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.

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.

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.

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.

Comparing the Safety and Effectiveness of Microfocused Ultrasound: Standard vs Targeted Tissue Protocol in Lifting and Tightening the Lower Face and Upper Neck.

BACKGROUND: Micro-focused ultrasound with visualization (MFU-V) delivers energy to specific soft tissue layers beneath the epidermis with the ability to lift and tighten the lower face and neck.  Objective: To determine the efficacy of microfocused ultrasound with visualization (MFU-V) using a standard treatment line protocol versus a customized treatment line protocol based on the patient's unique anatomy targeting the superficial muscular aponeurotic system and fibrous septae for lifting and tightening of the lower face and neck. METHODS: This was a single-center, prospective, randomized, investigator-blinded clinical trial. 51 subjects were randomized to receive a single treatment of MFU-V targeting the lower face and neck using either a standard or custom treatment protocol.   Results: Subjects in both standard and custom treatment groups noted a greater than one-point improvement in jawline laxity. Three-dimensional photography measurements also demonstrated lifting of the lower face and neck in both treatment groups. CONCLUSION: Custom and standard treatment MFU-V protocols produce a safe and effective treatment for tightening and lifting the lower face and neck. Custom treatment protocols aid in maximizing results for patients with variations in the anatomy of the lower face and neck.  J Drugs Dermatol. 2024;23(4):7647.     doi:10.36849/JDD.7647.

Basic concepts in facial and neck thread lifting procedures.

In this review article, our objective is to elucidate fundamental principles and offer practical illustrations concerning the procedures involved in facial and neck thread lifting. Moreover, we aim to explore associated concepts such as the fixing point, hanging point, and anchoring point terminologies, along with the elucidation of vectors. Additionally, we will provide anatomically oriented explanations of the lifting process required for each facial region using thread lifting methods like V, U, and I techniques using floating type threads (Secrete line, Hyundai Meditech., Inc., Wonjusi, Republic of Korea). Furthermore, our intention is to delve deeply into the concepts of tensile strength, anchoring strength, and holding strength, contextualizing their practical applications within this specific field.

Suture Net Technique for Mid-face Superficial Fat Compartments Restoration.

BACKGROUND: Facial fold and groove formation is influenced by the ptosis of the superficial fat compartments in the mid-face region. OBJECTIVE: This study aimed to design a facial rejuvenation technique that targets sagging of the mid-face fat compartments and achieves a youthful facial configuration. MATERIALS AND METHODS: A total of 102 patients underwent suture net restoration. Each specific ptosis fat compartment was carefully lifted and held at the regional facial ligaments to effectively restore volume distribution. Patient outcomes were evaluated through preoperative and postoperative photography comparison, 3-D photographic analysis, and postoperative evaluations. RESULTS: Significant mid-cheek rejuvenation was observed. The procedure resulted in a remarkable, 10.89% increase in malar projection. The nasolabial fold improved by at least 1 grade in 61.43% of the patients and by at least 2 grades in 37.14%. A total of 87.65% of the patients expressed high satisfaction or satisfaction with the outcomes of the procedure. CONCLUSION: By specifically targeting the mid-face ptosis fat compartments, the technique demonstrated significant enhancements of both the nasolabial fold and the malar projection. The results indicate that this novel technique holds promise as an efficient approach for satisfactorily addressing facial aging concerns.

A Systematic Review: Fibrin Glue in Drainless Rhytidoplasty.

The following questions guided the study: Can the use of fibrin glue in drainless rhytidoplasty reduce hematoma prevalence, seroma prevalence increase patient satisfaction or decrease the length of hospital in the adult population compared with standard treatment? The following inclusion and exclusion criteria apply: The procedure performed was rhytidoplasty for both groups. Participants were limited to adults who did not have any other procedure performed during the study. The intervention consisted of the use of fibrin glue without drains compared to the control group, in which drains and/or pressure dressing were applied. Databases: clinicaltrials.gov, MEDLINE, COCHRANE, mRCT, PubMed, Google Scholar, Scopus, Embase, VHL, GHL were searched on 03/25/2023 by 2 different investigators. The Cochrane Risk of Bias Tool 2.0 was used. Five studies were included with a total number of 1277 participants (2554 face sides). The cumulative hematoma rate was OR 0.47 (95% CI 0.26-0.84) in favor of using fibrin glue. Insufficient data were available to assess seroma rate, patient satisfaction, and length of hospital stay. The risk of study bias was judged to be low and moderate. The certainty for the use of fibrin sealant versus drainage is high and the importance of outcomes is rated as important in the GRADEpro GDT tool. Fibrin glue use is more beneficial comparing to drainage in patients undergoing rhytidectomy in terms of hematoma prevalence. This study was registered in PROSPERO (CRD42023421475).Level of Evidence I 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 .

SMAS repositioning technique utilizing cog thread: Anatomical perspectives.

INTRODUCTION: Face-lifting surgeries were once common among individuals over 60 years old due to skin laxity, but recent trends favor thread lifting in this age group. Understanding dynamic changes in facial anatomy during postural shifts is essential. METHOD: Fresh cadaver studies have demonstrated the passage of threads through the superficial musculoaponeurotic system (SMAS) layer, confirming the efficacy of the technique. Proper insertion depth targeting SMAS repositioning, rather than superficial skin layers, is crucial. RESULT: The natural movement of tissues secured by thread (N-Cog and N-Fix, N-Finders Inc., Korea) insertion results in lifting effects. However, complications may arise if threads affect deeper facial muscles, leading to discomfort. Fibrous septa play a significant role in guiding thread placement, with different densities influencing thread maneuverability and tissue response during lifting. CONCLUSION: Procedures targeting SMAS repositioning using threads aim to maintain the new position of relocated tissues. Understanding structural variations in facial regions informs thread selection and placement. Aligning threads with tissue movement and the intended SMAS layer positioning is vital to prevent complications. Balancing thread insertion depth and tissue traction is critical for successful outcomes. Modern thread lifting techniques prioritize SMAS repositioning, enhancing lifting effects while ensuring procedure safety and efficacy.

What are filling (volumizing) threads?

Facial aging prompts a shift in the demands for lifting procedures, transitioning from targeted improvements in younger individuals to overall facial contour enhancements as skin elasticity declines in later years. This paper examines the evolution of PDO volumizing threads, delineating their development from initial limitations to contemporary innovations aimed at addressing tissue deformation and maintaining thread integrity post-insertion. Categorizing these threads based on elasticity, shape, and functionality underscores their versatility and application nuances, catering to specific wrinkle correction, contour sculpting, and facial volume restoration. The discussion emphasizes the pivotal role of thread characteristics in achieving optimal outcomes while minimizing potential complications. By delving into historical contexts, mechanisms, effectiveness, and thread classification, this paper equips practitioners with a comprehensive understanding to make informed decisions in selecting threads for volumizing thread procedures. Recommendations for future research directions, including long-term safety assessments and patient-specific outcomes, seek to enhance the clinical utility and applicability of this analysis.