Revision and Secondary Facelift: Problems Frequently Encountered

Background: In the public’s mind, rhytidectomy, better known as a facelift procedure, is the technique most closely associated with plastic surgery. When done correctly, it yields highly satisfactory results. The aim of our study was to retrospectively review results of our patients whose procedures were performed using the superficial musculoaponeurotic system (SMAS) plication technique. Plication was performed with multifilament braided sutures, which provided a sustainable lift and satisfactory results. Methods: This study involves a retrospective review of 137 patients who underwent primary or secondary facelift procedures over a period of 46 months. The average patient age was 59 years, with ages ranging from 30 to 77. Patients were reviewed at 6 and 12 months postoperatively. Subjective evaluation based on photographic analysis was performed pre- and postoperatively. Results: All cases included in this study indicated satisfaction with postoperative results on 1 year postoperative review for both the patients and performing surgeons. Four patients presented with a postoperative hematoma that required surgical intervention. One patient developed skin infection that was followed by skin necrosis. Another patient presented with wound infection that resulted in partial wound dehiscence. Both cases were managed conservatively. Conclusions: With the abundance of techniques directed toward the SMAS layer, it has become a pivot point for facelift procedures. This expansion in approaches places emphasis on the SMAS layer and its manipulations. The type of suture material utilized in SMAS plication is, therefore, undoubtedly essential. Our use of braided multifilament sutures for SMAS plication provided satisfactory results at 1-year postoperative review.

Section: Discussionmentioning

confidence: 99%

The Use of Multifilament Suture for SMAS Plication in Rhytidectomy

Wahdan

Saloussy²

2023

“…Devices designed to tighten tissues, like high-intensity focused ultrasound 14,15 and threads, potentially complicate surgical dissection through increased collagenesis. 16 Although surgery can usually be performed with minimal morbidity, 17,18 residual material such as threads can also complicate surgery (Fig. 5).…”

Section: Discussionmentioning

confidence: 99%

Surgical or Nonsurgical Facial Rejuvenation: The Patients’ Choice

Corduff

2023

Background: Patients seeking a pan-facial rejuvenation may not receive appropriate medical advice on surgical versus nonsurgical treatments, resulting in those who are best-suited for surgery receiving nonsurgical options, and vice versa. Patients who requested total-face, nonsurgical revitalization were surveyed to understand the factors influencing this decision-making. Methods: Patients consulting for total facial rejuvenation were surveyed on their reasons for seeking nonsurgical versus surgical interventions by an investigator with 30 years of plastic surgery experience, practicing in a nonsurgical clinic alongside a dermatologist and aesthetic physician. Results: Of the 92 patients surveyed, 78% completed the survey, 47% of whom had considered facelift surgery, and 14% of whom proceeded to inquiries or consultations with a plastic surgeon about facelift surgery. All respondents were women, and age was not an exclusion factor. Forty-four percent would still consider facelifts in later life. Among the most common reasons for choosing nonsurgical approaches were a desire for natural and subtle results, cost, having flexibility in treatment choice, concerns about surgical and anesthesia risks, downtime, the ability to distribute treatments over time, and scarring. Conclusions: Many patients book nonsurgical treatments without prior professional advice, and consider these as a temporary solution, but may desire surgery later in life. Before conducting nonsurgical treatments, doctors should identify this group and avoid interventions that may interfere with optimal surgical outcomes later. Also, some patients desire surgical outcomes when surgery is not a feasible option, and thus seek nonsurgical alternatives. For this group, realistic goals must be set before treatment to avoid disappointment.

“…14,15 In fact, even traditional excisional surgery (ie, facelift/necklift) is often challenging due to the tendency for recurrent laxity in these areas postoperatively. 16…”

Section: Introductionmentioning

confidence: 99%

“…14,15 In fact, even traditional excisional surgery (ie, facelift/necklift) is often challenging due to the tendency for recurrent laxity in these areas postoperatively. 16 Numerous energy-based technologies have developed to address aesthetic concerns in the lower third of the face and neck, including laser, cryolypolysis, highintensity focused ultrasound (HIFU), and radiofrequency (RF). [17][18][19][20][21][22][23][24] Over the past 20 years, RF has emerged as a safe and efficacious method to produce soft tissue contraction through thermal energy.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Trial: Handsfree Thermoregulated Bipolar Radiofrequency for Face and Neck Contouring

Dayan

Chapas²,

Marte

et al. 2022

Background: The use of radiofrequency in aesthetic surgery has evolved significantly since it was first introduced in the early 2000s. Nonexcisional correction of the lower one-third of the face and neck has long been a challenging problem. The purpose of this prospective study was to assess the safety and efficacy of the first handsfree thermoregulated bipolar radiofrequency device for face and neck contouring. Methods: This prospective multicenter (New York, Nevada) IRB-approved study evaluated healthy candidates who desired noninvasive correction of their lower face and neck laxity. The primary objective of this study was to evaluate safety and soft tissue remodeling pretreatment and at 1-, 3-, and 6-months post last treatment. Assessment was made using blinded evaluators, 3D photographic analysis (Quantificare, France), and volumetric measurements. Investigator and subject assessments were obtained using a 0-4 point Likert scale. Results: A total of 34 patients completed both the cheek and chin applicator treatment series. Average age of patients was 38 (STD 3.4), BMI 27 (STD 2.2), average Baker Face & Neck classification 2.6 (STD 1.1), and average Fitzpatrick type 2.4 (STD 1.2). Mean treatment time was 41 min (STD 3.5) with a temperature of 42°C-43°C. Patient discomfort data were statistically very low based on t-test analysis. Satisfaction metrics measured at 1-and 3-month follow-up demonstrated a significant change in subject skin appearance, subject overall satisfaction, and investigator improvement perception. More patients were satisfied at the 3-month follow-up compared with the 1-month follow-up for all three measures. Volumetric data demonstrated an average change of −3.2 cm 3 (STD ±1.2 cm 3 ) per side for the cheek applicator and −4.1 (STD ±2.3) for the submental applicator. Of note there were cases where volume increases were noted that were believed to be related to soft tissue contraction. Conclusions: This is the first prospective study to evaluate a handsfree thermoregulated bipolar radiofrequency device for face and neck contouring. This device demonstrates a significant advance in the control and delivery of radiofrequency for aesthetic purposes. With a favorable safety and comfort profile, this device is able to concentrate thermal energy consistently at a depth that allows for fibroseptal network tightening to improve lower third of face and submental soft tissue contraction.