| fACIAL rejuveNATIoN | oPiNioN
Figure 4 The superficial muscular aponeurotic system
particularly important for achieving
optimal rejuvenation of the neck and mid-face (Figure 4). The key technical points to be
considered in this procedure are the use of tumescent local anesthesia for both the fat harvesting and the facelifting. Between 300–500cc of tumescent solution is infused into the neck and face prior to the procedure. The patient is either awake or lightly sedated. After waiting at least 15 minutes, criss-cross liposuction is performed to contour the neck and jowls. The facelift flaps are then elevated and the SMAS suspension sutures placed. Permanent SMAS plication sutures of 2-0 ethibond or 2-0 Proline are used in a purse string fashion. The knots of these permanent sutures must be buried with 3-0 vicyril sutures. The ideal vector of pull is superior–
laterally. This inevitably leads to some redundant tissue bunching at the temporal hairline that must be dealt with by some type of temporalplasty or endoscopic browlift. Adequate skin excision is key to achieving the desired rejuvenation without looking ‘wind swept’ or over-operated. There should be no tension on the periauricular incison line closures, and the earlobe should be well supported by the flap to avoid a ‘pixie ear’ deformity. Subcuticular sutures are recommended in the preauricular skin closure. Some patients have such significant
facial atrophy that they require alloplastic implants to the chin and cheeks to get the best aesthetic results. The ‘S-Contour Lift’ will often make use of these implants. The beauty of implants is that they are permanent yet reversible improvements. Some of our best results can be achieved
Figure 5 The Soft-Contour Lift. (A) and (B) before and (C) and (D) after treatment
with the S-Contour lift in patients who did not inherit optimal bone structure. Ageing is more rapid and dramatic in
such patients; we all know that patients who age the best have great bone structure. The S-Contour lift can convert patients who were not so genetically blessed so that they too will age well and gracefully. It is a very exciting advance in facial rejuventation (Figure 5).
Conclusions There is a new concept in facelifting that patients are happily embracing. The paradigm shift in thinking follows the concept that much ageing is owing to a loss of volume that must be replaced prior
to lifting. This simple manoeuvre with either autologous fat or alloplastic implants results in less radical tightening and a more natural aesthetic result. The Soft Lift embodies this new philosophy of facelifting and its popularity reflects our patients’ satisfaction with the results. our role as cosmetic surgeons is to
return to patients that which Mother Nature gifted them, and which father Time is trying to steal away.
prime-journal.com | October 2011
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