Getting Better Results in Facelifting

Abstract

The facelift has significantly evolved over the past several decades. What was once considered a skin only operation is now a sophisticated, elegant procedure that requires meticulous preoperative analysis, understanding of underlying anatomically based aging changes, and extreme attention to detail. According to the American Society of Plastic Surgeons, 125,697 facelifts were performed in 2017. It is not surprising that given these advances that facial rejuvenation surgery is still a very common procedure with a high degree of patient satisfaction despite the increase in nonsurgical facial aging treatments. With an improved understanding of facial anatomy including the facial retaining ligaments and intervening superficial and deep fat compartments, the modern facelift requires an anatomically targeted approach. Furthermore, the modern facelift surgeon must achieve consistently excellent results with reasonably little downtime while being aware of methods to improve the safety of this popular elective procedure. Hematoma is the most common complication after rhytidectomy with an incidence between 0.9% and 9%, with a higher incidence in males. Other potential complications include seroma, nerve injury, skin flap necrosis, siaolocele as a consequence of submandibular gland debulking, and skin flap rhytid and hairline distortion. This review aims to discuss safe, consistent, and reproducible methods to achieve success with facelift.

Revision Facelift and Neck Lift

“…To mitigate the risk of conspicuous facial scarring, it is customary to utilize the original surgical skin incisions when performing the secondary procedure and to excise any additional remaining scars. 2,7,9,18 Hatef and Sclafani delineated three exceptions to this rule: unnoticeable or hidden scars; women with pretragal scars and adequate skin laxity who can undergo retrotragal incision placement; patients with evidently, poorly positioned prior incisions who can undergo standard incision with appreciable mobilization of skin area for scar excision. 6 While a secondary facelift procedure typically contributes to greater technical complexity of the surgery, it can be performed safely with remarkable postoperative results.…”

“…If less than 5 cm, then the temporal portion of the incision can be placed posteriorly within the hairline; if greater than 5 cm, a pretrichial incision is recommended. 18 Although a somewhat less "scientific" method of assessment, the general position of the sideburn or temporal hairline can and should be used as a determinant for placement of the temporal incision. If the sideburn is located superior to the root of the helix, the use of a transverse pretrichial incision should be considered (►Fig.…”

“…If the surgeon deems that less than 2 cm of postauricular skin will be resected, then the incision should be carried into the posterior scalp; but if the surgeon expects that more than 2 cm will be excised, the incision should continue along the occipital hairline to prevent the step-off hairline deformity. 18 Again, having a discussion with the patient as to how they wear their hair may influence this decision, even when a limited amount of skin will be resected. To correct a displaced occipital hairline or significant scarring, the surgeon should widely undermine the cervical flap and perform a lateral platysmaplasty to release any tension present along the previous scar and to amend any existing deformity.…”

“…13 The use of a pre-, inter-, or retrotragal incision is highly surgeon-dependent, though a pretragal incision is commonly utilized to prevent additional tension or anterior displacement. [6][7][8]18,32 A surgeon may choose to perform a retrotragal incision in women who present with pretragal scarring and sufficient skin laxity; however, the same should not be performed in men to prevent incorporating facial hair into the tragus. [6][7][8]…”

The “Segmental SMAS Model”: A Didactic Concept of Face and Neck Lift Anatomy

“…Based on the surgical anatomy presented in the present paper, the following maneuvers are suggested as discriminators to differentiate various extents of the procedure. [26][27][28][29][30] • Elevation of a short skin flap.…”