Dr Subhakanta Mohapatra

Mch Plastic surgery , IPGME&R & SSKM Hospital,kolkata

 Facial aging is a panfacial phenomenon

 Changes in all layers of face including bone

 It converts inverted cone (heart shaped) of

face in to rectangular shape

 Facelift reposition the ptotic tissue

 Age for facelift – in 40s

75% 15 % 10%
 Uncontrolled hypertension is a C/I for Surgery
 Smoking , NSAIDs , HRT , anticoagulants - to be
stopped 3 wks prior to surgery
 Photographic documentation of face. Pt’s youth
time photograph can be helpful.
 Clinical assessment of facial nerve function
 Ptosis of sub-mandibular gland to be noted
 Patient counselling
 Subcutaneous facelift
 SMAS plication
 MACS facelift
 Supraplatysmal plane facelift
 Lateral SMASectomy
 Deep plane facelift
 Dual plane facelift
 Subperiosteal facelift
 Temporal hair incision
 Anterior hairline incision
 Incision in the hair + a transverse extension at
the base of sideburn
 Pretragal
 Tragal edge incision
 Short scar technique(limited to retro auricular
sulcus,no occipital incision)
Short scar
incision
Incorrect submental Correct submental
incision incision
 1st facelift
 Still used today
 Basis of other facelift techniques
 Subcutaneous dissection
 Leaving 2 mm of fat in dermis
 Large random pattern skin flap
 Shifted in superolateral direction
(perpendicular to nasolabial fold , along the
line of zygomaticus major muscle)
 Normal (long axis of
lobule is 15 ° Posterior
to long axis of ear)
 Adv  Disadv

 Relatively safe  Ineffective in heavier

patients with significant
ptosis of deep tissue
 Easy to do

 Skin will stretch with time

 Rapid recovery
leading to a loss of effect

 Distortion of facial shape

 Incision - vertical temporal +/- post auricular
extension
 Vector of traction - Postero – superior
 SMAS – SMAS fixation
 SMAS is sutured directly
(no purse string fashion)
 Platysmaplasty – direct (infralobular excision)
 ADV DISADV

 Easy  Cheese wire effect

 Safe  No release of
 Autologous malar ligaments
augmentation  Limited effect in
heavy jowls
 Based on specialised suture suspension
 Suture loops placed in purse string fashion
 Anchoring point – Deep temporal fascia
(SMAS – DTF)
 Vertical vector of traction
 No dissection in neck.(Liposuction in >95%)
 Types – 1. basic
2. extended
Temporal branch of facial nerve
 ADV
 No deep plane dissection
 Less dissection – faster
recovery
 No dissection over SCM
muscle
 Reversible during surgery
 Easy to learn
DISADV
 Loss of effect if
sutures pull through
 No ligament release
 Less effective for
heavy jowls
 Relative lack of
malar
augmentation
 Resection of a portion of SMAS - at the
interface of mobile & fixed SMAS

(directly overlying the anterior edge of

parotid gland).

 Extends from tail of parotid to lateral canthus

 ADV DISADV
 No SMAS flap elevation , so
lesser tearing of superficial  Not applicable
fascia & better holding of for thin face,
suture fixation
where fat needs
 Facial nerve injury is less , as to be preserved
majority of dissection carried
over parotid gland

 Rapid,safe,durable & with less

complications
 Also known as dual plane facelift

 Subcutaneous facelift with separate SMAS

flap

 SMAS flap shifted more vertically than the

skin flap
 Adv  Disadv
 2 different vector is  More time
more effective consuming
 No skin tension
 Excellent  More chance of
mobilisation & damage to deep
advancement of structures
SMAS (ligament
release)  Thin skin flap
 Deep subcutaneous dissection immediately
superficial to SMAS & platysma
 Raising skin & superficial fat as a single layer
 SMAS layer untouched
 Adv
 Thick robust flap
 No facial nerve injury
 Disadv
 Flap is unidirectional
 Skin tension at suture line
 Formerly known as deep plane facelift
 Composite musculo cutaneous flap
 Dissection – deep to SMAS platysma plane
(avascular plane so less hematoma)
 Robust flap (so indicated in secondary facelift, in
smokers )
 Particularly effective for deep nasolabial fold &
midface
 Disadv- facial nerve injury, single vector
 For central oval of the face (forehead , periorbita , midface ,
chin )
 Most suitable plane for implant placement
 Biplanar ( subperiosteal + subcutaneous )
 Midface gets maximum benefit
 Open / endoscopic technique
 One cosmetic unit
 Forehead & upper eye lid
 Lower eye lid & mid face
 Lower face & neck
Adv Disadv
 en bloc mobilisation(no tension on  Additional
skin) equipments
 Short incision needed
 Implant placement
 Better visibility & orientation  Limited effect in
 Safe plane lower face &
 More durable neck
 More balanced & natural
rejuvenation (no windswept/
motorcyclist appearance)
 Flap along the superior border of zygomatic
arch . (unlike traditional low cheek SMAS flap
elevated below arch )

 Extending the dissection medially to mobilise

midface soft tissue

 Improves midface , upper anterior cheek

 Allows simultaneous lift of jaw line , cheek &

mid face
Corset ( Feldman platysmaplasty )
 Light dressings
 Rest with head end of bed elevated
 No neck flexion (no pillow)
 Control of blood pressure (pain, anxiety,urinary
retention)
 Cool packs to face
 Drain removal on 1st post op morning
 Suture removal in 7-9th day
 Photographic documentation of result – after 6
months of surgery.
 Hematoma –
 most common
 Localised & worsening pain
 T/t – evacuation (rather than giving analgesic )
 Nerve injury(facial & great auricular)
 Skin slough (retro auricular area)
 Unsatisfactory scars
 Alopecia
 Infection(rare)
 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
 The worst of all outcomes is to look operated

 Surgical disharmony compromises the result