The Multiple Rhomboid Vector Suture—Our Experience of Two Years with a Modified Suspension Approach for SMAS Plication Facelifts

2021 ◽  
Author(s):  
Kai Kaye ◽  
Felix Paprottka ◽  
Sonja Kaestner ◽  
Phillipp Gonser
Keyword(s):  
Patient Satisfaction ◽  
Soft Tissue ◽  
Preoperative Assessment ◽  
Complication Rates ◽  
Facial Soft Tissue ◽  
Superficial Musculoaponeurotic System ◽  
Age Related ◽  
The Face ◽  
Subcutaneous Tissues ◽  
Lifting Techniques

AbstractPurse string sutures in superficial musculoaponeurotic system (SMAS) plication facelifts may cause technique-related problems, such as soft tissue deformities, dimpling, and bulkiness inside and between the independent sutures. Therefore, the authors have developed a new approach named the multiple rhomboid vector (MRV) suture. A total of 103 patients (89 female, 14 male patients; median age: 57 years) received a primary rhytidectomy with the MRV SMAS plication suture in our clinic (2015–2017). Intraoperative time to perform the suture per side was recorded. Postoperative complications and dimpling and bulkiness of subcutaneous tissues were judged by three independent surgeons from 1 (= none) to 4 (= extreme) after 1 week, 1, 3, 6, and 12 months. A standardized survey, the FACE-Q questionnaire, was performed to evaluate postoperative patient satisfaction. Mean time to perform the suture was 5:14 minutes per side (minimum: 3:20 minutes, maximum: 5:53 minutes; standard deviation: 0:51 minutes). During the follow-up period, four complications were detected (two cases of temporary neurapraxia of the marginal branch of the mandibular nerve {n = 2 [1.9%]} and two cases of retroauricular hematoma {n = 2 [1.9%]}). Postoperative dimpling or bulkiness of subcutaneous tissues was judged as absent. Overall patient satisfaction rate, after the surgery was performed, was measured as “very high.” The MRV suture offers a combined horizontal and vertical suspension approach, which effectively addresses the different vectors of age-related facial soft tissue descent with complication rates equal to other surgical lifting techniques. Apart from that, it may help reduce the possibility of contour irregularities, whereby it must be noted that a thorough preoperative assessment together with the patient and surgical planning is crucial to ensure realistic expectations of the surgical outcome.

Primary Repair of Soft Tissue Facial Trauma

2020 ◽  
Author(s):  
Michelle Seu ◽  
Amir H. Dorafshar ◽  
Fan Liang
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Primary Repair ◽  
Soft Tissue Injury ◽  
Facial Trauma ◽  
Facial Soft Tissue ◽  
The Face ◽  
Craniofacial Trauma ◽  
Facial Anatomy ◽  
Tissue Defects

Craniofacial trauma can result in a wide variety of injuries that cause soft tissue injury of face. However, despite the enormous diversity in presentation of these injuries, they tend to follow certain patterns. Most facial injuries are either contusions, abrasions, lacerations, or avulsions. The extent of injury and approach to repair can be further assessed by the size, depth, and number of facial subunits involved. A plastic surgeon in the setting of acute craniofacial trauma, armed with certain principles of facial anatomy and primary repair methods, can drastically restore function and cosmesis to the face, while also mitigating the chance of future deformity and functional deficit. This review contains 3 figures and 26 references Keywords: facial trauma, craniofacial surgery, primary repair, facial soft tissue defects, soft tissue, facial injury, plastic surgery, facial lacerations, facial avulsions

Fat Grafting to Improve Results of Facelift: Systematic Review of Safety and Effectiveness of Current Treatment Paradigms

2020 ◽  
Vol 41 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Felipe Molina-Burbano ◽  
J Michael Smith ◽  
Michael J Ingargiola ◽  
Saba Motakef ◽  
Paymon Sanati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fat Grafting ◽  
Treatment Modalities ◽  
Fat Graft ◽  
Cochrane Library ◽  
Complication Rates ◽  
Volume Loss ◽  
Level Of Evidence ◽  
Superficial Musculoaponeurotic System ◽  
Age Related

Abstract Background Autologous fat grafting is a helpful supplement to facelift surgery that helps to combat age-related volume loss of facial structures. Despite the widespread prevalence of combined facelift and fat-grafting, significant procedural variation exists between providers. Objectives The primary purpose of this systematic review was to study the efficacy and complication rates of facelift with lipofilling compared with facelift alone. Methods A systematic review of the Cochrane Library and MEDLINE databases as completed was undertaken to identify all clinical reports of fat grafting combined with facelift surgery based on the following key terms: (“fat grafting” OR “lipotransfer” OR “lipofilling” OR “fat transfer”) AND (“facelift” OR “rhytidectomy” OR “SMASectomy” OR “facial rejuvenation”). Data on techniques, outcomes, complications, and patient satisfaction were collected. Results The systematic review was performed in April 2017. In total, 248 articles were identified for review. After application of exclusion criteria, 15 primary studies were included in this review. Various facelift techniques were reported, including deep-plane or sub–superficial musculoaponeurotic system (SMAS) facelift, SMAS facelift, modified minimal access cranial suspension lift, component facelift, midface lift, SMAS plication, SMAS-stacking/SMASectomy, and SMASectomy. The most common locations of fat graft injection included the nasolabial folds, tear troughs, temporal regions, midface/cheek/malar eminence, marionette groove, lips, and ear lobes. The addition of fat grafting to facelift surgery resulted in significant improvements in facial volume and aesthetic assessments. Conclusions Combined facelift and fat grafting is a safe and efficacious means to simultaneously address age-related ptosis and volume loss. Further research is required to validate and improve existing treatment modalities. Level of Evidence: 3

scholarly journals 3D Soft-Tissue Prediction Methodologies for Orthognathic Surgery—A Literature Review

2019 ◽  
Vol 9 (21) ◽  
pp. 4550 ◽  
Author(s):  
Elena Carlotta Olivetti ◽  
Sara Nicotera ◽  
Federica Marcolin ◽  
Enrico Vezzetti ◽  
Jacqueline P. A. Sotong ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Literature Review ◽  
Surgical Planning ◽  
Maxillofacial Surgery ◽  
Three Dimensional ◽  
Facial Soft Tissue ◽  
Unknown Variable ◽  
Common Planning ◽  
The Face ◽  
Soft Tissue Changes

Three-dimensional technologies have had a wide diffusion in several fields of application throughout the last decades; medicine is no exception and the interest in their introduction in clinical applications has grown with the refinement of such technologies. We focus on the application of 3D methodologies in maxillofacial surgery, where they can give concrete support in surgical planning and in the prediction of involuntary facial soft-tissue changes after planned bony repositioning. The purpose of this literature review is to offer a panorama of the existing prediction methods and software with a comparison of their reliability and to propose a series of still pending issues. Various software are available for surgical planning and for the prediction of tissue displacements, but their reliability is still an unknown variable in respect of the accuracy needed by surgeons. Maxilim, Dolphin and other common planning software provide a realistic result, but with some inaccuracies in specific areas of the face; it also is not totally clear how the prediction is obtained by the software and what is the theoretical model they are based on.

scholarly journals Angular Photogrammetric Comparison of the Craniofacial Soft-tissue Profile of Three Ethnic Groups in Southern Nigeria

2020 ◽  
pp. 34-45
Author(s):  
P. D. Okoh ◽  
M. A. Amadi
Keyword(s):  
Soft Tissue ◽  
Ethnic Groups ◽  
Software Tool ◽  
Facial Soft Tissue ◽  
Microsoft Excel ◽  
Age Related ◽  
Soft Tissue Profile ◽  
Southern Nigeria ◽  
Ethnic Variations

Aim: The aim of this study was to determine the angular craniofacial soft tissue profile of adult southern Nigerian males of Igbo, Ijaw and Yoruba extractions. Methodology: The study made use of a total number of one thousand two hundred (1200) subjects divided into four hundred (400) subjects each from the Igbo, Yoruba and Ijaw ethnic groups of southern Nigeria whose ages ranged between 21 to 40 years. Determination of minimum sample size was done using the Taro-Yamane’s formula. The study employed the use of photogrammetry. Standardized photographic record of the 1200 adults were taken in the natural head position. Photographs were analysed using a software tool (WinImager). Data generated were subjected to statistical analysis using SPSS version 25.0 and Microsoft Excel 2019. Results: Results showed ethnic variations across the different ethnic groups. Age related changes were also observed. On comparison with other racial populations, marked differences were observed. Conclusion: These anthropometric values define the facial soft tissue norm of southern Nigeria and could be useful in anthropometric studies, orofacial, orthodontic and maxillofacial surgeries, and forensics.

SOFT TISSUE INJURIES OF THE FACE: EARLY AESTHETIC RECONSTRUCTION IN POLY TRAUMA PATIENTS

2021 ◽  
pp. 58-61
Author(s):  
RK Jain ◽  
Nitesh Lamoria
Keyword(s):  
Soft Tissue ◽  
Composite Structures ◽  
Wound Care ◽  
Primary Repair ◽  
Soft Tissue Injuries ◽  
Trauma Patients ◽  
Facial Soft Tissue ◽  
Study Results ◽  
The Face ◽  
Tissue Injuries

INTRODUCTION One of the most challenging and common problem faced by the plastic surgeons in polytrauma ward are Facial Soft tissue injuries, which can be completely isolated or be in combination with other injuries .The face consists of several organs and aesthetic units. The nal outcome depends on initial wound care and primary repair. So one should know the “do's and don'ts”. Disgurement following trauma, becomes a social stigma and has the gross detrimental effect on the personality and future of the victim. Therefore, such cases are most appropriately managed by Plastic Surgeons who have a thorough knowledge of applied anatomy, an aesthetic sense and meticulous atraumatic tissue handling expertise, coupled with surgical skill to repair all the composite structures simultaneously. METHOD This study is conducted in the department of Plastic and Reconstructive surgery, SMS Medical College & Hospital Jaipur India from January 2019 to December 2020. 50 patients with history of facial soft tissue injuries who were admitted in the polytrauma ward are included in the study. RESULTS Seventy-ve percent of the facial injuries were repaired primarily and the remainder were reconstructed with skin grafts or local aps from adjacent tissues. We had no post-operative infection, hematoma, ischemia, or necrosis in our patients and the patients were satised after the operation. CONCLUSION The study concludes that Primary reconstruction should be the mainstay of management and the most important responsibility of the surgeon is to convert the contaminated wound to a clean one and then to perform reconstruction.

scholarly journals The Superficial Musculoaponeurotic System of the Face: A Model Explored

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
M. Broughton ◽  
G. M. Fyfe
Keyword(s):  
Soft Tissue ◽  
Regional Differences ◽  
Current Model ◽  
The Body ◽  
Temporal Region ◽  
Superficial Musculoaponeurotic System ◽  
Proposed Model ◽  
The Face ◽  
Muscle Groups ◽  
A Current

Regional differences in the integument of the body are explained, at least in part, by differences in fascial arrangements. In the face, where the skin is more mobile due to the action of the underlying facial muscles, fascial organisation is important for support and separation of muscle groups. This study used bequeathed cadaver material to investigate a current model of the SMAS proposed by Macchi et al., the original boundaries of which were explored and extended using both histology and gross dissection. As a clearly identifiable structure spanning the lateral and midface, the SMAS in the specimen supported the model proposed by Macchi et al. The three main findings that support the model were the layered morphological appearance of the SMAS, its progression from fibrous to aponeurotic in a lateral to medial direction, and the enveloping of the zygomaticus musculature. Extension beyond the proposed model into the temporal region was observed, but nasal and forehead regions showed no evidence of SMAS, while its presence in the cervical platysma region remained inconclusive. Fascial and soft tissue variability was considerable within facial regions of the examined specimen, helping to explain the debate around the SMAS in the literature.

scholarly journals Management of Traumatic Soft Tissue Injuries of the Face

2021 ◽  
Author(s):  
Daniel Y. Cho ◽  
Brooke E. Willborg ◽  
G. Nina Lu
Keyword(s):  
Soft Tissue ◽  
Systematic Approach ◽  
Soft Tissue Injuries ◽  
Facial Soft Tissue ◽  
Initial Management ◽  
Lacrimal Apparatus ◽  
Parotid Duct ◽  
The Face ◽  
Tissue Injuries ◽  
Definitive Management

AbstractFacial soft tissue injuries encompass a broad spectrum of presentations and often present significant challenges to the craniofacial surgeon. A thorough and systematic approach to these patients is critical to ensure that the patient is stabilized, other injuries identified, and the full extent of the injuries are assessed. Initial management focuses on wound cleaning with irrigation, hemostasis, and debridement of nonviable tissue. Definitive management is dependent on the region of the face involved with special considerations for critical structures such as the globe, lacrimal apparatus, facial nerve, and parotid duct. Following sound surgical principles, these injuries can be managed to maximize both functional and aesthetic outcomes while minimizing complications.

scholarly journals Evaluation of facial soft tissue thickness in asymmetric mandibular deformities after orthognathic surgery

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Luo Huang ◽  
Zhicong Li ◽  
Jing Yan ◽  
Lunqiu Chen ◽  
Zheng-guo Piao
Keyword(s):  
Soft Tissue ◽  
Orthognathic Surgery ◽  
Class Iii ◽  
Class Iii Malocclusion ◽  
Tissue Thickness ◽  
Facial Soft Tissue ◽  
Thickness Change ◽  
Skeletal Class ◽  
Soft Tissue Thickness ◽  
The Face

Abstract Objectives The purpose of this study was to compare differences in facial soft tissue thickness in three-dimensional (3D) images before and after orthognathic surgery in patients with skeletal Class III malocclusion and to obtain a better understanding of the relationship between hard and soft tissue changes after surgery. Materials and method The present retrospective study included 31 patients with skeletal Class III malocclusion with mandibular chin deviation greater than 4 mm who had undergone cone-beam computed tomography before and 6 months after surgery. Seven bilateral points were established. Measurements were taken from software-generated multiplanar reconstructions. The predictor variables were timing (pre- and postoperatively) and side (deviated vs. nondedicated). A regression model and correlation analysis were conducted for statistical analysis. Results The difference of bilateral facial soft tissue thickness was statistically significantly different between deviated and nondeviated sides (P < 0.05), with lower values observed on the deviated side. The soft tissue thickness has become nearly symmetric at local regions of the lower thirds of the face after orthognathic surgery. However, most measurements showed a negative correlation between changes in soft tissue thickness and changes in bone tissues. Conclusions Skeletal Class III malocclusion with facial asymmetry is accompanied by differences in soft tissue thickness when comparing Dev and N-Dev sides of the posterior region of the mandible, where soft tissues are thinner on the Dev side. Soft tissue thickness can compensate for or camouflage the underlying asymmetric mandible. In addition, the asymmetric soft tissue thickness on the lower third of the face can be partially improved by orthognathic surgery, but the amount of soft tissue thickness change is not consistent with that of hard tissue positional change.

scholarly journals Evaluation of the Soft Tissue Changes after Rapid Maxillary Expansion Using a Handheld Three-Dimensional Scanner: A Prospective Study

2021 ◽  
Vol 18 (7) ◽  
pp. 3379
Author(s):  
Ali Alkhayer ◽  
Roland Becsei ◽  
László Hegedűs ◽  
László Párkányi ◽  
József Piffkó ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Prospective Study ◽  
Morphological Changes ◽  
Rapid Maxillary Expansion ◽  
Maxillary Expansion ◽  
Facial Soft Tissue ◽  
Retention Period ◽  
The Face ◽  
Tissue Changes ◽  
Soft Tissue Changes

Facial soft tissue esthetics is a priority in orthodontic treatment, and emerging of the digital technologies can offer new methods to help the orthodontist toward an esthetic outcome. This prospective study aimed to assess the soft tissue changes of the face after six months of retention following Rapid Maxillary Expansion (RME). The sample consisted of 25 patients (13 females, 12 males, mean age: 11.6 years) who presented with unilateral or bilateral posterior crossbite requiring RME, which was performed with a Hyrax expander. 3D facial images were obtained before treatment (T0) and at the end of a six-month retention period after the treatment (T1) using a structured-light 3D handheld scanner. Linear and angular measurements were performed and 3D deviation analyses were done for six morphological regions of the face. Significant changes in various areas of the nasal and the upper lip regions were observed. Based on the results of the study and within the limitations of the study, RME with a Hyrax expander results in significant morphological changes of the face after a six-month retention period.

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