Chapter-44-Lamellar High SMAS Face-Lift

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Chapter 44 Lamellar High SMAS Face-Lift

FIG 10  • A. AP view. On the left, preoperative view of patient, age 60. Atrophy in the infraorbital, perioral, and upper midface regions is evident. Loss of attractive facial contour due to deep tissue ptosis can be seen in the cheek, jowl and perioral regions. On the right, the same patient, 14 months after high SMAS face-lift, neck lift, closed foreheadplasty, conservative upper and lower blepharoplasty and partial facial fat injections. Fat injections have provided filling of the infra-orbital and per-oral areas. Note restoration of youthful facial shape without a tight or pulled appearance. B. AP smiling view. On the left, preoperative view of patient, age 60. On the right, the same patient, 14 months after high SMAS face-lift, neck lift, closed foreheadplasty, conservative upper and lower blepharoplasty, and partial facial fat injections. Note natural contour is present, even in animation. C. Oblique view. On the left, preopera- tive view of patient age 60. Note lateral brow ptosis, mid-face ptosis and loss of youthful malar, perioral and mandibular contour. On the right, the same patient, 14 months after high SMAS face-lift, neck lift, closed foreheadplasty, conservative upper and lower blepharoplasty and partial facial fat injections. Note improved brow position, restoration of cheek fullness, improved transition from lower lid to cheek, elevation of ptotic perioral tissue, smooth jawline and improved submental contour. D. Lateral view. On the left, preoperative view of patient age 60. Note malar flattening, perioral laxity, ptotic jowl and cervicosubmental laxity. A prominent submandibular gland can also be seen. On the right, the same patient, 14 months after high SMAS face-lift, neck lift, closed foreheadplasty, conservative upper and lower blepharoplasty and partial facial fat injections. The protruding portion of the submandibular gland has also been excised. Note the restoration of cheek fullness, elevation of ptotic perioral tissue, smooth jawline and improved cervicosubmental contour. The face has a natural appearance, and all scars are well concealed (Courtesy of T. J. Marten, MD, FACS).

REFERENCES 1. McKinney P, Katrana DJ. Prevention of injury to the great auricular nerve during rhytidectomy. Plast Reconstr Surg 1980;66:675-679. 2. Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg 1989;83:11. 3. Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg 1992;89:441-449. 4. Marten TJ. Face lift planning and technique. Clin Plast Surg 1997;24: 269-308. 5. Marten TJ. Lamellar high SMAS face and midface lift. In: Nahai F, ed. The Art of Aesthetic Surgery . St. Louis, MO: Quality Medical Publishing; 2005:1110-1192.

Most hematomas will occur in the first 12 hours postopera- tively so close monitoring in the recovery and over the first evening is critical. This includes proper management of pain, anxiety, blood pressure, and nausea. ■■ A less common complication is skin slough which is most commonly the result of tension. Skin slough resulting from underlying circulatory problems includes smoking, acne scarring, and diabetes. ■■ One of the most devastating complications after a face-lift is facial nerve injury. Fortunately, the incidence is less than 1%. The facial nerve branches most at risk include the buc- cal, frontal, and marginal mandibular.