Face and Neck Lift Article 1

Statistics on Facelifting in the US

In 1999, according to the statistics of the American Society of Plastic Surgeons, approximately 60,000 Americans had face lift surgery performed. Men constituted 10% of these facelifts.

Stigmata of Facial Aging

Typical Stigmata of Facial Aging include midface infraorbital flattening, prominent or deepening nasolabial folds, deepening of the labiomandibular fold or marionette lines, and jowling.

The History of the Modern Facelift

Otto Bames of Los Angeles in 1927 introduced the concept of the continuous periauricular and hairline incision accompanied by undermining of the cheek and neck skin and advancement of the skin flaps. Thus, the skin-only facelifts had their start. Skoog in 1974 and Mitz and Peyronie in 1976 focused attention on the role of the superficial fascia, fat, and mimetic muscles in the development of facial aging changes. Mitz and Peyronie designated the superficial musculoaponeurotic system (SMAS), which is the deeper layer below the skin and fat that is manipulated various ways in the modern facelift. Liposuction for facial and neck contouring was introduced in the mid-1980s and is a useful adjunct in facelifting techniques. More recently, fat grafting to the face has been introduced to restore volume and reduce the appearance of folds and lines.

Lip Rejuvenation

The central lip lift procedure lifts the lip through incisions underneath the nose. These incisions can be noticeable, and this procedure decreases the distance between the nose and lip. The central lip lift is only indicated in those patients with a vertically long lip. One can also perform vermilion border excisions and corner of the lip lifts, all of which leave visible scars. Fillers such as Juvederm are used more commonly today as well as CO2 laser resurfacing and dermabrasion for perioral wrinkles.

What are marionette lines and how are they treated?

These lines extend from the oral commissures vertically down toward the chin. These consistof a complex combination of overlapping muscle structures, including the orbicularis oris, the depressor anguli oris, and the depressor labii muscles, in association with a vertically oriented series of fibrous bands (marionette cutaneous ligaments) attaching the lateral aspect of the muscle to the skin. This area is difficult to fully correct with any single technique and often requires a combination of approaches.

A face lift approach with undermining of the skin and release of the marionette cutaneous ligaments will improve this area, but the distance from the point of maximum pull to the affected area or marionette line often precludes full correction or can result in early recurrence. Soft tissue augmentation with fillers, laser resurfacing, dermabrasion, and deep chemical peels work better on static rather than on dynamic lines. In rare instances, direct excision of lines can be performed.