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Face Lift

Face Lift

Face Lift also written as facelift, is known medically as rhytidectomy. This is one of an important cosmetic surgery or procedure. It is about removal of excess facial skin and wrinkle with it, which brings about a younger rejuvenated looking face. Take an example of a temporal incision to expose the glistening deep temporal fascia for a mid-face lift. The plane is dissected by blunt dissection all the way down to the orbital rim where it is connected with the sub-periosteal fascia, and further through the sub labial incision assisted with incision through the lower eyelid.

There are many surgical techniques employed to remove the excess skin with or sometime without the tightening of underlying tissues. There are frequently combined with other surgery such as upper blepharoplasty and eye bag removal to further enhance the result. A top up of non-surgical face lift by using the thread, filler, anti-wrinkle, PRP rejuvenation or even a Vampire lift, of the part not covered by the full face lift, such as the forehead may be done together. This is one of our clinic hot selling service.

 

 

BEFORE Face Lift_ Prominent Naso-labial & Marionette Folds, Droopy Brow.

BEFORE Face Lift_ Prominent Naso-labial & Marionette Folds, Droopy Brow.

AFTER Face Lift_ Disappeared Naso-labial & Marionette Folds, Double Eyelid Thicker Towards the Side..

AFTER Face Lift_ Disappeared Naso-labial & Marionette Folds, Double Eyelid Thicker Towards the Side..

BEFORE Face Lift Left Oblique_ Prominant Naso-labial & Marionette Folds, Double Eyelid Thinner Towards the Side..

BEFORE Face Lift Left Oblique_ Prominant Naso-labial & Marionette Folds, Double Eyelid Thinner Towards the Side..

AFTER Face Lift Left Oblique_ Disappeared Naso-labial & Marionette Folds, Double Eyelid Thicker Towards the Side..

AFTER Face Lift Left Oblique_ Disappeared Naso-labial & Marionette Folds, Double Eyelid Thicker Towards the Side..

BEFORE Face Lift Right Oblique_ Prominant Naso-labial & Marionette Folds, Double Eyelid Thinner Towards the Side..

BEFORE Face Lift Right Oblique_ Prominant Naso-labial & Marionette Folds, Double Eyelid Thinner Towards the Side..

AFTER Face Lift Right Oblique_ Disappearing Naso-labial & Marionette Folds, Double Eyelid Thicker Towards the Side..

AFTER Face Lift Right Oblique_ Disappearing Naso-labial & Marionette Folds, Double Eyelid Thicker Towards the Side..

Development of Face Lift

Cutaneous period (1900-1070)

During the early 20th century, it was mostly lifting of the skin of the face. An elliptical shaped skin in-front of the ear is removed, skin pulled up and fixed. This is a very save procedure with short downtime. The only drawback is that it is not so lasting, for a year only.

SMAS period (1970-1980)

Sub-facial dissection to free up the skin, superficial facia and muscle, mobilization, fixation and trimming. SMAS stand for Superficial Musculo-Aponeurotic System is the complex that is mobilized, fixed and trimmed for rejuvenation. The technique is less technically demanding, safe, minimal complication is seen. This becomes the gold standard of face lift.

Deep plane period (1980-1991)

Here, dissection goes deeper until it reached the sub-periostel tissue around the superior and lateral orbital rims allowing correction and elevation of soft tissue around the eye for better result. The objective is to lift up soft tissue and fixed to a higher location for a youthful rejuvenation.

Volumetric period (1991-today)

Here, the surgeon have a change of concept of aging facial skin. They realized that aging is brought about by the loss of volume within the facial tissue. Therefore, it is best to restore back the volume rather than doing extensive incision for skin tightening. The trend going forward is to use own body tissue such as the fat as a natural filler to replace the lost volume due to aging face.

 

 

Face Lift: Increased distance from the ciliary margin to the inferior-most point of the orbicularis oculi muscle (caused by decreasing tone of the orbicularis oculi muscle)

Face Lift: Increased distance from the ciliary margin to the inferior-most point of the orbicularis oculi muscle (caused by decreasing tone of the orbicularis oculi muscle)

 

Indication of face lift

 

  • An increased redundancy of the nasolabial fold (culprit is chiefly caused by a descent of cheek’s fat)
  • Increased distance from the ciliary margin to the inferior-most point of the orbicularis oculi muscle (caused by decreasing tone of the orbicularis oculi muscle)
  • Jowl (a broken jaw line is due to the ptosis of the platysma muscle)
  • The intended effect of a face lift

 

Thus 3 structures causes the aging face:

  • Platysma
  • Cheek fat
  • Orbicularis oculi

Therefore 3 landmark features of aging face:

  • Appearing jowl line ( broken jaw line is due to lax platysma)
  • Naso-labial fold (by cheek fat descent)
  • Increased distance from the ciliary margin to the inferior-most point of orbicularis oculi ( lost tone of orbicularis oculi)
  • 4th is the skin

 

Facial nerves

The facial nerve is the major motor nerve that innervate the facial muscles from the deep surface of the muscle. Hence, there is little chance to damage it. Hence, the dissection of the deep plane can be done very safely. This is except for muscle that lie deeper to the plane of the facial nerve, the mental nerve, levator anguli oris & the buccinator). The nerve ending medially becomes more superficial as we dissect towards the mid-line. Hence, the dissection towards the side, meaning nearer to the ear is the beginning point of the surgery. Then, it proceed toward the naso labial fold without risk of damaging the facial nerve.

Greater auricular nerve is the only major sensory nerve. Be careful for injury during elevation over the sternocleidomastoid muscle, as the terminal branches pass superficially to the earlobe.

Retaining ligaments of the face

The main function is to provide anchorage of surface structure to the bone beneath.

4 retaining ligaments to remember:

  • Platysma-cutaneous ligament & platysma-auricular ligament are basically an aponeurotic condensation which connect platysma to the skin dermis.
  • Osteocutaneous ligaments
  • Zygomatic ligament
  • Mandibular ligament

The last 3 are the most important. At the one end is attached to the skin, the other end to the bone. All these ligaments must be mobilized, freed and released to get a fully mobile tissue to be fixed at a higher position.

 

Types Face Lift Procedures

  • SMAS lift
  • Deep plane face lift
  • Composite face lift
  • Mid face lift
  • Mini face lift
  • Thread lift
  • Sub-periosteal lift
  • Skin-only face lift
  • MACS face lift

 

SMAS face lift

For a traditional face lift, incision is given in front of the ear, extending upward towards the hairline, down and backward around the ear and end into the hairline on the back of the neck. The skin is dissected from the deeper tissue using scissor by blunt dissection into the cheek and the neck. The deeper SMAS layer can be tightened by plication without removing excess tissues. After mobilization, the skin is re-positioned and fixed. Modification of this lead to Deep lane face lift.

 

 

 

Face Lift: The technique of a SMAS face lift, consisting of first mobilization, repositioning and finally fixation. SMAS is better for re-positioning the platysma.

Face Lift: The technique of a SMAS face lift, consisting of first mobilization, re-positioning and finally fixation. SMAS is better for re-positioning the platysma.

 

The technique of a SMAS face lift, consisting of first mobilization, re-positioning and finally fixation. SMAS is better for positioning the platysma.

 

 

Deep plane face lift

This is quite like SMAS, except that it goes deeper by freeing cheek fat and muscles from the cheek bone attachment, re-positioned and fixed.

Composite face lift

This is quite like the deep plane face lift. The difference is that there is extra re-positioning of orbicularis oculi here. The malar crescent or the tear trough is due to the orbicularis oculi droop.

Mid face lift

The mid face area between the 2 cheeks, flattens and makes a lady look more masculine. This face lift is suitable with people without neck droop or jowing.  Ideal candidate is in the 40s. Several incisions are make along the hairline and inside the mouth. The fatty tissue layer can be lifted and re-positioned. Recovery time is short, usually is combined with eyelid surgery.

Mini face lift

This is least invasive, and is similar to full face lift. This is also called S-lift due to the shape of the incision. The incision is make along the hairline around the ear. The soft tissue is mobilized, re-positioned and fixed.

 

 

Face Lift: Blue represent the incision in the skin only face lift. Green represent the S-lift. Red is the extensive undermining done in several face lift techniques.

Face Lift: Blue represent the incision in the skin only face lift. Green represent the S-lift. Red is the extensive undermining done in several face lift techniques.

 

Blue represent the incision in the skin only face lift. Green represent the S-lift. Red is the extensive undermining done in several face lift techniques.

Thread lift

Also called the feather lift is used for people seeking minor improvement to sagging face skin. The pull is dependent on the barbed hook that pulls on the skin. The thread can non-dissolvable or dissolvable.

Sub-periosteal face lift

This is done by mobilizing the soft tissue from the bone, re-positioned and fixed for a pleasing result.

Skin-only face lift

Here, only the skin is lifted from beneath structure like the SMAS and beyond. It is mobilized, repositioned, and fixed. The drawback is that it last only a short time of a year.

MACS lift

Minimal Access Cranial Suspension lift allow elevation of soft tissue vertically and suspension from above through minimal small scar. The advantage over traditional face lift is that it is very natural than a “windswept” look of full face lift. It has very short downtime and no risk of complication.