Chapter 28
Rhytidectomy and Neck Rejuvenation
Rhytidectomy
1. Techniques (see Table 28.2 and Figures 28.5–28.10)
Table 28.2
Facelift Techniques
TECHNIQUE | DESCRIPTION | ADVANTAGES/DISADVANTAGES |
Subcutaneous facelift | Dissection and tightening of excess skin only | Advantages: Safe, rapid recoveryDisadvantages: Recurrence of ptosis because tightening relies on skin tension alone |
SMAS plication | Dissection in subcutaneous plane with suture plication of the SMAS over the parotid gland | Advantages: Relatively safe, long-lasting results without need for sub-SMAS dissectionDisadvantages: Potential loss of effect from suture failure |
MACS lift | Limited preauricular/pretemporal hairline incision with skin elevation and purse-string suture of lower SMAS to deep temporal fascia (extended MACS lift places a 3rd suture in the SMAS to suspend the malar fat pad) | Advantages: Similar to SMAS plication, but firmer point of fixation to deep temporal fasciaDisadvantages: Similar to SMAS plication |
Subcutaneous facelift with SMASectomy | Similar dissection as SMAS plication, but limited strip of SMAS is removed obliquely across the cheek, and the defect is closed primarily with sutures | Advantages: Allows for skin and SMAS to be moved in different vectors, more secure than plication, more rapid than sub-SMAS liftsDisadvantages: Possible nerve injury |
Deep plane facelift | Skin, fat, and SMAS are elevated in a single layer | Advantages: Long-lasting results, retaining ligaments are thoroughly releasedDisadvantages: Potential for nerve injury, more complex than supra-SMAS techniques above |
Subperiosteal facelift | Dissection of the midface in a subperiosteal plane; occasionally adds a lower lid or intraoral incision | Advantages: Deep to all critical structures, relatively short incision, no tension on skin, can combine rejuvenation of lower lid and browDisadvantages: Relatively complex procedure, limited effect on lower face/neck, and excess skin |

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