LCL: (Locked Cheek Lift) Three-Dimensional Cheek Lift and Inferior Palpebral Rejuvenation.

BACKGROUND: Many recent advances in face lift techniques have been made to reverse the aging process of the mid-face. In this study, we present a new technique by which mid-face rejuvenation can be achieved in double-angle vectors and allows adaption to the underlying bony structure. The locked cheek lift (LCL) allows effective, simple and rapid lifting of the malar fat pad in two planes. Correction of the curvature of the face and reduction of the height of lid cheek junction distance can be achieved without an incision at the lower eyelid. METHODS: In total, 115 patients (77 females and 38 males) have been operated on using the LCL technique by a single surgeon; patient ages ranged between 37 and 71 years old (average = 51). Follow-up was performed by the same team for a year postoperatively. The facial expression and lid cheek distance have been evaluated during this period. RESULTS: After a year from the operation, the lid cheek distance correction was maintained in 95.7% of the cases, with stable position of the ascended malar fat pad. Postoperative edema and ecchymosis were limited. CONCLUSION: LCL is an effective, simple and rapid surgical technique, which is capable of correcting the cheek gravitational migration, reducing the lid cheek distance (LCD), maintaining the ascended stable malar fat pad for a long time with a short recovery period and minimal risk of complications. 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 .

Split-face histological and biochemical evaluation of tightening efficacy using temperature- and impedance-controlled continuous non-invasive radiofrequency energy.

BACKGROUND: Bipolar radiofrequency (RF) is capable of heating dermal collagen fibers and inducing skin tightening by collagen remodeling. OBJECTIVE: To substantiate safety and improvement of skin laxity following skin heating with a novel temperature- and impedance-controlled non-invasive radiofrequency (RF) device by histological and biochemical evaluations. METHODS: A split-face study was performed on 4 subjects who underwent 8 weekly RF sessions on one side of their face, leaving the other side an untreated control and then underwent facelift procedure. Clinical evaluation by photographs was done prior to the surgical procedure. Ex vivo fragments were harvested from both sides and compared. Morphometric analysis of dermal collagen fibers, collagen synthesis, and elastin synthesis evaluations were compared in triplicates. RESULTS: Facial skin tightening was apparent in split-face photographs. A significant increase of 7.9% in dermal collagen content, and a significant increase of 34.7% in collagen synthesis were demonstrated in the treated samples. No statistically significant effect on elastin synthesis was detected. CONCLUSIONS: Skin tightening following treatment with non-invasive RF has proven histologically and biochemically to derive from increase in dermal collagen synthesis and content.

A clinical and biological evaluation of a novel, noninvasive radiofrequency device for the long-term reduction of adipose tissue.

BACKGROUND AND OBJECTIVE: A novel, noninvasive technology, utilizing suction-coupled radiofrequency (RF) heating and ultra-short pulse duration, high-voltage electrical pulses was studied for its efficacy and safety on adipose tissue reduction. METHODS: Twenty-one subjects underwent treatment of their abdominal fat once weekly for 6 weeks. Clinical outcomes including abdominal circumference, adipose tissue thickness (measured by ultrasound), adipose tissue weight, body weight, and clinical photographs were obtained at visits 1 and 3 months after last treatment. Adverse events were recorded. Three subjects, who were undergoing a future elective abdominoplasty, were treated with the same protocol, but on only one side of the abdomen before abdominoplasty. Biopsies from the RF-treated and untreated sides were harvested during abdominoplasty and cultured; measurements of adipocyte size and shape, rate of apoptosis, collagen production, and dermal thickness were determined. RESULTS: Significant clinical improvements (P < 0.05) were observed for the following clinical outcomes: reduction of abdominal circumference (113.4-110.7 cm), reduction of subcutaneous adipose tissue thickness (40.5-38.5 mm), and reduction in adipose tissue weight (32.2-30.7 kg) at 3-month follow-up visits. Overall patient weight also decreased, which was statistically significant at 1-month follow-up, but was not statistically significant at 3-month follow-up (73.9-73.3 kg, P = 0.609). Histologically, adipocytes were observed to have decreased size and withered shape, with increased levels of apoptosis; increased collagen synthesis, with compaction and reorganization of the dermis was also observed. Only minor, transient side effects were reported. CONCLUSIONS: This novel, noninvasive RF device was effective for improving subcutaneous fat, reducing abdominal circumference and reducing subcutaneous fat layer thickness. Histologically, these improvements appear to be partly related to increased adipocyte apoptosis.

"Mirror Face Lift": Concept, Description, and Evaluation 1 Year Postoperatively.

The mirror facelift1,2 is a new concept of mid-face rejuvenation that we apply during the preoperative consultation to explain and show the patient the possible results that can be achieved postoperatively and have this result stay stable over time and in different positions. It is characterized by (1) the use of a mirror during the preoperation visit and the taking of pictures from different angles, allowing for a precise analysis of the redistribution of the facial soft tissues on each hemi-skeleton; (2) the Divaris et al2 locked cheek lift technique (Locked Cheek-Lift), which is done with 2 vectors that achieve a tri-dimensional redistribution of the soft tissues; and (3) postoperative photographs which are very useful in precisely evaluating the results and comparing them with the preoperative pictures. METHODS: Two hundred and sixty patients (216 women and 44 men), average age 53 (34 to 73 years old), were operated on between 2010 and 2016, applying the concept of mirror lift in the consultation to show the patients the expected possible results after the surgery. The patients see for themselves the deterioration of the facial condition (looking older) with the anti-mirror position as well as the younger appearance of the face following the mirror position. Surgically, the locked cheek lift technique was performed by the same surgeons. The follow-up 1 year later was done by the same team. The fat compartment positions were evaluated during this period. RESULTS: The fat compartments' stability was evaluated 3 months and a year postoperatively to assess the stability of the result over time. The mean value is 4.62 out of 5 in anti-mirror position before surgery and 1 year postoperatively. The mean value is 4.34 out of 5 after 1 year measured in both standing and lying positions. Postoperative edema and ecchymosis were limited. CONCLUSIONS: The concept of the Mirror Facelift is to precisely reposition the soft tissues of the face on the bone structure by correcting the fat compartments that have migrated over years. It harmoniously redistributes the soft tissues without any palpebral cutaneous incision, thus allowing for a short recovery period free of any risk of palpebral complications.

Face expressive lifting (FEL): an original surgical concept combined with bipolar radiofrequency.

BACKGROUND: Aging can lead to changes in facial expressions, transforming the positive youth expression of happiness to negative expressions as sadness, tiredness, and disgust. Local skin distension is another consequence of aging, which can be difficult to treat with rejuvenation procedures. The "face expressive lifting" (FEL) is an original concept in facial rejuvenation surgery. On the one hand, FEL integrates established convergent surgical techniques aiming to correct the age-related negative facial expressions. On the other hand, FEL incorporates novel bipolar RF technology aiming to correct local skin distension. METHODS: One hundred twenty-six patients underwent FEL procedure. Facial expression and local skin distension were assessed with 2 years follow-up. RESULTS: There was a correction of negative facial expression for 96 patients (76 %) and a tightening of local skin distension in 100 % of cases. CONCLUSIONS: FEL is an effective procedure taking into account and able to correct both age-related negative changes in facial expression and local skin distension using radiofrequency. Level of Evidence: Level IV, therapeutic study.