12. Primary Superficial Musculoaponeurotic System (SMAS) Facelift and Neck Lift

In this study, we explore the changes in the earlobe segments following an extended superficial musculoaponeurotic system (SMAS) face-lift and neck lift. We proposed to delineate the effect of the cheek and neck skin tension vectors on the earlobe based on the amount of excised skin length. A retrospective study identified patients who underwent extended SMAS rhytidectomy performed by the senior author (A.M.) at the Cosmetic Plastic Surgery Institute (CPSI) from 2017 to 2020. A total of 34 North American Caucasians, who had preoperative and postoperative photographs available for comparison, were evaluated. Preoperative and postoperative cephalic (the distance from the intertragal notch to the otobasion inferius, abbreviated as I to O) and caudal earlobe segment (the distance from the otobasion inferius to the subaurale, abbreviated as O to S) heights were collected. The change from the postoperative to preoperative measurements was calculated. The effects of the degree of cheek skin (superior ear [SE]) and neck skin (mastoid peak [MP]) excision lengths were then determined by comparing the change in I to O and O to S. The postoperative attached cephalic segment (15.94 ± 1.02 mm) increased significantly compared with the preoperative attached cephalic segment (12.99 ± 1.03 mm). The postoperative free caudal segment (3.62 ± 0.81 mm) decreased significantly compared with the preoperative free caudal segment (5.44 ± 0.95 mm). The SE median was found to be 3.0 cm and the MP median was found to be 3.5 cm. I to O increased by 3.85 mm for SE ≤3.0 cm compared with only 1.57 mm for SE >3.0 cm. O to S decreased by 2.79 mm for SE ≤3.0 cm compared with only decrease of 0.14 mm for SE >3.0 cm. I to O increased by only 1.67 mm for MP < 3.5 cm. O to S decreased less dramatically by 0.55 mm for MP ≤3.5 cm compared with decrease of 2.39 mm for MP >3.5 cm. These data demonstrate that more aggressive SE >3.0 cm cheek excision lengths resulted in a protective effect on decreasing the free caudal segment of the earlobe. More aggressive excisions of the cheek demonstrate a protective effect on preserving the free earlobe caudal segment, whereas more aggressive neck skin excisions result in higher propensity for loss of the free earlobe caudal segment. In our study, we demonstrate findings observed with clinical observations that a face-lift and neck lift will result in increase in the attached cephalic earlobe segment height (I to O) and a decrease in caudal free earlobe segment height (O to S). These findings may assist plastic surgeons when trying to fine-tune the earlobe aesthetics during face-lift and neck lift. If the patient has a small free hanging earlobe, the more aggressive pull on the cheek flap will result in less reduction in the earlobe hang.

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Long-Term Study of Complications of Neck Lift

Clinics in Plastic Surgery ◽

10.1016/s0094-1298(20)31874-5 ◽

1983 ◽

Vol 10 (3) ◽

pp. 563-572 ◽

Cited By ~ 2

Author(s):

José Guerrerosantos ◽

Mario Sandoval ◽

Jorge Solazar

Keyword(s):

Term Study ◽

Neck Lift ◽

Long Term Study

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Concepts of Neck Lift

Clinics in Plastic Surgery ◽

10.1016/s0094-1298(20)31862-9 ◽

1983 ◽

Vol 10 (3) ◽

pp. 367-378

Author(s):

Thomas M. Biggs ◽

Lawrence Koplin

Keyword(s):

Neck Lift

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Indikation des Superficial-musculoaponeurotic-system-Lappens in der Parotischirurgie?

HNO-Informationen (Kongressabstracts) ◽

10.1055/s-2005-869393 ◽

2005 ◽

Vol 84 (01) ◽

Author(s):

S Schumacher ◽

R Grossenbacher

Keyword(s):

Superficial Musculoaponeurotic System

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Cosmetic Lower Face and Neck Lift with Local and Tumescent Anesthesia.

Advances in Plastic and Reconstructive Surgery ◽

10.31700/2572-6684.000124 ◽

2017 ◽

Vol 01 (04) ◽

Keyword(s):

Lower Face ◽

Tumescent Anesthesia ◽

Neck Lift ◽

Face And Neck Lift

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Facelift Part II: Surgical Techniques and Complications

Aesthetic Surgery Journal ◽

10.1093/asj/sjab081 ◽

2021 ◽

Author(s):

Ahmed M Hashem ◽

Rafael A Couto ◽

Chris Surek ◽

Marco Swanson ◽

James E Zins

Keyword(s):

Plastic Surgery ◽

Surgical Techniques ◽

Aesthetic Surgery ◽

Program Directors ◽

Recent Survey ◽

Critical Reading ◽

Neck Lift ◽

Macs Lift ◽

Face And Neck Lift

Abstract Although previous publications have reviewed face and neck-lift anatomy and technique from different perspectives, seldom were the most-relevant anatomical details and widely practiced techniques comprehensively summarized in a single work. As a result, the beginner is left with a plethora of varied publications that require sorting, re-arrangement, and critical reading. A recent survey of US plastic surgery residents and program directors disclosed less facility with facelift surgery when compared to aesthetic surgery of the breast and trunk. To this end four of the widely practiced facelift techniques (ie, MACS-lift, lateral-SMASectomy, extended-SMAS, and composite rhytidectomy) are described in an easy review format. The highlights of each are formatted followed by a summary of complications. Finally, the merits and limitations of these individual techniques are thoroughly compared and discussed.

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Surgical Anatomy for Extended Facelift Techniques

Facial Plastic Surgery ◽

10.1055/s-0040-1712472 ◽

2020 ◽

Vol 36 (03) ◽

pp. 309-316

Author(s):

Ozcan Cakmak ◽

Ismet Emrah Emre

Keyword(s):

Facial Nerve ◽

Soft Tissues ◽

Extended Techniques ◽

Surgical Anatomy ◽

Superficial Musculoaponeurotic System ◽

Increased Risk ◽

The Face ◽

Facial Soft Tissues ◽

Relationship Of ◽

The Relationship

AbstractPreservation of the facial nerve is crucial in any type of facial procedure. This is even more important when performing plastic surgery on the face. An intricate knowledge of the course of the facial nerve is a requisite prior to performing facelifts, regardless of the technique used. The complex relationship of the ligaments and the facial nerve may put the nerve at an increased risk of damage, especially if its anatomy is not fully understood. There are several danger zones during dissection where the nerve is more likely to be injured. These include the areas where the nerve branches become more superficial in the dissection plane, and where they traverse between the retaining ligaments of the face. Addressing these ligaments is crucial, as they prevent the transmission of traction during facelifts. Without sufficient release, a satisfying pull on the soft tissues may be limited. Traditional superficial musculoaponeurotic system techniques such as plication or imbrication do not include surgical release of these attachments. Extended facelift techniques include additional dissection to release the retaining ligaments to obtain a more balanced and healthier look. However, these techniques are often the subject of much debate due to the extended dissection that carries a higher risk of nerve complications. In this article we aim to present the relationship of both the nerve and ligaments with an emphasis on the exact location of these structures, both in regard to one another and to their locations within the facial soft tissues, to perform extended techniques safely.

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Optimizing Outcomes in Neck Lift Surgery

Aesthetic Surgery Journal ◽

10.1093/asj/sjab056 ◽

2021 ◽

Author(s):

Thomas Gerald O’Daniel

Keyword(s):

Surgical Planning ◽

Planning Process ◽

Objective Evaluation ◽

Volumetric Analysis ◽

Anterior Neck ◽

Surgical Specimen ◽

Neck Lift ◽

Fat Reduction ◽

The Mean ◽

The Impact

Abstract Background In certain patients there is an imbalance between the volume of the anterior neck and the mandibular confines that require reductional sculpting and repositioning of the hyoid to optimize neck lifting procedures. Objectives A quantitative volumetric analysis of impact of the management of supraplatysmal and subplatysmal structures of the neck by comparing surgical specimen was performed to determine the impact of reduction on cervical contouring. Methods In 152 patients undergoing deep cervicoplasty, the frequency of modification of each surgical maneuver and amount of supraplatysmal and subplatysmal volume removed was measured in cubic centimeters using a volume displacement technique. Results The mean volume of total volume remove from the supraplatysmal and subplatysmal planes during deep cervicoplasty was 22.3 cm3 with subplatysmal volume representing 73%. Subplatysmal volume was reduced in 152 patients. Deep fat was reduced in 96% of patients with mean volume of 7 cm3, submandibular glands (76%) with mean volume 6.5cm, anterior digastric muscles (70%) with mean volume 2cm3, peri-hyoid fascia (32%) with mean volume <1cm3 and mylohyoid reduction (14%) with mean volume < 1cm3 in the series. The anterior digastric muscles were plicated to reposition the hyoid in 34% of cases. Supraplatysmal fat reduction was 6.3 cm3 in 40% of patients. Conclusions The study provides a comprehensive analysis of the impact of volume modification of the central neck during deep cervicoplasty. This objective evaluation of neck volume may help guide clinicians in the surgical planning process and provide a foundation for optimizing cervicofacial rejuvenation techniques.

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