Facial Aging Surgery: Healing Time, Duration Over the Years, and the Right Time to Perform a Facelift

Background The "time variable" assumes paramount importance, especially regarding facial rejuvenation procedures. Questions regarding the length of recovery time before returning to work, how long the results will last and the ideal time (age) to undergo this particular type of surgery, are the most commonly asked by patients during the initial consultation. Objectives this article will endeavor to determine the healing time, the optimal age to perform the surgery and the duration of the results after cosmetic face surgery. Methods A 35-year observational study of 9313 patients who underwent facial surgeries was analyzed. The principal facial rejuvenation interventions were divided into two subgroups: on the one hand, eyelid and periorbital surgery, including eyebrow lift, blepharoplasty and its variants and midface lift; on the other hand, face and neck lift. Significant follow-ups were conducted after 5, 10 and 20 years. In order to evaluate the course of convalescence, the degree of satisfaction with the intervention and the stability of the results, a questionnaire survey was administered to a sample of 200 patients who underwent face and neck lifts. Results The answers given indicated that surgery performed according to rigorous standards allowed for a relatively rapid recovery and the positive results were stable up to 10 years after surgery. The level of patient satisfaction also remained high even after 20 years. Conclusions The right “time” for a facelift, taking into account age, recovery time and the longevity of the results, is an important consideration for both the patient and the cosmetic surgeon.

The Selection of Facelift Approach on the Basis of Midfacial Ptosis

Facial aging in the midface has been described to encompass both soft tissue descent and volumetric change. Currently, there is no established and widely accepted grading system for midfacial ptosis. We propose a simplified grading system for midfacial ptosis ranging from mild to severe in terms of Grades I through III. Using this classification system, we describe an algorithm to help select the facelift approach most appropriate for each patient. The sub-superficial musculoaponeurotic system rhytidectomy, deep plane rhytidectomy, and subperiosteal midface lift techniques are described in detail. The nuances of the selection process also include a discussion on the various approaches to the orbital fat, namely a transconjunctival lower lid blepharoplasty with skin pinch versus a lower lid blepharoplasty with fat transposition, as well as the aging neck. Furthermore, we integrate the addition of postoperative adjunctive procedures which include injectables, chemical peels, and dermabrasion to address facial rejuvenation from not only a gravitational aspect but also the volumetric and textural components.

Repair of Lower Eyelid Cicatricial Entropion With Midface Lift, Spacer Graft, and Drill-Hole Canthoplasty

Postoperative cicatricial lower lid retraction is a challenging surgical problem that often disfigures the shape of the eye and has functional consequences. Depending on the severity, more than one surgical procedure may be needed to achieve the desired lower lid shape and position given the recurrent nature of scarring. Concepts of scar release, establishing lower lid vertical height, soft tissue replacement, and midcheek support are discussed in this video.

Distribution of the Laterally Supplying Facial Nerve to the Orbicularis Oculi Muscle

Background The facial nerve that traverses the lateral border of the orbicularis oculi muscle is considered the primary motor for the muscle. Nevertheless, the lateral motor supply to the orbicularis oculi muscle has not yet been fully described. Objectives The aim of this study was to report detailed anatomic information about the lateral motor supply route to the orbicularis oculi. Methods Facial nerve branches that cross the lateral orbicularis oculi border were fully traced from the parotid border to the nerve destinations in 43 fresh hemifaces by microscopic surgical dissection and time-lapse photography. Results Through the lateral route, the anterior temporal and upper zygomatic branches supply the superior orbital and superior preseptal orbicularis oculi of the upper eyelid, as well as the lateral pretarsal and malar orbicularis oculi, excluding the upper medial pretarsal portion of the upper eyelid and most of the lower eyelid. The nerve supplying the lateral pretarsal orbicularis oculi muscle crosses the anterior area of the zygomatic arch. It then traverses an area 6 mm above and 4 mm below the lateral canthal crease. Conclusions The anterior area of the zygomatic arch and an area 6 mm above and 4 mm below the lateral canthal crease are the facial nerve danger zones. The present anatomic findings provide surgeons with further insights for performing blepharoplasty, midface lift, facelift, and facial nerve reconstructive surgery.