient follow-up was 11 months. Patients achieved excellent or significant improvement in a sagging cheek, melolabial fold, oral commissure, and lateral canthus in 79% (n = 42), 70% (n = 37), 72% (n = 38), and 65% (n = 34) of cases, respectively. CONCLUSIONS: It has been written often that standard face-lifting techniques fail to address many of the aging changes seen in the cheeks. Many authors argue that a separate, unique procedure is required to effectively rejuvenate the cheek, nasolabial fold, and corner of the mouth. Our experience is contrary to this notion. The middle third facial rejuvenation can be achieved by our standard temporal cheek face-lift, and the term midface-lift may be a misnomer.

The art of building a successful facial plastic surgery practice.

The young surgeon will do well to heed the advice and experiences of the experienced surgeon, especially when it comes to surgical techniques and caring for patients as people. Numerous proven philosophies will help build up the satisfied patient population and reduce the frequency of dissatisfied patient populations.

Transcutaneous lower eyelid blepharoplasty with fat excision: a shift-resisting paradigm.

OBJECTIVE: To prove through our experience that the use of transcutaneous lower eyelid blepharoplasty results in negligible incidence of unacceptable scar and eyelid malposition and that the overall lower eyelid contour is acceptable. A detailed overview of the lower eyelid anatomy and a discussion of the "aging" eyelid are further discussed. DESIGN: Retrospective, observational study. The study population comprised 50 patients (100 eyes) seen at the McCollough Plastic Surgery Clinic, Gulf Shores, Ala, between 2002 and 2003 (45 women and 5 men), who had undergone transcutaneous lower eyelid blepharoplasty with fat excision. Lower eyelid blepharoplasty was performed by the senior surgeon (E.G.M.), and the surgical technique was identical in all cases. The patients were followed up for a minimum of 6 months and a maximum of 2 years. Patients were selected on the basis of return visits to record the findings, documented by consecutive digital photos. By comparing standard blepharoplasty digital views, the patients were assessed by 3 independent unbiased plastic surgeons. This study was performed in a private practice setting. The main outcome measure was mean score for the presence of unacceptable scarring, the presence of lower eyelid malposition, and the overall appearance of the eyelid after transcutaneous lower eyelid blepharoplasty, as assessed with the Garcia-McCollough Scale for Lower Eyelid Appearance. RESULTS: The 50 patients were retrospectively reviewed and analyzed by a group of 3 unbiased plastic surgeons, and there was negligible evidence of lower eyelid contour abnormality, lower eyelid malposition, or easily visible scars. CONCLUSIONS: Transcutaneous lower eyelid blepharoplasty with fat excision is a time-tested method of correcting the undesirable sequelae of the aging eye. This technique not only is a safe and effective manner to rejuvenate the lower eyelid but also results in virtually nonexistent ill effects.