Top 50 Highly Cited Publications in Facelift Surgery: A 50-Year Bibliometric Analysis Review.

INTRODUCTION: Facelift surgery, also known as rhytidectomy, is a commonly performed procedure to address aging-related changes in the face and neck. Over the years, its techniques and methodologies have evolved. This study aimed to provide a bibliometric analysis of the top 50 most cited publications related to facelift surgery over a fifty-year period (1973-2023). METHODS: The authors obtained data from the Web of Science Core Collection on July 15, 2023. Using a predefined search strategy, the most cited articles from 1973 to 2023 on facelift surgery were identified. The publications were analyzed for their type of study, journal of publication, geographic origin, and primary outcomes. Furthermore, the authorship gender distribution was assessed. RESULTS: The majority of the publications (34 out of 50) were published in the "Plastic and Reconstructive Surgery" journal. The USA contributed to 72% of the research, followed by the UK, Mexico, Australia, and Germany. The primary outcomes varied from surgical techniques, anatomical studies, risk factors, patient-specific outcomes, and facial rejuvenation techniques, to comparative and historical progression of techniques. Notably, male authors dominated the field with 47 out of 50 papers having both a first and senior male author. CONCLUSION: Facelift surgery has seen substantial research development over the past fifty years. The USA has been at the forefront of this research, with a predominant focus on surgical techniques and anatomical studies. Male dominance in authorship indicates potential scope for increased gender diversity in this specialty. Annual updates are recommended for continued insights. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[New technologies for noninvasive aesthetic treatments]. / Neue Technologien für nichtinvasive Therapien in der ästhetischen Medizin.

In recent years, the demand for noninvasive aesthetic treatments has increased significantly. New systems and technological innovations open new possibilities for practitioners and patients in the field of body contouring, noninvasive face lifting, skin tightening and rejuvenation, as well as effective therapies for urinary incontinence or erectile dysfunction. Currently, the most well-known innovations include technologies such as high-intensity focused electromagnetic field (HIFEM™) and radiofrequency (RF), which, after more than 30 years of research, could be combined in the RF-SYNCHRODE™ (BTL Medizintechnik GmbH, Prague, Czech republic) without any health risks for the patient. This allows the reduction of adipose tissue and the building of muscle in a single treatment. The newer HIFES™ technology was developed specifically for the treatment of the facial area and facial muscles. It is used with synchronized radiofrequency for noninvasive, painless face lifting and skin tightening, and is also suitable for botulinum toxin patients. Visible, noticeable, and long-lasting treatment results are achieved without significant side effects after only 4-6 sessions. These noninvasive, FDA(Food and Drug Administration)- and CE-certified systems are used in everyday practice and clinical routine in dermatology, gynecology, urology, and physiotherapy and represent a real alternative to invasive aesthetic plastic surgery.

Biplanar approach to the transfollicular forehead and brow lift: a technical note.

The forehead and brow lift is one of the most commonly performed surgical cosmetic procedures for the rejuvenation of the upper third of the face. Various surgical techniques have been developed to achieve maximum aesthetic results alongside minimum complications; each method has its advantages and disadvantages. Therefore, the ideal surgical approach for each patient should be selected based on careful preoperative evaluation and proper case selection. This article presents a novel modification of the transfollicular forehead and brow lift using a simultaneous biplanar approach to the subcutaneous and sub-periosteal tissue planes. This technique is beneficial to the patient by taking advantage of both the endoscopic and transfollicular methods.

Corrección de bolsas malares con colgajo invertido del músculo orbicular en la blefaroplastia transcutánea

Las deformidades en el párpado inferior frecuentemente están asociadas al envejecimiento facial. La cirugía plástica de los párpados se popularizó desde la segunda mitad del siglo XX. Furnas identificó la redundancia del músculo orbicular inferior, se centró en la resección del exceso de tejido flácido para restaurar una apariencia más juvenil. Se presenta el caso de una paciente femenina, de 40 años de edad, que acudió a consulta de Cirugía Plástica solicitando corrección de sus párpados superiores e inferiores, y con la inconformidad de bolsas malares. Los defectos fueron corregidos mediante colgajo invertido del músculo orbicular inferior, el cual se fijó a la fascia del músculo temporal a través de una blefaroplastia transcutánea. Los resultados estéticos alcanzados en esta paciente evidencian que la blefaroplastia transcutánea y la utilización de un colgajo invertido del músculo orbicular son alternativas efectivas para lograr el rejuvenecimiento de los párpados y corrección de las bolsas malares, al conferir una mayor armonía de estas estructuras en relación con la cara.

Lower eyelid deformities are frequently associated with facial aging. Plastic surgery of the eyelids became popular in the second half of the 20th century. Furnas identified the redundancy of the inferior orbicularis muscle, focused on resection of excess flaccid tissue to restore a more youthful appearance. The case of a 40-years-old female patient is presented, who attended the Plastic Surgery consultation requesting correction of her upper and lower eyelids, and with malar bags nonconformity. The defects were corrected with an inverted inferior orbicularis muscle flap, which was fixed to the fascia of the temporalis muscle through a transcutaneous blepharoplasty. The aesthetic results achieved in this patient show that transcutaneous blepharoplasty and the use of an inverted flap of the orbicularis oculi are effective alternatives to achieve eyelid rejuvenation and correction of the malar bags, by conferring a greater harmony of these structures in relation to face.

Reconstruction of Scalp Anterior Hairline with Tissue Expansion and Skin Flap.

Introduction: Cutaneous defects involving the frontal region and anterior hairline of the scalp can result from congenital or acquired conditions. The negative esthetic impact can cause disturbances in the psychic and social sphere of the patient, causing problems in interpersonal relationships and in the body image itself. The use of skin expanders is usually effective in this region due to the bone base providing support and stability for its use. Case Report: We describe the case of a 64-year-old woman submitted to reconstruction of the anterior hairline of the scalp due to scar sequelae after coronal rhytidoplasty followed by pustular erosive dermatosis. We used tissue expansion (50 mL of saline per week until it reached 300 mL) and advancement flap. Discussion/Conclusion: Scalp reconstruction also includes vascularized soft tissue coverage, acceptable cosmetic appearance, and minimal morbidity for the donor area. The correction of scalp scars must obey 2 basic principles: tissue similarity and natural capillary pattern (direction, angle, capillary growth, and proper capillary line design). Tissue expansion and skin flap techniques can successfully correct defects in extensive scarring alopecia such as in the presented case.

Lift temporal com reposicionamento do músculo orbicular e da cauda da sobrancelha / Temporal lift with repositioning of the orbicular muscle and eyebrow tail

Introdução: O sistema musculoaponeurótico superficial (SMAS) é a melhor estrutura que temos à nossa disposição para elevar e reposicionar a face e o pescoço no face lift. No entanto, na região têmporo-orbitária, esta estrutura é frequentemente negligenciada. Na busca por uma solução de execução simples, eficiente e segura para tratar a queda têmporo-orbitária, o autor descreve uma tática de lift temporal com reposicionamento da cauda das sobrancelhas para tratamento do envelhecimento e flacidez da região têmporo-orbitária. Métodos: Foi realizado o tratamento em 358 pacientes entre 2017 e 2020, em lifts completos ou apenas temporais. Destes, apenas 30 foram incluídos no artigo por terem sido submetidos exclusivamente a lifts temporais, acompanhados ou não de blefaroplastias. Através de incisão intracapilar marginal quebrada em região temporal e com descolamento supraSMAS, foi realizado tratamento musculoaponeurótico da região órbito-temporal, além de ressecção da pele em excesso. Resultados: A tática apresentada foi eficiente na elevação e na abertura da cauda das sobrancelhas em todos os casos tratados, além do efeito de perda da função contrátil da porção lateral do músculo orbicular, com melhora significativa das rugas periorbitais e da flacidez órbito-temporal. Conclusão: A eficácia e os ótimos resultados alcançados com a tática operatória descrita, associada à escassez de opções de tratamento isolado ou específico da região órbito-temporal, tornam o lift têmporo-orbitário proposto uma excelente alternativa para o rejuvenescimento desta região.

Introduction: The superficial musculoaponeurotic system (SMAS) is the best structure that we have at our disposal to raise and reposition the face and neck in face lifts. However, in the temporal-orbital region, this structure is often overlooked. In search of a simple, efficient and safe solution to treat temporal-orbital fall, the author describes a technique of temporal lift with repositioning of the eyebrow tail to treat aging and flaccidity of the temporal-orbital region. Methods: The treatment was performed on 358 patients between 2017 and 2020, in face lifts or temporal lifts. Of these, only 30 were included in the article because they underwent temporal lifts exclusively, with or without blepharoplasty. Through a marginal, "W" type, intra-capillary incision in the temporal region and with supra-SMAS detachment, we performed muscle-aponeurotic treatment of the orbital-temporal region and excessive skin resection. Results: The technique presented was efficient in raising and opening the tail of the eyebrows in all treated cases, in addition to the effect of loss of contractile function of the lateral portion of the orbicularis muscle, with significant improvement of peri-orbital wrinkles and temporal-orbital flaccidity. Conclusion: The efficacy and the excellent results achieved with the described operative technique, associated with the scarcity of isolated or specific treatment options for the orbital-temporal region, make the proposed temporo-orbital lift an excellent alternative for the rejuvenation of this region.

Ritidoplastia clásica: una técnica vigente / Classic rhythodoplasty: a current technique

La cirugía de correctiva del envejecimiento facial tiene más de un siglo de historia documentada. Los cambios culturales han aumentado el número de operaciones. En Latinoamérica también ha aumentado, y la región ha sido activa en realizar aportes en los conceptos, técnicas y procedimientos complementarios. Además del crecimiento cuantitativo, la comprensión de los planos anatómicos faciales, cambios con la edad y los modos de corregirlos han sido de gran utilidad. Nuestra técnica del lifting cérvico-facial presentan ventajas como seguridad en el plano de disección, ausencia de tracción cicatricial y respeto capilar, proporcionando un resultado final natural de acuerdo a la solicitud de los pacientes

Corrective surgery for facial aging has more than a century of documented history. Cultural changes have increased the number of operations. In Latin America it has also increased, and the region has been active in making contributions in complementary concepts, techniques, and procedures. In addition to quantitative growth, the understanding of facial anatomical planes, changes with age and the ways to correct them have been very useful. Our cervical-facial lifting technique presents advantages such as safety in the dissection plane, absence of scar traction and capillary respect, providing a natural final result according to the request of the patients

Description of custom thread IGM technique with use of PDO facial support threads in the orofacial harmonization

The aim of this article was to describe a thread lifting procedure used for face lifting and skin rejuvenation, developed by the Doctor Molina Dental Institute (IGM, in the Portuguese acronym), termed "IGM custom thread technique" that has shown excellent results in facial tissue repositioning for facial harmonization. In this study, rather than presenting the results, we have described and discussed the proposed custom thread injection technique.

Facelift light, ritidoplastia para tratamento do terço inferior da face e pescoço com cicatriz reduzida e pontos de adesão / Facelift light, rhytidoplasty for the treatment of the face and neck lower third with reduced scarring and adhesion points

Introdução: O facelift light apresenta uma padronização da técnica com o objetivo de tratar o terço inferior da face e o pescoço, com menores cicatrizes, plicatura do SMAS em todos os pacientes e utilização de pontos de adesão para redução de hematomas. O descolamento moderado permite um retorno mais rápido do paciente às suas atividades. Métodos: A cirurgia é feita após uma marcação prévia periauricular de todos pacientes, com a área a ser descolada e o desenho da pele a ser retirada. A anestesia é local e sedação, sem a necessidade de cortes no cabelo. É feito o descolamento dos retalhos, plicatura do SMAS, pontos de adesão nos retalhos anterior e posterior, além da sutura interna por planos e lipoaspiração do submento quando necessária. O curativo é compressivo sem a utilização de drenos. Resultados: Foram submetidos à ritidoplastia por essa técnica 185 pacientes a partir de 2014. Com a idade variando entre 31 e 84 anos, sendo a média de 55 anos. É feita drenagem linfática a partir de sete dias e com duas semanas observou-se uma redução considerável do edema. Conclusão: O facelift light é uma técnica eficaz, de simples execução, cicatrizes reduzidas e com poucas complicações, favorecendo o retorno precoce dos pacientes às suas atividades.

Introduction: Facelift light represents a technique standardization to treat face and neck lower third, with lesser scars, SMAS plication in all patients, and adhesion points to reduce bruises. Moderate detachment allows the patient to return to their activities faster. Methods: Surgery is performed after prior periauricular marking of all patients of the area to be detached and the skin's design to be removed. Anesthesia is local with sedation, and without the need for haircuts. Flap detachment, SMAS plication, adhesion points in the anterior and posterior flaps are performed, in addition to the internal suture by layers and liposuction of the subment when necessary. The dressing is compressive without using drains. Results: One hundred and eighty-five patients underwent rhytidoplasty using this technique since 2014. Their age varied between 31 and 84 years, with an average of 55 years. Lymphatic drainage is performed after seven days, and after two weeks, a considerable reduction in edema has been observed. Conclusion: Facelift light is a useful technique, simple to perform with reduced scarring and few complications, favoring the early return of patients to their activities.

Um novo conceito em envelhecimento de pescoço: "cintura cervicofacial" / A new concept in neck aging: "cervicofacial waist"

Introdução: O envelhecimento do terço inferior da face promove o apagamento da definição da borda mandibular e do ângulo cervicofacial, além do surgimento das bandas platismais na região anterior do pescoço. Os pacientes têm grande expectativa de que o facelift resolva de maneira significativa tais efeitos. Para alcançar estes resultados, desenvolvemos uma abordagem cuja finalidade é a definição marcante do que chamamos de cintura cervicofacial. Métodos: O autor propõe uma nova abordagem cirúrgica de facelift já realizada em 444 pacientes consecutivos, desde 2015, que envolve uma plicatura agressiva do SMAS-platisma somada a uma tração lateral, também por plicatura, das bandas mediais do platisma. Resultados: Apesar da dificuldade em comparar resultados com diferentes técnicas, percebemos claramente uma melhora significativa nos nossos resultados com a nova técnica cirúrgica, sem aumento dos índices de complicações. Discussão: Buscamos novas técnicas pelo fato de que os tratamentos clássicos da região cervical nos parecem falhos e baseados em conceitos mal fundamentados. Estes envolvem a plicatura medial das bandas platismais por abordagem submentoniana, aproximando-as e prejudicando a elevação cranial do SMAS-platisma. Assim, passamos a realizar plicaturas laterais diretamente sobre as bandas através do acesso lateral do descolamento da face, com confecção de uma cintura cervicofacial. Conclusão: A soma dos efeitos da plicatura do SMAS com a plicatura lateral da banda medial do platisma torna a definição cervicofacial mais nítida com otimização importante dos efeitos estéticos desejados.

Introduction: The aging of the lower third of the face stimulates the definition deletion of the mandibular border and the cervicofacial angle, besides the appearance of platysmal bands in the anterior neck region. Patients have high expectations that the facelift will significantly resolve such effects. To achieve these results, we have developed an approach to defining what we call the cervicofacial waist. Methods: The author proposes a new surgical facelift approach that has been performed on 444 consecutive patients since 2015, which involves an aggressive plication of the SMAS-platysma plus lateral traction, also by plication, of the platysma medial bands. Results: Despite the difficulty in comparing results with different techniques, we perceive a significant improvement in our results with the new surgical technique, without increasing the complication rates. Discussion: We are looking for new techniques because the cervical region's traditional treatments seem flawed and based on ill-founded concepts. These involve the medial plication of the platysma bands by a submental approach, bringing them closer together and impairing the cranial elevation of the SMAS-platysma. Thus, we started to directly perform lateral plications on the bands through the lateral access of the face detachment, making a cervicofacial waist. Conclusion: The sum of the effects of the plication of the SMAS with the lateral plication of the platysma medial band makes the cervicofacial definition clearer with important optimization of the desired aesthetic effects.

Lifting frontal reverso: alternativa para o tratamento da paquidermoperiostose / Reverse frontal lifting: alternative for the treatment of pachydermoperiostosis

Introdução: Paciente com diagnóstico de paquidermoperiostose, apresentando forte manifestação cutânea, impossibilitando a correção do defeito pelas técnicas usuais de lifting facial. O lifting frontal reverso foi a técnica idealizada para o caso. É uma técnica inovadora, não havendo publicação prévia na literatura. Relato de caso: Paciente italiano, sexo masculino, 56 anos, apresentando síndrome de manifestação cutânea, em especial na região frontal da face, com pele inelástica de aspecto coriáceo, que gerava desconforto estético, ensejando um estigma sindrômico. Métodos: A técnica elaborada para este caso envolve incisão, que se inicia na raiz da hélice (ponto A), contorna o supercílio em linha sinuosa distando meio centímetro da implantação dos pelos da sobrancelha, indo até a região da glabela, curvando para a raiz do nariz e indo se encontrar com dimensões idênticas do outro lado. Do ponto A, também ascende uma linha curva inclinando-se para o sentido medial, com uma distância de 2cm. A intenção é diminuir a distância entre a área a ser tracionada e a área de incisão, a fim de obter maior tração, possibilitando assim a correção do aspecto da face em foco. Resultados: A tração caudal do retalho por incisão supraciliar possibilitou a correção do defeito em região frontal sem que houvesse alteração da linha de implantação capilar ou ascensão excessiva das sobrancelhas. Conclusão: A técnica de lifting frontal reverso foi criada para um caso específico de síndrome de paquidermoperiostose. Quando bem indicada esta técnica pode ser utilizada atingindo bons resultados.

Introduction: Patient diagnosed with pachydermoperiostosis, presenting a strong cutaneous manifestation, making it impossible to correct the defect by the usual facial lifting techniques. The reverse frontal facelift was the idealized technique for this case. It is an innovative technique, there being no previous publication in the literature. Case report: Italian male patient, 56 years old, with cutaneous manifestation syndrome, especially in the frontal region of the face, with leathery inelastic skin, which generated aesthetic discomfort, predisposing for a syndromic stigma. Methods: The technique developed for this case involves an incision, which starts at the root of the helix (point A), bypasses the eyebrow in a sinuous line distant half a centimeter from the implantation of the eyebrow hair, going to the glabella, curving towards the nasal root and going to meet identical dimensions on the other side. From point A, a curved line also leans towards the medial direction, at a distance of 2 cm. The intention is to reduce the distance between the area to be pulled and the incision area, in order to obtain more traction, thus enabling the correction of the aspect of the face in focus. Results: Caudal traction of the flap by a supraciliary incision made it possible to correct the defect in the frontal region without altering the capillary implantation line or causing excessive eyebrow rise. Conclusion: The reverse frontal lifting technique was created for a specific case of pachydermoperiostosis syndrome. When correctly indicated, this technique can be used to achieve good results.

Aumento mentoniano com retalho cervical associado à ritidoplastia / Chin augmentation with cervical flaps associated with rhytidoplasty

Introdução: A falta da projeção mentoniana no terço inferior da face algumas vezes é responsável pela quebra da harmonia do contorno facial. A utilização de implantes aloplásticos, preenchimentos submetidos à ritidoplastia para correção destas deformidades. Neste estudo, propomos uma nova manobra para aumento da projeção mentoniana com uso de um retalho cervical associado à ritidoplastia. Métodos: Foram avaliados 11 pacientes operados no período de 01/2017 a 01/2018, utilizando-se o retalho cervical para projeção mentoniana, e tendo como critério de inclusão somente pacientes que almejavam um aumento mentoniano, sem utilização de próteses, preenchimentos ou abordagem óssea, e que seriam submetidos à ritidoplastia. Resultados: Através da análise cefalométrica evidenciou-se melhora da projeção mentoniana e do contorno cervical, e não houve complicações no pós-operatório imediato ou tardio. Conclusão: O retalho cervical utilizado para aumento mentoniano além de apresentar resultados e aceitação satisfatórios, elimina o uso de materiais sintéticos, redução de custos, segurança e durabilidade, alcançando um contorno mandibular mais refinado e uma projeção mentoniana mais natural.

Introduction: The lack of chin projection in the lower third of the face is sometimes responsible for the breaking of the facial contour harmony. Alloplastic implants, fillers, and osseous advancements have been used to correct these deformities. In this study, we propose a new maneuver to increase chin projection by using a cervical flap associated with rhytidoplasty. Methods: We assessed 11 patients who underwent operations using the cervical flap for chin projection between January 2017 and January 2018. The inclusion criteria were only patients who desired chin augmentation without the use of prosthetics, fillers, or osseous approaches, and those who would undergo rhytidoplasty. Results: A cephalometric analysis revealed improvements in chin projection and cervical contour, and no complications in the immediate or late postoperative period. Conclusion: In addition to presenting satisfactory results and acceptance, the cervical flap used for chin augmentation eliminated the use of synthetic materials, reduced surgical costs, and improved safety and durability, achieving a more refined mandibular contour and natural chin projection.

Modified facelift incision and superficial musculoaponeurotic system flap in parotid malignancy: a retrospective study and review of the literature.

BACKGROUND: Data reporting the use of modified facelift incision (MFI) approach with or without superficial musculoaponeurotic system (SMAS) reconstruction in parotid malignancy are limited. To enhance the limited knowledge in this subject, the authors of the current study report quality data of MFI in patients with parotid malignancy with or without SMAS reconstruction. METHODS: We performed a retrospective review of parotid malignancy patients treated with the MFI over a 5-year period (2015-2019) in the 1st ENT University Department, University of Athens, Greece. RESULTS: We identified five patients with parotid malignancy. We performed MFI parotidectomy in 5/5 patients and SMAS reconstruction in 2/5 patients. All tumors were classified as T1N0M0. After a mean follow-up of 43.6 months (minimum, 36; maximum, 55), we noted no recurrence. The patients reported no Frey's syndrome. CONCLUSIONS: The authors of the current study suggest consideration of the MFI approach in parotid malignancy. A MFI approach should at least favor small parotid tumors without neck metastatic disease (T1cN0). Surgeons could also address larger tumors with a MFI approach. Surgeons should reconstruct the parotid lodge with a SMAS advancement flap in tumors not in proximity with the SMAS.

Cross-cultural validation of the FACE-Q Satisfaction with Facial Appearance Overall Scale (FACE-Q SFAOS) in Brazilian rhytidoplasty patients

OBJECTIVES: This study aimed to culturally validate the FACE-Q - Satisfaction with Facial Appearance Overall Scale (Face-Q SFAOS) in a population of Brazilian rhytidoplasty patients. METHOD: Authorization for the translation and validation of the questionnaire was obtained from the FACE-Q SFAOS distribution rights holders. The FACE-Q SFAOS was translated and then back-translated. For cultural validation, a total of 57 women were selected 5 to 8 months after undergoing rhytidoplasty. Twenty of them participated in the cultural adaptation, 30 participated in the reproducibility analysis, and 57 participated in the construct validation. RESULTS: The analysis identified two factors (general appearance and face geometry) that exhibited excellent internal consistency. The total satisfaction score, which comprised nine items, also presented excellent internal consistency. Good reproducibility was found for Overall Appearance, Geometry and Total. There was a difference in the satisfaction means (total and factors) between procedure locations; patients undergoing frontal, upper eyelid and lower eyelid procedures were less satisfied than those who did not undergo such procedures. Satisfaction was higher with geometry than with overall face appearance. CONCLUSION: The FACE-Q SFAOS was adapted to the cultural context of Brazilian rhytidoplasty patients and was reproducible, and the scale exhibited face, content and construct validity.

Condutas na ritidoplastia e apontamentos histológicos na pele da face do paciente pós-bariátrica / Rhytidoplasty practices and histological notes for the facial skin of post-bariatric patients

Introdução: O número de pacientes classificados com sobrepeso ou obesos e, com isso, dos pacientes pós-bariátricas vem aumentando, gerando uma demanda por ritidoplastias neste perfil de público. O objetivo é expor a rotina e táticas cirúrgicas em um hospital de ensino, o perfil destes pacientes, além de um comparativo superficial histológico da pele, tecido celular subcutâneo e SMAS, entre os pacientes pós e não pós-bariátrica. Métodos: Foi realizado revisão de dados do centro cirúrgico e de prontuário entre os anos de 2012 e 2016 em um hospital público na cidade de Goiânia-GO, com levantamento de 32 casos. Resultados: A tática de ritidoplastia utilizada nos pacientes pós-bariátrica não apresenta grandes diferenças entre a utilizada nos pacientes não pós-bariátrica. A análise histopatológica das amostras colhidas evidenciou diferenças marcantes entre os pacientes pós e não pós-bariátrica. Conclusão: Percebeu-se que a técnica operatória na ritidoplastia do paciente pós-bariátrica sustentou detalhes específicos, com resultado cirúrgico pós-operatório satisfatório, uma pele de pior qualidade histológica, com complicações perioperatórias dentro do esperado e com necessidade de maiores estudos para avaliar durabilidade do procedimento.

Introduction: The number of patients classified as overweight or obese has resulted in an increased number of post-bariatric patients, generating a demand for rhytidoplasty in this public profile. The objective is to expose the routine and surgical tactics in a teaching hospital, patient profiles, subcutaneous cellular tissue, and the superficial musculoaponeurotic system are compared between post-bariatric and non-post-bariatric patients, as well as histological superficial comparison of the skin. Methods: A review of the data of 32 cases treated in 2012­2016 was conducted in a public hospital in Goiânia-GO. Results: The tactics of rhytidoplasty used in post-bariatric patients do not differ significantly from those used in nonpost- bariatric patients. A histopathological analysis of the collected samples showed marked differences between post-bariatric and non-post-bariatric patients. Conclusion: The surgical technique of rhytidoplasty of post-bariatric patients sustained specific details with satisfactory postoperative surgical results, skin with worse histological quality, perioperative complications within the expected range, and the need for further studies to assess the procedure's durability

Ritidoplastia e paralisia facial: como lidar? / Facelift and Facial nerve injury: how to deal with?

Não é novidade para os cirurgiões plásticos, especialmente aos que se dedicam à cirurgia de face, que o nervo facial pode ser lesado virtualmente em qualquer cirurgia de ritidoplastia. Porém, apesar da importância contida nesse tema, não é tarefa simples encontrar na literatura artigos que abordem de forma objetiva a correlação entre lesão do nervo facial e cirurgia facial. Paralisias faciais, sejam elas completas ou não, podem se tornar situações potencialmente conflituosas na relação médicopaciente. Este artigo, portanto, visa propor de forma clara e sucinta, baseada na experiência dos autores, um guia de como evitar, identificar e tratar uma potencial lesão do nervo facial no contexto de uma cirurgia de face, em especial a ritidoplastia.

Is largely known that the facial nerve virtually can be injured in every facial lift. Even though its importance, it is difficult to find in the literature articles related to this theme. Complete or incomplete facial paralysis after a facial procedures, may become a very uncomfortable situation between the patient and the surgeon, that is why we propose in this article a guide which intends to help avoid, identify and manage a facial nerve injury in the event of a face lift. Identifying Facial palsy before the surgery: Intending to make the pre-op facial assessment as simple as possible, we suggest a systematic approach examination. Avoiding facial nerve injury during face lifting: Several technical details are discussed along the text aiming to minimize the risk of nerve damage during the surgical procedure. What to in the event of a post-operative facial palsy: The authors propose a logical approach to the facial palsy, suggesting a planning for diagnosis, classification of the lesion and a rational treatment for the injury. Conclusion: This article presents a guide showing some safe technical options to avoid nerve damage during rythidoplasty, how to identify the lesion and treat it if necessary.

Hair transplantation in patients with hair loss or scar deformity in the side hairline after midfacelifting surgery.

BACKGROUND: Successful aesthetic plastic surgery is devoid of both unsightly scarring and postoperative disfigurement. Patients undergoing midface-lifting surgery are very often disconcerted by an altered side hairline, including sideburns, despite considerable amelioration of facial wrinkles. This study was conducted to identify an effective means of approaching an altered hairline and the unavoidable scarring arising from midface-lifting surgery. METHODS: A total of 37 patients who underwent corrective surgery with hair transplantation for hair loss or scar deformity arising from midface-lifting surgery from June 2014 to June 2017, and were observed for more than 6 months thereafter, were enrolled in the study. Prior to corrective surgery, the patients were administered a multiple-choice survey regarding their dissatisfaction arising from midface-lifting surgery. Among the 37 patients, 24, 12, and one underwent donor harvesting by the strip method, non-shaven follicular unit extraction, and partial shaving follicular unit extraction, respectively. Additionally, 33 of the 37 patients underwent hair transplantation in the frontotemporal recess area along with hairline correction surgery. The average number of transplanted grafts was 1,025. RESULTS: Surgery resulted in a natural and satisfactory appearance in all patients. The average patient and physician subjective satisfaction scores were 4.6 and 4.8, respectively. No adverse events such as folliculitis occurred. CONCLUSIONS: Side-hairline correction surgery by hair transplantation can be considered an effective method of realigning an altered hairline accompanied by scars following midfacelifting surgery.

Assessing Improvement of Patient Satisfaction Following Facelift Surgery Using the FACE-Q Scales: A Prospective and Multicenter Study.

INTRODUCTION: Assessment of patient satisfaction following an aesthetic surgery has shown an increasing trend over the past years. To date, there is no prospective and comprehensive study evaluating this aspect after surgical facial and neck rejuvenation. The aim of the current work was to address patient satisfaction after face and neck lift surgery using a validated questionnaire. PATIENTS AND METHODS: We present a prospective and multicenter study (five regional centers) involving all patients undergoing face and neck lift surgery between April 2015 and April 2017 in several French centers for aesthetic surgery. All subjects assessed the FACE-Q scales before the procedure, and furtherly at 3-month, 6-month and 12-month follow-ups. RESULTS: Thirty-six patients were included with a median age of 58.5 years old [IQR 54.0-66.0]. The FACE-Q outcomes were significantly higher at 3-month follow-up (p < 0.001). Seventy-five percent of the patients underwent an additional surgical procedure associated with face and neck lift. Particularly, a combined blepharoplasty led to a significant increase in the score of global facial appearance. The patients considered themselves a mean of 6 years younger in the third month after surgery. These results remained constant at six and twelve postoperative months. CONCLUSION: A statistically significant improvement of the FACE-Q scores could be highlighted on every scale, with permanent results at 6 and 12 months postsurgery. We hereby present the first study with evidence that appearance and quality of life outcomes can be reliably assessed after rhytidectomy. LEVEL OF EVIDENCE IV: 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Intramasseteric schwannoma treated with facelift incision and retrograde facial nerve dissection.

Schwannoma is a slow-growing, well-demarcated, benign soft tissue tumor of the peripheral nerve sheath. It commonly develops in the head and neck region, usually in the parapharyngeal space. In this case, a 42-year-old woman visited the outpatient department to manage a painless mass on her left cheek. She had no history of concern and no neurological symptoms were observed. In the enhanced computed tomography scan, a 2.8 × 2.8 × 1.8 cm, heterogeneously enhanced tumor was detected in the left masseter muscle. A tumor resection under general anesthesia was planned. For the resection, a facelift incision was chosen; branches of the facial nerve were identified and retrogradely dissected. A well-marginated, yellowish, solid mass was found in the left masseter muscle. The mass was excised and given a histopathological diagnosis of schwannoma. A definite diagnosis of schwannoma, originating in the masseter muscle, is difficult to arrive at with radiographic findings alone; it is often misdiagnosed as intramuscular hemangioma. Histopathological examinations, including fine-needle aspiration or histological biopsy after surgery, are necessary. Using a facelift incision with retrograde facial nerve dissection, tumor resection in an intramasseteric lesion can be performed efficiently, without nerve damage, or leaving conspicuous scars on the face.