Face lift cosmetic procedure techniques

1. FACE LIFT
Dr. S.Satish Kumar

2. Introduction
• Facial aging is a panfacial phenomenon
• Changes in all layers of face including bone
• Converts inverted cone (heart shaped) of face in to rectangular shape
• Repositions the ptotic tissue
• Not a treatment for wrinkles, sun damage, creases or irregular
pigmentation
• Age for facelift – 40 +

3. ANATOMY OF FACE

4. Anatomy

5. Facial nerve
• Temporal – frontalis,
orbicularis oculi,
corrugator
• Zygomatic – orb. Oculi,
zygomaticus maj., min.
• Buccal – buccinator,
procerus, corrugator
• Marginal mandibular –
depressor labii inf,
depressor anguli oris,
mentalis
• Cervical - platysma

7. Retaining ligaments
• Zygomatic (Mc Gregor patch)
• Mandibular

11. Mid cheek
1. Palpebro-malar groove
2. Naso-jugal groove
3. Mid-cheek groove

12. Ageing Changes
1. Forehead and glabellar creases
2. Ptosis of the lateral eyebrow
3. Redundant upper eyelid skin
4. Hollowing of the upper orbit
5. Lower eyelid laxity and wrinkles
6. Lower eyelid bags
7. Deepening of the nasojugal groove and
palpebral-malar
groove

13. Ageing Changes
8. Ptosis of the malar tissues
9. Generalized skin laxity
10. Deepening of the nasolabial folds
11. Perioral wrinkles
12. Downturn of the oral commissures
13. Deepening of the labiomental creases
14. Jowls
15. Loss of neck definition and excess fat in neck
16. Platysmal bands

16. FACE LIFT

17. Pre-Op
• Uncontrolled hypertension is a C/I for Surgery
• Smoking , NSAIDs , HRT , anticoagulants - to be stopped 3 wks prior
to surgery
• Photographic documentation of face.
• Clinical assessment of facial nerve function
• Ptosis of sub-mandibular gland to be noted
• Patient counselling

18. Standard facelift incision

20. Subcutaneous facelift
• 1st facelift
• Still used today
• Basis of other facelift techniques
• Incision
• Undermining
• Redraping

21. • Only subcutaneous undermining
• Leaving 2 mm of fat in dermis
• Large random pattern skin flap
• Depends on – degree of aging change, areas of change, health and
vascularity of tissues
• Blind technique or under vision
• Cephaloposterior direction of redraping
• Cheek skin – vertical
• Neck skin – horizontal
• Tension bearing sutures – top of ear, apex of retroauricular incision

25. • Advantages
• Relatively safe
• Easy to do
• Rapid recovery
• Disadvantages
• Ineffective in heavier patients with significant ptosis of deep tissue
• Skin will stretch with time leading to a loss of effect
• Distortion of facial shape

26. Traditional Superficial Musculoaponeurotic
System Dissection
• Dual plane facelift
• Transverse incision - just below zygom. Arch
• Intersecting preauricular incision ext. over angle of mandible – along
ant. border of SCM
• Upto just beyond ant. border of parotid
• Cephaloposterior rotation
• Mobile flap to immobile SMAS along incision line
• Platysma – to tissue over mastoid
• Advantages - Minimises jowls , Highlights mandibular angle

27. Extended Superficial Musculoaponeurotic System
Dissection
• Transverse incision just above
zygomatic arch
• Same intersecting incision
• Dissection well beyond parotid gland
• Over the zygomaticus major muscle
• Same closure as traditional
• Advantage over traditional – malar
augmentation

29. Disadvantages
• More time consuming
• More chance of damage to
deep structures

30. Lateral SMAS-ectomy
• Baker
• Most frequently performed
• Resection done at the interface of mobile & fixed SMAS
• directly overlying the anterior edge of parotid gland
• Extends from angle of mandible to lateral canthus
• Mobile SMAS to immobile SMAS
• Platysma to mastoid

34. • ADVANTAGES
• No SMAS flap elevation so lesser tearing of superficial fascia &
better holding of suture fixation
• Facial nerve injury is less as majority of dissection carried over
parotid gland
• Rapid, safe, durable & with less complications
• DISADVANTAGES
• Not applicable for thin face where fat needs to be preserved

35. Platysma - SMAS Plication (PSP)
• Along same line as SMASectomy
• No removal of tissues
• Suited for thin pts
• ADVANTAGES
• Simple
• Less time consuming
• Malar augmentation
• DISADVANTAGE
• Injury to buccal branch if suture placed too deep

37. Deep plane facelift
• Composite rhytidectomy or foundation facelift
• Hamra
• Composite musculo cutaneous flap
• Dissection – deep to SMAS-platysma plane (avascular plane so less
hematoma)
• Robust flap (indicated in secondary facelift in smokers )
• Particularly effective for deep nasolabial fold & midface
• Disadvantage - facial nerve injury

39. Short scar technique
• Baker
• SMASectomy and Platysma
tightening done
• Incision only in preauricular
region
• Younger pts
• Minimal excess neck skin
• Vertical redraping of skin

40. Others
• Minimal Access Cranial Suspension Lift
• Tonnard
• Purse string sutures in SMAS and malar fat pad with vertical
suspension
• Subperiosteal facelift
• Tesier, Heinrichs and Kaidi
• Upper and middle third of face

41. NECK REJUVENATION

42. Submental dissection and Platysmaplasty
• Pts with redundant skin, excess fat , redundant platysma
• Incision just caudal to submental crease
• Subcutaneous undermining
• Defatting of platysma
• Midline plication of platysma
• Midline platysmaplasty with wedge resection

44. Full width Platysma transection
• Single most powerful way to create well
defined neck
• Divided 6cm below inf border of mandible
• Disadvantages
• Over corrected look
• Risk of hematoma high
• Induration of neck

45. Corset Platysmaplasty
• Feldman
• Medial border of platysma
• Plicated with continuous
mnofilament sutures
• Run up and down midline of neck
• Submandibular gland excision
• Ant. belly of digastric shaving

46. Secondary facelift
• Goals
• To relift the face & neck
• Remove primary facelift scars
• Preserve maximum temporal & sideburn
• Less skin resection
• Time consuming, technically demanding
• Intra op bleeding & postop hematoma – less
• Risk of nerve injury is slightly higher

47. Post Op
• Light dressings
• Rest with head end of bed elevated
• Control of blood pressure
• Cool packs to face
• Drain removal on 1st post op morning
• Suture removal in 4th-8th day
• Reasonably acceptable – 1st wk, Good with makeup – 2nd wk, Able to
attend social func – 3rd week

48. Complications
• Hematoma -most common
• 10-12 hrs post-op
• Localised & worsening pain
• Rx – evacuation (rather than giving analgesic )
• Nerve injury(facial & great auricular)
• Skin slough (retro auricular area)
• Excessive tension
• Smoking
• dehydration
• Unsatisfactory hypertrophic scars

49. Conclusion
• The worst of all outcomes is
to look operated
• Surgical disharmony
compromises the result

50. THANK YOU