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'Facelift Anatomy' (823)


Feb
2018

Patients with thick skin typically present with a redundant, baggy, lax skin envelope together with prominent nasolabial folds, jowls, and a heavy neck. Durable and natural-appearing rejuvenation is not possible unless the deformities are addressed adequately and harmoniously in these patients. Traditional superficial musculoaponeurotic system techniques do not include surgical release of the zygomatic cutaneous ligaments and repositioning of descendent malar fat pad, and may lead to an unbalanced, unnatural appearance and the lateral sweep phenomenon.

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Jan
2018

In the malar region, the SMAS flap can be thin and tear easily, making it difficult to securely fix it. And the surgical anatomy of the region may be unclear and confusing. The authors performed an anatomical study on the location of the lateral margin of the orbicularis oculi muscle (OOM) and the origin of the zygomaticus major muscle (ZMM) when using a high-SMAS facelift with finger-assisted spaces dissection technique, which included elevation of the SMAS flap with OOM.

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Feb
2018

In previous papers, we demonstrated that the treatment of human photoaged skin with stromal-vascular fraction-enriched fat or expanded adipose-derived stem cells showed a decrease of elastosis and the appearance of new oxytalan elastic fibers in dermis and an increase in the vascular network. The utilization of fat plus platelet-rich plasma (PRP) led to an increase in the vascular permeability and reactivity of the nervous component.
The purpose of this study was to analyze the histologic and ultrastructural changes of human skin after the injection of only PRP in the retroauricular area that was not exposed to sun and did not present the photoaging process, in comparison with our previous results.

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Oct
2017

[Clinical analysis before surgery in facial and neck rejuvenation].

Ann Chir Plast Esthet 2017 Oct 27;62(5):375-386. Epub 2017 Sep 27.
M Rouif, P Bogaert
The first step to determine a medical or surgical intervention is the clinical exam. The clinical exam is the paramount step to provide a treatment plan that can be modified and individualized accounting the patient preferences. During the consultation for facial rejuvenation, attention should be paid to understand the patient's motivation and expectations.

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Oct
2017

This second article of a three-part series addresses techniques and recommendations for aesthetic treatment of the midface. Injectable fillers are important for rejuvenation of the midface by replacing lost volume and providing structural support; neuromodulators play a smaller role in this facial region. Fillers are used for volumization and contouring of the midface regions, including the upper cheek and lid-cheek junction and the submalar and preauricular areas.

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Nov
2017

In rhinoplasty patients radix position profoundly impacts the appearance of the nasal profile by influencing dorsal length, contour, angulation, and height. The authors wanted to introduce a new perspective to radix, and decided to focus on subcutaneous tissues, especially procerus muscle. Actually resection of procerus and corrugator supercilii is a part of browlift and endoscopic facelift techniques, with which the authors are already familiar.

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Sep
2017

Anatomical study has proven vital to the understanding and improvement of rejuvenation techniques of the face and neck. The microscopic septa responsible for individual facial fat compartments are also present in the neck. The authors' anatomical studies of the neck, including supraplatysmal and subplatysmal elements, have influenced their surgical and nonsurgical techniques.

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Oct
2017

[Facelift under local anesthaesia in outpatient surgery].

Ann Chir Plast Esthet 2017 Oct 4;62(5):567-574. Epub 2017 Aug 4.
G Vitale, S Piereschi
Facelift under local anesthesia: the author recounts his experience and methodology developed to operate facelift under local anesthesia in order to reduce operative morbidity and be able to operate persons who do not desire general anesthesia. The technique is based on the knowledge of the sensitive anatomy of the face as well as the practice of sensitive conduction blocks at the level of the face allowing to decrease the doses of local anesthetics.

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Nov
2017

A histological evaluation of peeling-induced skin changes in subcutaneous undermined preauricular facial skin flaps of nine patients was performed. There were three treatment groups: Trichloroacetic acid (TCA) 25%, TCA 40% and phenol/croton oil; one group served as control. Two independent evaluators determined the epidermal and dermal thickness and the depth of necrosis (micrometre).

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Jul
2017

Periauricular paresthesia may afflict patients for a significant amount of time after facelift surgery. When performing face and neck lift surgery, temple and posterior auricular flap dissection is undertaken directly over the auriculotemporal, great auricular, and lesser occipital nerve territory, leading to potential damage to the nerve. The auriculotemporal nerve remains under the thin outer superficial fascia just below the subfollicular level in the prehelical area.

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Oct
2017

Masseter-to-facial nerve transfer is a highly efficient technique for reanimating paralyzed muscle and has been reported to restore facial symmetry at rest. However, no systematic studies have been performed, and the effects of preoperative droop of the oral commissure on postoperative symmetry at rest have rarely been reported.
The authors retrospectively analyzed 35 patients with masseteric-to-facial nerve anastomosis and assessed the quality and quantity of the dynamic recovery and the oral commissure symmetry at rest.

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Jun
2017

Surgical Anatomy for Facelift.

Facial Plast Surg 2017 Jun 1;33(3):250-251. Epub 2017 Jun 1.
Rami K Batniji

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Jun
2017

Anatomical knowledge of the facial vasculature is crucial for successful plastic, reconstructive, and minimally invasive procedures of the face. Whereas the majority of previous investigations focused on facial arteries, the precise course, variability, and relationship with adjacent structures of the facial vein have been widely neglected.
Seventy-two fresh frozen human cephalic cadavers (32 male and 40 female cadavers; mean age, 75.

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Aug
2017

Cumulative long-term exposure to solar ultraviolet radiation promotes premature skin aging characterized by wrinkle formation and reduced skin elasticity. In this study, we assessed whether microfat transfer could improve dermal and subcutaneous tissue thickness loss associated with photoaging. Twenty-one patients affected by facial photoaging (photodamage grade II-IV; age range 35-62 years; 19 females, 2 males; all of Caucasian origin) were treated using minimally invasive autologous dermal white fat transfer harvested with a recently designed microcannula.

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May
2017

The mylohyoid (MH) musculature separates the sublingual and submandibular spaces and is, therefore, important with regard to the spread of infection and space occupying lesions. Moreover, the MH may be elevated and included in the myocutaneous submental island flap or sutured in conjunction with the platysmas and the anterior bellies of the digastric muscles (ABDMs) to add stability to submental muscular medialization procedures. Therefore, variation in the anatomy of the MH musculature must be considered in the management of the spread of infection and space occupying lesions as well as in surgical planning.

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Oct
2017

With the evolution of facial rejuvenation methods, thread lifts have gained popularity among patients who seek cosmetic improvement. Absorbable wedge-shaped polydioxanone (PDO) sutures are currently available, and they are extremely popular in the aesthetic clinics in Korea. In case of midface and mandibular jowl lift, threads are most often inserted in an oblique manner with vectors of rejuvenation directed toward the temple.

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Sep
2017

Wound healing influences both the cosmetic and functional outcomes of facial surgery. Study of cutaneous innervation may afford insight into patients' preoperative wound healing potential and aid in their selection of appropriate surgical procedures.
To present the quantitative and qualitative differences of epidermal nerve fibers (ENFs), neurotransmitters, vasculature, and mast cells in facial skin among patients after primary and revision rhytidectomies.

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Dec
1969

The superficial facial fascia comprises the superficial musculoaponeurotic system (SMAS) and the temporoparietal fascia (TPF) and is regarded as a continuous monolayer. However, some evidence indicates that the superficial facial fascia consists of 2 layers in specific areas.
The authors evaluated the superficial facial fascia for bilayered regions.

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Dec
1969

Knowledge of variable anatomy is key for excellent outcomes from the administration of botulinum toxin for aesthetic purposes. One must understand the location and function of each facial muscle to predict the patient's desired outcome. One concept often overlooked by injectors is the understanding of the target muscle's depth.

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Dec
1969

The cervical retaining ligaments anchor the platysma and soft tissues of the neck to the deep cervical fascia and deeper skeletal structures. The cervical retaining ligaments tether the platysma and prohibit free mobilization and redraping of the platysma muscle in rhytidectomy. This ligament system has previously been described in the literature only qualitatively.

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Feb
2017

Current literature suggests that preserving the lobular branch of the great auricular nerve has greater impact on sensory function of the auricle than preservation of the posterior branch during rhytidectomy. However, no methodology exists to efficiently and accurately determine the topographic location of the lobular branch. This study describes the branching characteristics of the lobular branch and algorithmic surface markings to assist surgeons in preservation of the great auricular nerve during rhytidectomy flap elevation.

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Dec
1969

This study evaluated the feasibility of non-magnified resection of various benign lesions of the upper neck using the facelift incision without endoscopic equipment to establish indications for the procedure.
This retrospective analysis examined 86 patients who underwent surgery for upper neck masses using the facelift incision or conventional transcervical incision at our institute between January 2012 and December 2015.
We performed 41 operations using facelift incisions (facelift group) and 45 using conventional horizontal incisions (conventional group).

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Mar
2017

The anterior belly of the digastric muscle (ABDM) is important in numerous esthetic surgeries including rhytidectomy, alteration of the cervicomental angle via partial resection of the ABDM muscle belly, and suprahyoid muscular medialization and suspension. Recently, the connection between the ABDM and the mylohyoid muscle (MH) has been proposed as important for the mechanism of the digastric corset procedure. This report refers to the connection between the ABDM and the MH as a type of retaining ligament of the anterior digastric muscle (RLAD).

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Jan
2017

Evidence-Based Medicine: Face Lift.

Plast Reconstr Surg 2017 Jan;139(1):151e-167e
Brian M Derby, Mark A Codner
After studying this article, the participants should be able to: 1. Describe pertinent surgical anatomy relevant to safe and effective face-lifting techniques. 2.

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Jan
2017

Median facial dysplasia is a distinct development anomaly of the craniofacial region that is characterized by deficient mid facial structures. Medial femoral condyle free flap could be used as a bony flap, and the unique characteristics of this flap provide the surgeons with the periosteal component as well. In this work, the authors present our experience with a patient of median facial dysplasia with unilateral cleft lip, cleft palate, and premaxillary deficiency.

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Feb
2017

Treating Scars in the Auricle Region.

Facial Plast Surg Clin North Am 2017 Feb;25(1):73-81
Deborah Watson, Bharat Panuganti
This article provides a review of the surgical and nonsurgical options available to manage a variety of auricular scars. The basics of wound healing are discussed in addition to the etiology of keloids and the cauliflower ear. Many auricular scars can be revised with scar excision techniques, but separate discussions for the treatment of keloids and the cauliflower ear are provided.

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Dec
2016

Botulinum toxin type A (BTA) has been approved for the treatment of strabismus, blepharospasm, muscle spasm, cervical dystonia, pain syndrome, glabella wrinkles, and severe primary axillary hyperhidrosis. Intradermal injection of BTA has been used off-label by many clinicians for the purpose of face-lifting effect. Few studies on onabotulinumtoxinA (ONA) demonstrated no clinical efficacy on face-lifting effect when comparing to normal saline solution (NSS).

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Oct
2016

One of the most impressive soft tissue injuries is the facial degloving, normally associated with industrial machines and traffic accidents. This injury is characterized by the separation of the skin and cartilage from the bones, compromising the soft tissues correlated in the trauma area, nerves, and blood vessels. A 28-year-old patient, male, was referred to Araçatuba's Santa Casa Hospital, after a motorcycle accident, hitting his face on the sidewalk.

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Jan
2017

Owing to its potentially greater mechanical force on the implanted tissue, barbed thread is frequently used in face-lifting procedures. However, the long-term durability thereof remains controversial. Moreover, reports on underlying histologic and molecular changes resulting from face-lifting procedures are scarce.

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Dec
2016

The purpose of this study is to establish a relationship between the skin lines on the upper third of the face in cadavers, which represent the muscle activity in life and the skin lines achieved by voluntary contraction of the forehead, glabellar, and orbital muscles in patients.
Anatomical dissection of fresh cadavers was performed in 20 fresh cadavers, 11 females and 9 males, with ages ranging from 53 to 77 years. Subcutaneous dissection identified the muscle shape and the continuity of the fibers of the eyebrow elevator and depress muscles.

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Oct
2016

Augmenting the Prejowl: Deciding between Fat, Fillers, and Implants.

Facial Plast Surg 2016 Oct 28;32(5):513-9. Epub 2016 Sep 28.
Fred G Fedok, Harry Mittelman
The prejowl sulcus is a complex anatomic structure that results from several age-related changes in the lower face. These changes include the localized atrophy of a segment of the mandible inferior to the mental foreman, fat atrophy, and dehiscence and laxity of the ligamentous and muscular components of the region. The correction of the prejowl sulcus is rarely accomplished through rhytidectomy alone.

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Jan
2017

Platysma bands are one of the first signs of aging of the neck. Current theories suggest that these bands develop because of skin sagging followed by loss of muscle tone. Treatment strategies therefore aim to tighten skin and muscle.

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Sep
2016

The Endoscopic Brow Lift.

Atlas Oral Maxillofac Surg Clin North Am 2016 Sep 5;24(2):165-73. Epub 2016 Jul 5.
Jon D Perenack

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Sep
2016

Open Brow Lift Surgery for Facial Rejuvenation.

Atlas Oral Maxillofac Surg Clin North Am 2016 Sep 16;24(2):161-4. Epub 2016 Jun 16.
Tirbod Fattahi

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Sep
2016

Upper Eyelid Blepharoplasty.

Atlas Oral Maxillofac Surg Clin North Am 2016 Sep;24(2):125-33
Michael J Will

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Aug
2016

A huge number of procedures for forehead and brow rejuvenation have been described. Nevertheless, the surgical approach of brow aesthetics in terms of correction of brow fullness and symmetry has not been systematically evaluated in the literature. We recently proposed a 20-degree beveled brow incision technique for direct brow lifting.

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Jul
2016

The anterior belly of the digastric muscle (ABDM) is important in a variety of surgeries including submental lipectomy, rhytidectomy, alteration of the cervicomental angle via muscle resection, the "digastric corset" procedure for submental rejuvenation, the submental artery flap, and reanimation of the mouth after facial nerve palsy. Despite its clinical significance, little information exists regarding the morphometrics of the ABDM or its associated intermediate tendon. This study analyzed a total of 35 intact ABDMs and 43 intact intermediate tendons from 23 cadavers.

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Jul
2016

Most patients requesting aesthetic rejuvenation treatment expect to look healthier and younger. Some scales for ageing assessment have been proposed, but none is focused on patient age prediction. The aim of this study was to develop and validate a new facial rating scale assessing facial ageing sign severity.

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Jun
2016

For reconstruction of intraoral and lower face defects, it is important to use flaps that prevent reliable and pliable soft tissue and it is possible to use aesthetically most compatible with recipient site. In this study, the authors aimed to present their clinical experiences and results of lower face and intraoral defects reconstructions with submental artery island perforator flap without including the digastric muscle to have a thinner and useful flap.
Six patients with lower face and intraoral defects that were reconstructed using the submental artery island flap between November 2013 and February 2015 were retrospectively analyzed.

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Jul
2016

[Cosmetic Eyelid Surgery].

Klin Monbl Augenheilkd 2016 Jul 20;233(7):869-87. Epub 2016 May 20.
R Thiesmann, K-H Emmerich, H-W Meyer-Rüsenberg

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May
2016

A novel device using micro-focused ultrasound with high-resolution ultrasound visualization (MFU-V) produces non-invasive lifting and tightening of lax skin on the face and neck when treatment is delivered at a single focal depth (Ulthera® System; Ulthera, Inc., Mesa, AZ).

The following study was performed to test the hypothesis that customized application of MFU-V at two focal depths will produce clinical results that are superior to treatment at a single focal depth.

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Aug
2016

The aim of this study is to compare the superficial fascia (SF) in the cheek and parotid areas histologically and through MRI.
An in vitro study included a histological report and an MRI of the cheek of two Korean adult cadavers. The in vivo study included 100 MRI images and three axial image cuts (mandibular condyle, notch, and half the distance between the top of the condyle and the angle).

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May
2016

After reading this article and watching the accompanying videos, the participant should be able to: 1. Assess patients seeking facial volumization and correlate volume deficiencies anatomically. 2.

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May
2016

Lower Eyelid Blepharoplasty.

Facial Plast Surg Clin North Am 2016 May;24(2):129-38
Gregory H Branham
The goal of lower eyelid blepharoplasty is to rejuvenate the lower lid while maintaining a natural, unoperated appearance. Successful lower eyelid blepharoplasty depends on knowledge of the anatomy and surgical techniques, accurate preoperative analysis, and attention to detail. Common issues of the lower eyelid such as malar descent, tear trough deformity, pseudoherniated fat, lid laxity, and skin texture changes as well as dermatochalasis and festoons must be recognized.

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May
2016

Periorbital Surgery: Forehead, Brow, and Midface.

Facial Plast Surg Clin North Am 2016 May;24(2):107-17
John J Chi
Periorbital rejuvenation requires a careful understanding of the interplay between the eyelids, brow, forehead, and midface. Reversing periorbital signs of aging requires a correction of volume loss, soft tissue ptosis, and skin changes. Many surgical and nonsurgical techniques exist to treat the aging periorbital region; however, careful consideration of the patient's complaints and existing anatomy is critical to achieving a safe and esthetically pleasing outcome.

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Aug
2016

Despite the area of insertion of the facial portion of the platysma being broad and highly variable, the details of its pattern of extension and morphology are not well described in the medical literature. The aim of this study was to clarify the extension patterns of the platysma on the middle and lower face by topographic examination and detailed dissection.
A detailed dissection was performed in the cheek region of 34 cadaveric specimens.

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Oct
2016

The marginal mandibular branch (Mbr) of the facial nerve is vulnerable to damage during rhytidoplasty, surgical reduction of the mandibular angle, parotidectomy, and excision of the submandibular gland.
The authors sought to map the Mbr and determine the relationship between the number of Mbr offshoots and the course of the Mbr.
The Mbr was examined in 29 hemifaces from 12 embalmed and 4 fresh cadavers (10 males, 6 females; mean age, 73.

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