Rhytidectomy

Discuss the anatomy of the SMAS, platysma and the facial nerve.  Please help us understand the temporal fascia.  Do the nerves travel in the superficial layer of the deep temporal fascia, or the deep layer of the superficial temporal fascia? I am so confused!

What are your pearls for avoiding facial nerve injury?

Reference(s):

Roostaeian, J., Rohrich, R. J., & Stuzin, J. M. (2015). Anatomical considerations to prevent facial nerve injury. Plastic and Reconstructive Surgery, 135(5), 1318–1327.

What are the retaining ligaments of the face and why are they important?

Reference(s):

Stuzin, J. M., Baker, T. J., & Gordon, H. L. (1992). The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plastic and Reconstructive Surgery, 89(3), 441.

Alghoul, M., & Codner, M. A. (2013). Retaining ligaments of the face: review of anatomy and clinical applications. Aesthetic Surgery Journal, 33(6), 769–782.

Discuss the blood supply of a face lift flap.

A middle aged woman inquires about a facelift.  She wants a dramatic result.  Her friend recently underwent a subperiosteal facelift with a well-known plastic surgeon.  How is this procedure performed?  What are its shortcomings?  How does this differ from the deep plane facelift?  What is a composite facelift?

Reference(s):

Chang, S., Pusic, A., & Rohrich, R. J. (2011). A systematic review of comparison of efficacy and complication rates among face-lift techniques. Plastic and Reconstructive Surgery, 127(1), 423–433.

A patient seeks your expert opinion on the management of her deep nasolabial folds.  Describe the anatomy of the nasolabial folds. What are her options?

Reference(s):

Robertson, K. M., & Dyer, W. K. 2nd. (1999). Expanded polytetrafluoroethylene (Gore-Tex) augmentation of deep nasolabial creases. Archives of Otolaryngology–Head & Neck Surgery, 125(4), 456–461.

Rudkin, G., & Miller, T. A. (1999). Aging nasolabial fold and treatment by direct excision. Plastic and Reconstructive Surgery, 104(5), 1502–1507.

Is it safe to lift and peel at the same time?

Reference(s):

Truswell, W. H. 4th. (2012). Combining fractional carbon-dioxide laser resurfacing with face-lift surgery. Facial Plastic Surgery Clinics of North America, 20(2), 201–13, vi.

How do deep-plane and composite rhytidectomies compare to the traditional SMAS procedures?

Reference(s):

Godin, M. S., & Johnson, C. M. J. (1996). Deep-plane/composite rhytidectomy. Facial Plastic Surgery : FPS, 12(3), 231–239.

Your mother in law had a facelift 15 years ago.  She feels it has not held up well and is interested in more surgery.  What are important considerations in secondary rhytidectomy?

Reference(s):

Rasko, Y. M., Beale, E., & Rohrich, R. J. (2012). Secondary rhytidectomy: comprehensive review and current concepts. Plastic and Reconstructive Surgery, 130(6), 1370–1378.

Should you treat the male face lifts patients differently?

What is a tear trough deformity and how do you fix it?

What is a festoon?

Correct an aging neck.

Reference(s):

Labbe, D., & Giot, J.-P. (2014). Open neck contouring. Clinics in Plastic Surgery, 41(1), 57–63.

Feldman, J. J. (2014). Neck lift my way: an update. Plastic and Reconstructive Surgery, 134(6), 1173–1183.

Discuss cervical suspension.

Reference(s):

Conrad, K., Chapnik, J. S., & Reifen, E. (1993). E-PTFE (Gore-Tex) suspension cervical facial rhytidectomy. Archives of Otolaryngology–Head & Neck Surgery, 119(6), 694–698.

How do you get rid of those pesky platysmal bands?

Reference(s):

Farrior, E., Eisler, L., & Wright, H. V. (2014). Techniques for rejuvenation of the neck platysma. Facial Plastic Surgery Clinics of North America, 22(2), 243–252.

Discuss wrinkle fillers-such as gortex, collagen, fat, etc.

Reference(s):

Lam, S. M. (2015). Integrating injectable fillers and fat in facial rejuvenation. Facial Plastic Surgery : FPS, 31(1), 35–42.

Role of laser resurfacing in facial rejuvenation?

Reference(s):

Nguyen, A. T., Ahmad, J., Fagien, S., & Rohrich, R. J. (2012). Cosmetic medicine: facial resurfacing and injectables. Plastic and Reconstructive Surgery, 129(1), 142e–153e.

Hassan, K. M., & Benedetto, A. V. (2013). Facial skin rejuvenation: ablative laser resurfacing, chemical peels, or photodynamic therapy? Facts and controversies. Clinics in Dermatology, 31(6), 737–740.

Your mother in law has prominent jowls and aging neck but is not interested in surgery. What are non-invasive techniques for neck rejuvenation?

Reference(s):

Mulholland, R. S. (2014). Nonexcisional, minimally invasive rejuvenation of the neck. Clinics in Plastic Surgery, 41(1), 11–31.

What is Thermage?  Does it really work or is it a gimmick?

Give us a table of facelift complications.  How would you treat each?