Revision Facelift and Neck Lift

Facial rejuvenation procedures have become more commonly performed due to an increasing elderly population and greater general public acceptance. As a result, patients are now increasingly undergoing secondary and tertiary rhytidectomies to treat natural aging and/or to correct complications from prior procedures. Revision face and neck lifts are more complex by nature of the procedure and require a comprehensive preoperative assessment for enhanced outcomes. In this review, we discuss the preoperative evaluation, surgical challenges encountered, primary face and neck lift deformities, and their surgical management for patients undergoing secondary face and neck lifts.

Subcutaneous Face and Neck Lift: A Traditional Method With Definite Effects Among Asians

Background The mainstream face lifts in western countries always involve the SMAS treatment. Meanwhile, subcutaneous face and neck lift is wildly applied among Asians. Objectives To evaluate outcomes of subcutaneous face and neck lift, including patient-reported and 3D measurement outcomes, and report on details of surgical procedures. Methods Patients who received a subcutaneous face and neck lift from January 2017 to June 2019 were asked to complete FACE-Q scales, and facial information was collected by the Vectra 3D imaging system preoperatively and postoperatively. Volume changes in midface and possible displacement of facial landmarks were measured. The range of dissection and the amount of skin removed were recorded intraoperatively. Results In total, 119 patients (median age 46 years, interquartile range 40 - 53 years) received a subcutaneous face and neck lift. Among them, 88 patients completed pre- and postoperative FACE-Q scales. Patients’ satisfaction with facial subunits improved and wrinkles were significantly relieved (p＜0.001). Nineteen patients (38 midface sides) completed 3D image data collection. Postoperatively, zygomatic volume was increased, while nasolabial and lateral cheek volumes were decreased, with the volume change of 2.2 ± 1.3 mL. Mouth, nose, and eye displacements were negligible postoperatively. The widths of skin removed at the middle temporal, front of the sideburns, upper helix, earlobe, and retro-auricular were 13.8±1.9 mm, 19.6±3.1 mm, 27.6±3.9 mm, 16.4±3.9 mm, and 32.2±4.0 mm, respectively. Conclusions Our subcutaneous face and neck lift was effective in relieving nasolabial sagging, improving wrinkles, and achieving facial rejuvenation.

Facelift Part II: Surgical Techniques and Complications

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.

The “Segmental SMAS Model”: A Didactic Concept of Face and Neck Lift Anatomy

Profound understanding of the surgical anatomy of the face and neck is the key to successful face lift surgery. The “Segmental SMAS Model” presented herein is the result of a decade-long effort in teaching fellows a logical and coherent anatomic model of face lift anatomy. The superficial musculo-aponeurotic system (SMAS) consists of segments with distinct surgical characteristics. These are determined by the presence of a deep gliding plane and/or adhesion through fibrous insertions. In this article, we define SMAS segments that are profoundly heterogeneous in their behavior and have surgical implications on the maneuvers required for a deep plane face lift. The present model introduces several novel interpretations of the surgical anatomy of the face and neck lift procedure and hopes to convey a better understanding of face lift anatomy to training surgeons.

Face and Neck Lift—Postoperative Care

Primary aim of the article is a discussion of the postoperative care after face and neck lift. A brief history of face and neck lift along with different techniques are described. Importance of preoperative assessment is stressed.