The Effect of Extended SMAS Face-lift on Earlobe Ptosis and Pseudoptosis

2021 ◽  
pp. 074880682110390
Author(s):  
Allison Altman ◽  
Zachary Sin ◽  
Erik Dan Tran ◽  
Jeanie Nguyen ◽  
Arian Mowlavi
Keyword(s):  
Protective Effect ◽  
Senior Author ◽  
Face Lift ◽  
Skin Tension ◽  
Neck Lift ◽  
Clinical Observations ◽  
Superficial Musculoaponeurotic System ◽  
Cheek Flap ◽  
Fine Tune ◽  
Caudal Segment

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.

Deep Plane Facelift: An Evaluation of the High-SMAS versus Standard Incision Points

2018 ◽  
Vol 34 (06) ◽  
pp. 646-650
Author(s):  
Chiara Amodeo ◽  
Vishad Nabili ◽  
Gregory Keller ◽  
Jordan Sand
Keyword(s):  
Skin Flap ◽  
Vertical Direction ◽  
Senior Author ◽  
Entry Point ◽  
Face Lift ◽  
Vertical Movements ◽  
Plane Face ◽  
Superficial Musculoaponeurotic System ◽  
Entry Points ◽  
Tissue Movement

AbstractIn surgery of the aging face, operative adjustments of the superficial musculoaponeurotic system (SMAS) enhance facial contours. The senior author has observed that the standard deep plane face lift entry points on the SMAS do not provide as much tissue movement in a vertical direction as high-SMAS deep plane face lift entry points. In this study, tissue movement was measured comparing the conventional SMAS entry point with a high-SMAS entry point for deep plane face lifts. Institutional review board approval was obtained. Fourteen facelift patients were enrolled, 10 female and 4 male. Average age was 63.4 (50–81) years. Tissue movement at three points along the jaw line was measured intraoperatively. Standard SMAS entry point suspension resulted in average vertical movements of 6.4, 10.3, and 13.8 mm and average horizontal movements of 3.5, 5.7, and 6.5 mm. High-SMAS entry point resulted in average vertical movements of 11.8, 17.9, and 24.1 mm and average horizontal movements of 5.8, 9.8, and 9.9 mm. This resulted in a 77.3% increase (p = 0.03) in vertical movement and a 61.4% increase (p = 0.02) in horizontal movement with a high-SMAS entry compared with standard SMAS entry. The high-SMAS entry point for a deep plane facelift resulted in a significant increase in lift for both the horizontal and vertical vector on the facial skin flap when compared with the conventional entry.

Modified Superficial Musculoaponeurotic System Face-Lift: A Review of 327 Consecutive Procedures and a Patient Satisfaction Assessment

2010 ◽  
Vol 35 (2) ◽  
pp. 147-155 ◽  
Author(s):  
Manuel Francisco Castello ◽  
Davide Lazzeri ◽  
Alessandro Silvestri ◽  
Tommaso Agostini ◽  
Diego Gigliotti ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Face Lift ◽  
Superficial Musculoaponeurotic System

First Bite Syndrome Following Rhytidectomy: A Case Report

2020 ◽  
Vol 130 (1) ◽  
pp. 92-97
Author(s):  
Anne E. Gunter ◽  
Charles M. Llewellyn ◽  
Paloma B. Perez ◽  
Marc H. Hohman ◽  
Scott B. Roofe
Keyword(s):  
Parotid Gland ◽  
Expectant Management ◽  
Myoepithelial Cells ◽  
Sympathetic Chain ◽  
Face Lift ◽  
Parotid Region ◽  
Cervical Sympathetic Chain ◽  
Superficial Musculoaponeurotic System ◽  
Cervical Sympathetic ◽  
First Bite Syndrome

Background: First bite syndrome (FBS) is a known complication of parotid gland resection, parapharyngeal space dissection, and cervical sympathetic chain injury. It can be described as severe cramping or spasms in the parotid region triggered by the first bite of a meal, with the pain lessening during each subsequent bite. Although dissection for a rhytidectomy is in the vicinity of the parotid parenchyma, face-lift is not typically characterized as a procedure that can lead to FBS. Case description: A 53-year-old female underwent a deep plane face-lift to address her goals of improving jowls, nasolabial folds, and cervicomental angle. Intraoperatively, the dissection proceeded without any complications. Initially, her postoperative course was uneventful; 3 weeks after surgery, she noticed pain at the start of mastication that would improve throughout the course of a meal. She elected to proceed with observation. At 6 months after surgery, she began to experience improvement in her symptoms, and shortly thereafter had complete resolution. Discussion: First bite syndrome is a complication associated with deep lobe parotid resection, first described in 1998. The innervation of the parotid gland is complex and includes contributions from the auriculotemporal nerve, the great auricular nerve, and the cervical sympathetic chain. During rhytidectomy, dissection occurs along the parotidomasseteric fascia in order to elevate a flap of the superficial musculoaponeurotic system. Inadvertent injury to the parotid parenchyma can lead to damage to the postganglionic sympathetic fibers innervating the myoepithelial cells. Ultimately, expectant management is the mainstay of treatment and symptoms typically resolve within 6 months to 1 year. Conclusion: First bite syndrome is a complication that can be seen with a variety of facial surgeries. In the case of rhytidectomy, FBS should be considered a potential risk, as dissection into the parenchyma of the parotid gland can result in postoperative autonomic dysfunction.

Face lift, part 3: Plication of the superficial musculoaponeurotic system

1983 ◽  
Vol 6 (2) ◽  
pp. 696-701 ◽  
Author(s):  
Richard C. Webster ◽  
Richard C. Smith ◽  
Karen F. Smith
Keyword(s):  
Face Lift ◽  
Superficial Musculoaponeurotic System

scholarly journals A Cumulative Effect of Food and Viruses to Trigger Celiac Disease (CD): A Commentary on the Recent Literature

2021 ◽  
Vol 22 (4) ◽  
pp. 2027
Author(s):  
Maria Vittoria Barone ◽  
Salvatore Auricchio
Keyword(s):  
Celiac Disease ◽  
Protective Effect ◽  
Inflammatory Diseases ◽  
Cumulative Effect ◽  
Chronic Inflammatory Diseases ◽  
Clinical Observations ◽  
Effect Of Food ◽  
Gliadin Protein

Celiac disease (CD) is a type of inflammatory chronic disease caused by nutrients such as gliadin that induce a TC (T cell)-mediated response in a partially known genetical background in an environment predisposed to inflammation, including viruses and food. Various experimental and clinical observations suggest that multiple agents such as viruses and bacteria have some common, inflammatory pathways predisposing individuals to chronic inflammatory diseases including celiac disease (CD). More recently, a Western diet and lifestyle have been linked to tissue inflammation and increase in chronic inflammatory diseases. In CD, the gliadin protein itself has been shown to be able to induce inflammation. A cooperation between viruses and gliadin is present in vitro and in vivo with common mechanisms to induce inflammation. Nutrients could have also a protective effect on CD, and in fact the anti-inflammatory Mediterranean diet has a protective effect on the development of CD in children. The possible impact of these observations on clinical practice is discussed.

scholarly journals NAL Neck Artificial Ligament Lifting: Neck Rejuvenation with Polytetrafuotoethylene (PTFE) Bands

2021 ◽  
Vol 7 (1) ◽  
pp. 16-28
Author(s):  
Alessandro Gennai ◽  
Keyword(s):  
Minimally Invasive ◽  
Invasive Technique ◽  
Artificial Ligament ◽  
Face Lift ◽  
Skin Laxity ◽  
Platysma Muscle ◽  
Superficial Musculoaponeurotic System ◽  
Neck Rejuvenation ◽  
Clinical Advantage ◽  
Over Time

Background: The current surgical method allows a short recovery and minimally invasive technique with polytetrafluotoethylene (PTFE) bands application, minimal skin excision for a fallen platysma muscle and skin laxity in facelift surgery; the clinical advantage of this method is a short recovery and an anatomic less invasive dissection, ideal for also younger patients who want more and more short healing times. Methods: Retrospective analysis of a 294 cases series of patients seeking platysma and skin laxity increase of neck-face region were included in the study. All of them were primary neck-face lift performed with PTFE bands of dual mesh that are customized for suture to the platysma and anchored to the mastoid, creating a neck artificial ligament (NAL) that is buried into the muscle and tightened, without modifying the superficial musculoaponeurotic system and platysma. Result: Data collection on surgery time, implant dimension selection, and postoperative complications were included. The most frequent complications were rare and include 5 case of superficial epidermolysis (healed within 21 days) and 1 case of mild band infection (treated with antibiotics). The surgical results are still stable over time, like those of a normal facelift after 6 months. Conclusion: minimally invasive NAL application avoids a large dissection and deep modifications of the superficial musculoaponeurotic system and platysma getting a strong upward tension that lasts over time with stable results. Keywords: Cervicoplasty, Neck, Rejuvenation, Aging, Mandible, Platysma Muscle.

Rhytidectomy

2019 ◽  
pp. 207-218
Author(s):  
Malcolm D. Paul
Keyword(s):  
Facial Nerve ◽  
Clinical Examination ◽  
Skin Tension ◽  
Aging Face ◽  
Superficial Musculoaponeurotic System ◽  
Supporting Layer ◽  
Surgical Options ◽  
Selection Of

Current concepts in rejuvenating the aging face and neck have evolved from simple undermining of the skin resulting in skin tension-based closure to various techniques that utilize the superficial musculoaponeurotic system (SMAS) as a supporting layer with no tension on the skin. The evolution of techniques regarding the manipulation of the SMAS began with an understanding of the anatomy of the facial nerve and sub-SMAS anatomy. Both volume-based and vector-based corrections are required. The selection of the appropriate technique is based on the clinical examination and the surgical options that the surgeon possesses. A safely performed procedure that provides impressive rejuvenation of the aging face and neck is always the goal.

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