Advances in Face-lift Techniques, 2013-2018

Abstract

IMPORTANCE Rhytidectomy, or face-lift surgery, is the mainstay of facial rejuvenation and is constantly evolving. There is continuous research to improve outcomes and minimize complications of this surgery.OBJECTIVE To synthesize the updated techniques in rhytidectomy published during the past 5 years, including surgical technique, advances in anesthetic technique, minimally invasive techniques, and adjunctive procedures performed at the time of rhytidectomy.EVIDENCE REVIEW On February 8, 2018, a literature search was performed of the PubMed and Cochrane databases using the search terms, face-lift or rhytidectomy and techniques. Articles published from February 8, 2013, to February 8, 2018, that related to techniques of facial rejuvenation in the lower one-third of the face by lifting and supporting tissue with 5 or more patients were included. Systematic reviews and primary literature were considered; narrative reviews, validation studies, and anatomic studies were eliminated. The initial search resulted in 604 articles after duplicates were removed. This was reduced to 84 articles after dual independent review screening.FINDINGS Of the 84 articles included, 51 (61%) regarding techniques of face-lifting in the past 5 years pertained to soft-tissue techniques; 14 (17%) pertained to implants or adjunctive medications, such as tissue sealants; and 12 (14%) related to adjunctive techniques performed in addition to face-lifting, such as fat grafting, resurfacing, and liposuction. All studies found the techniques reported therein to be effective, with similar or fewer complications compared with the literature. However, according to the Oxford Centre for Evidence-Based Medicine criteria, the level of evidence of the studies was generally poor, because 45 of the studies (54%) were case series (level 4 of evidence).CONCLUSIONS AND RELEVANCE Several new techniques have been explored for rhytidectomy or face-lift in the past 5 years, including soft-tissue techniques, introduction of implants or topical medications such as tissue sealants, and concomitant adjunctive techniques to enhance results. The overall quality of the evidence is poor, with most articles using case series with nonvalidated measures to evaluate outcomes. There is considerable room for improvement in the literature if additional studies using cohort designs and validated outcomes are performed to validate the quality of the techniques introduced during the past 5 years.

Multi-modal treatment strategy for achieving an aesthetic lower face

“…In contrast, faces with a wide lower area or a strongly-curved jawline are considered unappealing. The conventional workhorse for aesthetic enhancement of the lower face is the facelift; however, demand is growing for surgical pro-cedures with a shorter downtime that avoid the complications of invasive techniques, such as facelift procedures [1]. Common minimally invasive methods to make the lower face youthful and attractive include botulinum toxin type A (BoNTA) injection, filler injection, suction-assisted liposuction (SAL), laserassisted lipolysis (LAL), thread lifting, and fat grafting.…”

Outcome Measurement of Beauty and Attractiveness of Facial Aesthetic Rejuvenation Surgery

“…44 Numerous patient-reported measures are available at present with increasing utilization trends; however, valid, reliable, and responsive instruments are generally still lacking. 31,50,51,52 Floyd et al 53 have very recently reviewed the updated facial rejuvenation techniques. In most articles nonvalidated patientreported measures were used providing poor overall quality of evidence.…”

Secondary alopecia induced by aesthetic procedures: An unrecognized potential complication

“…Facelift surgery is one of the mainstays of facial rejuvenation and a constantly evolving technique. Rhytidectomy or facial lift surgery consists of the dissection of the superficial musculoaponeurotic system (SMAS) and a deep‐plane facelift 1 . Complications after rhytidectomy are well‐documented in the literature 2 .…”