Change in Brow Position After Upper Blepharoplasty With or Without Internal Browpexy.

BACKGROUND: Only upper blepharoplasty can cause a change in the eyebrow position, so browpexy can be combined with blepharoplasty in selected patients. There are many brow lifting techniques, both surgical and nonsurgical, and internal browpexy is one of the most widely used surgical brow lifting techniques. The purpose of this study was to evaluate the change in brow position after upper blepharoplasty with or without internal browpexy using preoperative and postoperative photographs. METHODS: Patients who underwent upper blepharoplasty by a single surgeon at Dokuz Eylul University Hospital between 2018 and 2022 were retrospectively evaluated. A total of 48 patients, 30 of whom underwent upper blepharoplasty only and 18 of whom underwent upper blepharoplasty combined with internal browpexy, were examined to present the change in brow position postoperatively. Preoperative and postoperative photographs were analyzed using the ImageJ program and the proportional changes in brow height were shown. RESULTS: The first group, which only underwent upper blepharoplasty only, consisted of 30 patients (62.5%), all female; the second group, which underwent upper blepharoplasty and internal browpexy, consisted of 18 patients (37.5%), all female. The change at the midpupil level was determined as a 6.13% decrease in the first group and a 2.99% increase in the second group; at the brow peak level, this change was a 6.2% decrease in the 1st group and a 4.38% increase in the 2nd group. CONCLUSIONS: In cases of dermatochalasis, blepharoplasty alone can cause a shortening of the distance between the eyebrow and the upper eyelid groove and an unaesthetic appearance. Internal browpexy is an easy-to-apply technique that allows stabilization of the eyebrow after skin excision and a small amount of elevation.

Lifting With Neuromodulators.

BACKGROUND: The use of botulinum toxins for facial rejuvenation and improvement of dynamic wrinkles has become a mainstay in the aesthetic treatment armamentarium. However, using these same neuromodulators (NMs) for lifting the structures of the face, is a newer addition to antiaging protocols. The muscles of facial animation all interplay with each other. Lifting can be accomplished by treating those muscles that are responsible for depression, leaving the elevators unopposed and resulting in a rejuvenated, lifted outcome. Brow lifting, cheek lifting, and even contouring of the lower face and jawline are all possibilities using NMs. OBJECTIVE: To review the literature and current practices in techniques for lifting the different anatomic facial zones. METHODS: The authors present and discuss the published data and personal experiences of using NM for lifting and retraining of the facial musculature. This article will discuss the effects and approaches to lifting with botulinum toxin injections, including the potential success and side effects associated with these off-label injections. RESULTS/CONCLUSIONS: The use of botulinum toxins has expanded beyond its traditional use as a reducer of dynamic wrinkles. A significant amount of published data now exists for the off-label use of botulinum toxins for lifting and shaping the face. These can be considered advanced techniques as each region has its own anatomic intricacies and side effects can occur. More placebo-controlled objective data would also help elucidate exact dosing strategies for each region.

The Gliding Brow Lift: A Systematic Review of the Literature.

INTRODUCTION: Gliding brow lift (GBL) has become one of the most popular techniques for eyebrow lifting in recent years. Despite the widespread use of the technique, there are a few publications in the literature. This systematic review was conducted to present current data on GBL and determine its place among brow lift procedures. METHOD: GBL-related studies were searched in PubMed, Google Scholar, Web of Science, and Scopus databases. The screening was carried out from January 2019 to December 2023. All publications in which GBL was performed alone or in combination with other facial rejuvenation procedures or in which the results related to the technique were included. RESULTS: Sixty-three publications were evaluated, and four met the review criteria. The total number of patients who underwent GBL was 181. Most studies were retrospective case series and had a low level of evidence. It was observed that the evaluation parameters were mostly subjective. The technique was found to be generally effective and had low complication rates. CONCLUSIONS: Although this systematic review shows that GBL is an effective and low-complication technique for a brow lift, there is a need to share prospective, more extensive case series and objective data of patients with longer follow-up periods.

The pixie ear: How to prevent and correct it-a review of the literature.

As the life expectancy of the population continues to increase, more facial-rejuvenating procedures are sought. As the number of facelift procedures increases, it is mandatory to acknowledge, and most importantly prevent, any possible associated complications. One of the complications after rhytidectomy, and a sign of facelift, is the so-called "pixie ear deformity" or "bat ear." This is regarded as a telltale sign of a facelift procedure and appears to be identified in 5% of earlobe inset cases. The ear's location is a crucial hallmark of an aesthetically pleasing face, not only by itself but also in relation with other aesthetic units. When performing a facelift procedure, tension vectors of the rhytidectomy flap could cause alterations in ear's position and appearance: the ear loses its great mobility and becomes more fixed in its acquired position, resulting in a "stuck-on" appearance. The auricle is displaced following an anteroinferior direction, with the otobasion inferius (the most caudal anterior attachment of the earlobe to the cheek) being dislocated from its original more posterior and upper position to a new more anterior and caudal location. The displacement of the auricle is usually accompanied by distortion of the earlobe rotating forward and becoming more anterior than the rest of the ear. In recent decades, many techniques and procedures have been described to prevent and correct the pixie ear; in this review, we aim to analyze and describe them comprehensively.

An Approach to Selection of Face-Lift Techniques for Different Types of Faces: An Analysis of 1000 Asian Patients Over 9 Years.

BACKGROUND: A face-lift or rhytidectomy is the procedure most directly associated with rejuvenation. There are several surgical techniques for face-lifts, but criteria for the selection of techniques, based on the patient's face shape, are lacking. In this study, we report on our experience with specific indication criteria for each technique and the consequent achievement of good outcomes. METHODS: From 2015 to 2023, 1 surgeon performed face-lifts on 1000 patients. Three different superficial musculoaponeurotic system (SMAS) techniques (SMAS dissection, SMASectomy, and SMAS plication) were applied depending on the degree of sagging of the patient's lower face, lateral facial profile, and SMAS mobility and condition. Superficial musculoaponeurotic system dissection was considered for the improvement of a square face, sagging jowls, and marionette lines. Superficial musculoaponeurotic system plication was applied with patients with less sagging jowls and prominent zygoma with concave lateral facial profile. SMASectomy was applied with patients with convex lateral facial profiles or when the SMAS was too thin or damaged. Patient postoperative satisfaction was surveyed using the FACE-Q score 1 year post surgery. RESULTS: Most of the patients attained natural-looking and long-lasting aesthetic outcomes and exhibited high satisfaction. The patients indicated that they looked about 11.2 ± 5.2 years younger than their actual age after the surgery. The mean satisfaction scores for each facial feature were as follows: cheeks (91.1 ± 7.8), marionette lines (88.5 ± 13.6), lower face and jawline (92.5 ± 14.2), under chin (87.8 ± 15.1), and neck (86.2 ± 18.5). Complications such as facial nerve injury, infection, hematoma, and flap necrosis were very rare. CONCLUSIONS: Establishing criteria for the selection of face-lift surgical techniques based on the degree of lower face sagging, lateral facial profile, and SMAS mobility and condition led to good outcomes. These criteria can be used by physicians to determine the most effective face-lift surgery technique based on a patient's individual features, which may improve surgical outcomes.

Rejuvenecimiento quirúrgico facial, deep plane facelift y procedimientos complementarios / Deep plane facelift

El tratamiento del envejecimiento facial debe ser tratado en su conjunto. Elegimos la técnica DPFL (Deep Plane Facelift) por ser la más efectiva en el tratamiento del tercio medio e inferior, la liberación de los ligamentos de retención facial permite una reposición vertical sin energía en los tejidos. La no deslaminación del complejo SMAS-Platisma conforma un colgajo compuesto de mayor estabilidad en las suturas y mayor trofismo cutáneo. Como procedimientos complementarios incluimos el lifting fronto-temporal extendido con incisión mínima, blefaroplastia, lipofilling facial, lifting de labio, rinoplastia, lobuloplastia auricular y cuello profundo. Esta sinergia quirúrgica optimiza el resultado siendo más natural y armónico, conservando la fisonomía de los 10 a 15 años anteriores de los pacientes, hecho observado en fotografías.

The treatment of facial aging must be treated as a whole. We chose the DPFL (Deep Plane Facelift) technique because it is the most eff ective in the treatment of the middle and lower 1/3, the release of the facial retaining ligaments allows a vertical repositioning without energy in the tissues. The non-delamination of the SMAS-Platysma complex forms a composite fl ap with greater suture stability and greater skin trophism. As complementary procedures we include the extended fronto-temporal lift with minimal incision, blepharoplasty, facial lipofi lling, lip lift, rhinoplasty, auricular lobuloplasty, deep neck. This surgical synergy optimizes the result being more natural and harmonic, preserving the physiognomy of 10 to 15 years ago of the patients, fact observed in photographs.

Deep plane facelift extendido. Técnica de disección diseñada para lograr el máximo reposicionamiento de la región centrofacial, definición del contorno del cuello y la línea mandibular / Extended deep plane face lift. Dissection technique designed to achieve maximum repositioning of the centrofacial region, defi nition of the contour of the neck and jaw line

El lifting de plano profundo es una técnica de rejuvenecimiento facial que nos permite lograr resultados altamente satisfactorios aun en casos de difícil resolución. El conocimiento detallado de la anatomía facial es de primordial importancia para su aprendizaje y perfeccionamiento. Es una técnica que insume mayor tiempo operatorio, ya que requiere una adecuada liberación de ligamentos faciales y cervicales para la correcta movilización de los tejidos y su reposicionamiento sin tensión, pero al mismo tiempo es segura y confi able.

Deep plane lifting is a rejuvenation technique. facial treatment that allows us to achieve highly satisfactory even in cases of diffi cult resolution. He met Detailed understanding of facial anatomy is of primary importance importance for your learning and improvement. It is a technique that requires more operating time, since it requires adequate release of ligaments facial and cervical for the correct mobilization of the tissues and their repositioning without tension, but at the same time time is safe and reliable.

Feminization of the Forehead: A Scoping Literature Review and Cohort Study of Transfeminine Patients.

BACKGROUND: Facial feminization may be performed to alleviate gender dysphoria among transfeminine patients. The upper third of the face has several characteristics, including hairline shape and position, brow position, and forehead protrusion, that may confer feminine identity. The purpose of this study is to conduct a scoping literature review of techniques performed for forehead feminization and to additionally study clinical outcomes within an institutional cohort. METHODS: A systematic literature review was conducted to review articles that discussed techniques and clinical outcomes associated with procedures performed for feminization of the upper third of the face. A retrospective review of patients undergoing such procedures by the senior author was then conducted. Variables collected included demographic factors, operative details, and postoperative outcomes such as complications, revisions, and re-operations. RESULTS: Initial review yielded sixty-seven articles. Title and abstract review followed by standardized application of inclusion and exclusion criteria resulted in a total of twenty-two studies for analysis. Priorities of forehead feminization entail frontal bossing reduction, frontonasal angle widening, orbital contouring, brow lifting, and hairline advancement. Eighty-five patients were included for analysis. The majority were of Caucasian race (56%) and had type 3 forehead classification (92%). The average planned setback of the anterior table was 4.12 mm. CONCLUSIONS: The core tenets of the feminization of the forehead lie in the overall creation of a harmonic curvature of the forehead with other facial features. Our multi-pronged analysis presents an updated review of these principles, which may help plastic surgeons in performing procedures to feminize the upper third of the face. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

Direct Neck Lift for Men.

Direct neck lift offers an excellent surgical technique for men seeking to rejuvenate the neck and avoid a full rhytidectomy. In this chapter, we provide an overview of direct submentoplasty techniques, as well as clinical pearls to consider in the preoperative, intraoperative, and postoperative periods. Different surgical incisions and resultant scars in the anterior neck are discussed and illustrated with figures. Given the degree of variation of submental fullness with which patients present, it is beneficial to be familiar with several different techniques to address the submental and submandibular areas.

Male Brow Lift and Blepharoplasty.

After reading this article, one should better understand the anatomy of the forehead, brow, and eyelid complexes in the male patient. A thorough history and physical examination allows the facial plastic surgeon to properly select male patients in whom blepharoplasty and brow lift may be indicated. Specific surgical approaches to upper and lower blepharoplasty are discussed in detail. Surgical techniques and indications for each approach to brow lift in men, including direct, midforehead, coronal, pretrichial, endoscopic, temporal, and transblepharoplasty are explicitly outlined.

Fat Grafting the Male Face.

There are many developmental sexual dimorphisms of the human face, and thereby differences in aging based on sex. Sensitivity regarding the nature of the changes that are unique to the male face as well as understanding men's unique aesthetic goals will allow the skilled practitioner to tailor rejuvenating treatments accordingly. Fat grafting of the male face has not been extensively described but is an excellent tool for facial rejuvenation either as an adjunct or a stand-alone procedure. Each treatment area demands different techniques and special attention to avoid unintentional feminization.

Male Deep-Plane Face and Neck Lifting: Advanced and Customized Techniques.

In this article, the authors describe their preferred advanced deep-plane techniques and modifications that have universally improved outcomes and durability in both men and women. Performing a proper extended deep-plane facelift and neck lift avoids the need to camouflage scars and stigmata of lifts seen in superficial musculoaponeurotic system plication and other techniques. In the author's experience, vertical vector deep-plane surgery is more durable, natural, and less reliant on lipofilling and volume addition. The subtleties of examination and analysis, surgical technique, clinical outcomes, and gender-specific considerations in the reconstruction of gonial and cervicomental angles, deep planar volumetric reduction, facial volumetric change, limited skin delamination, and revision techniques are discussed.

New Ultherapy method: Utilizing novel surgical and anatomical concepts yields outstanding results.

BACKGROUND: Micro-focused ultrasound (MFU) is a technique for skin rejuvenation and lifting, targeting the facial SMAS-a fibrous network encompassing the platysma muscle and parotid fascia. OBJECTIVE: This study aims to propose a novel and cost-effective method (suggested by Fatemi) for Ultherapy, comparing its effectiveness with the conventional approach. MATERIALS AND METHODS: A prospective double-blind clinical trial was conducted with 30 female volunteers randomly assigned to two groups: The control group (conventional method) and the experimental group (new method). Ultherapy procedures utilized MFU technology with low energy and a higher frequency. RESULTS: Statistically significant differences in lifting effects and improvement in skin laxity were observed between the two groups. The new method, with a focus on the parotideal area of the SMAS, demonstrated superior outcomes and higher patient satisfaction. CONCLUSION: The parotideal region's accessibility, increased thickness, and safety profile make it an ideal target for Ultherapy. This not only reduces the risk of nerve injury but also yields effective collagen remodeling and skin-lifting results.

Dual-plane lift-and-hold technique for brow ptosis in young patients with facial paralysis.

BACKGROUND: Direct browlift is useful but leaves a scar above the brow. We proposed a dual-plane browlift to avoid facial scarring while effectively resolving brow ptosis in young and young adult patients. METHODS: Seven patients with facial palsy underwent dual-plane browlift between July 2018 and June 2022. The mean postoperative follow-up period was 31.9 months. Skin resection at the hairline was combined with subcutaneous dissection down to the inferior margin of the brow to "lift" the brow. Fascia lata strips were fixed to the dermis just inferior to the eyebrow to "hold" the brow, and the strips were suspended upward through the subperiosteal tunnel and fixed to the periosteum. Brow height was compared before and after the procedure and with the contralateral side. RESULTS: The reported complications included slight hematoma at the recipient site, temporary difficulty in closing the eye, and seroma at the fascia donor site. The paralyzed side showed significant differences between the preoperative period and postoperative months (POM) 3, 6, and 12, but differences were not shown in the intervals between POM 3 and 6, 6 and 12, or 3 and 12. The difference in eyebrow height between the paralyzed and nonparalyzed sides was significant preoperatively but not at POM 3, 6, or 12. All scars matured well, and the fascia silhouette was not visible in the forehead region. CONCLUSIONS: Dual-plane browlift enables rigid suspension using the fascia lata and excises flaccid skin without leaving facial scars, yielding excellent cosmetic quality and stable long-term outcomes.

Anatomical Insights on the Cervical Nerve for Contemporary Face and Neck Lifting: A Cadaveric Study.

BACKGROUND: Despite the significant roles it plays in the functions of the platysma and lower lip, the cervical branch of the facial nerve is often overlooked compared to other branches, but its consideration is critical for ensuring the safety of neck surgeries. OBJECTIVES: The aim of this study was to clarify the anatomical discrepancies associated with the cervical branch of the facial nerve to enhance surgical safety. METHODS: The study utilized 20 fresh-frozen hemiheads. A 2-stage surgical procedure was employed, beginning with an initial deep-plane facelift including extensive neck dissection, followed by a superficial parotidectomy on fresh-frozen cadavers. This approach allowed for a thorough exploration and mapping of the cervical nerve in relation to its surrounding anatomical structures. RESULTS: Upon exiting the parotid gland, the cervical nerve consistently traveled beneath the investing layer of the deep cervical fascia for a brief distance, traversing the deep fascia to travel within the areolar connective tissue before terminating anteriorly in the platysma muscle. A single branch was observed in 2 cases, while 2 branches were noted in 18 cases. CONCLUSIONS: The cervical nerve's relatively deeper position below the mandible's angle facilitates a safer subplatysmal dissection via a lateral approach for the release of the cervical retaining ligaments. Due to the absence of a protective barrier, the nerve is more susceptible to injuries from direct trauma or thermal damage caused by electrocautery, especially during median approaches.