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A face lift is an operation in which the skin and supporting structures of the face are tightened and re-draped over the facial skeleton. There are now almost as many different types of face lifts as there are movies to see in a large multiplex cinema. These multiple options benefit the patient in the various stages of the aging process.
The face is traditionally divided into three zones. The upper face includes the forehead above the eyebrows. The mid-face includes the eyebrows, eyes, nose, cheeks and ends at the sub nasal line just beneath the nose. The lower face is the remainder, the lower cheeks, jaw line and mouth. The upper portion of the mid-face can further be divided into five equal segments: the eyes occupy two zones; one zone extends from one medial canthus (the angle formed by the meeting of the upper and lower eyelids at either side of the eye) to the other and contains the root of the nose. The last two zones encompass the area from the lateral canthi to the temple. The five zones should be of equal size for facial harmony.
There are different types of procedures, all of which fall under the umbrella of “face lift.” Several face lift techniques are used based upon each patient’s goals and their individual features.
There are various stages to the aging process as displayed in the face. The endoscopic mid-face lift and endoscopic forehead lift address the early signs of aging that emerge in the upper and middle regions of the face. The rhytidectomy (traditional face lift) addresses the later signs of aging that emerge in the neck and lower region of the face. These procedures can be performed individually or in conjunction with each other, depending on the particular facial rejuvenation needs.
It is interesting that, even today, there is no clear answer to the question, "Which face lift technique is best?" Variations of the "classic" skin flap technique, used in its basic form as early as the 1950s, still are preferred by some plastic surgeons. Technical refinements including, more recently, the option of less extensive incisions for appropriately selected patients have enhanced the results.
In the early days of face lifting, additional procedures to improve the neck were done in a separate operation at a later time, because surgeons feared compromising the blood supply to the facial skin flap. Today, a face lift and neck lift usually are performed simultaneously. Over time, surgeons learned to design their face lift incisions and suturing techniques so as to relieve the high tension that inevitably resulted from pulling and securing the tissues. The "wind tunnel" look of older-style face lifts was replaced by more natural-looking results.
Endoscopic Mid-Face Lift. The earliest signs of aging affect the mid-face region. The cheekbones start to lose their structure, cheek fat starts to droop and smile lines begin to emerge. This results in a look of sadness or tiredness.
In the mid-face the most noticeable changes occur under the eyes and around the cheeks. The deepening of the nasolabial creases (smile lines or cheek folds) and the increasing lower eyelid depression lend a saggy appearance to the face. The endoscopic mid-face lift, and its variations including vertical lift, mini lift or cheek lift, elevates sagging skin and cheek fat, thus reducing smile lines and relieving lower eyelid depression. An endoscopic face lift is the medical name for an improved plastic surgical technique that provides facial rejuvenation with minimal scars.
Endoscopic techniques were first developed for use in general surgery, gynecology and orthopedic surgery, but has found successful applications in plastic and cosmetic surgical procedures.
The endoscope is a surgical instrument, which has been used by orthopedic surgeons for many years. It allows the surgeon to "see" inside the human body because the endoscope has a tiny camera on the end of it. When the surgeon inserts the endoscope into the body, the camera displays what the camera "sees" inside of the patient on a TV screen. The endoscope was adapted to plastic surgery about ten years ago. It allows the plastic surgeon to handle the muscle and tissue much more gently than traditional surgical techniques. This allows for less bleeding, less swelling and faster healing.
Traditionally to perform a brow and face lift, the surgeon needed to make an incision from ear to ear on top of the head and incisions around the ear to the posterior neck. Endoscopic technique allows for just fewer, smaller incisions along the hairline, on the back of the ear and under the chin.
The endoscope is best suited for those individuals who have minimal to moderate skin excess and whose signs of aging are limited to loss of upper cheek fullness.
Rhytidectomy (traditional face lift). The last and most pronounced signs of aging occur in the lower face and neck. Gravity wipes joy and youth out of the face and can make a person appear older than they feel. The underlying muscles in the face and neck weaken and sag; excess fat accumulates in the neck and jowls, laugh lines (some people call this their “hound dog look”) and sagging "turkey-neck" skin form. Because excess skin must be removed to correct these particular signs of aging, the endoscopic technique is not used.
Rhytidectomy procedure, or traditional face lift, smoothes and tightens the skin of the lower face and neck, reduces jowls and tightens the underlying neck muscles.
SMAS face lift (also called deep plane). The classic face lift technique changed little until the early 1970s, when a Swedish surgeon, Tord Skoog, MD, presented and published his work. Skoog said that getting rid of excess skin was not enough, and that tightening the underlying structures of the face and neck - the so-called SMAS (superficial muscular aponeurotic system) - was the key to better and longer-lasting results. Superficial muscular aponeurotic is the anatomical term for the muscles, suspensory ligaments and support structures of the face.
In the late 1970s, some plastic surgeons began to use lipoplasty (liposuction) as a method of sculpting the area beneath the chin and jaw line as well as "spot suctioning" other areas of the face in conjunction with a face lift. Around the same time, surgeons recognized the value of repairing the muscles of the neck (platysma) to help eliminate vertical neckbands.
The SMAS-lift is the most commonly performed face lift technique today.