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PubMed1980

The extended neck lift: the "bottom line".

Although adequate submental lipectomy and procedures to reposition and modify the supportive role of the platysma muscles have added to the quality and duration of neck lifts, the "bottom line" is still excision of as much excess skin as possible. A method of extended neck lift is described. It involves ancillary methods of cervical lipectomy and platysma repositioning but it also permits excision of large amounts of excess skin, by extending the posterior incisions medially and inferiorly and pulling the dog ears toward the midline. The results appear to make the additional effort worthwhile.

Adipose Tissue↗

PubMed1982

The seagull incision in posterior cervical lift: indications, limitations, and surgical technique.

A seagull incision in the posterior scalp as used by us for the past 15 years for the correction of flaccidity in the posterior and anterior lower neck regions through a posterior cervical lift has been described in detail with its advantages, indications, and limitations. In our experience, the posterior cervical lift has little or no effect in correcting flaccidity in the upper anterior neck region, and therefore, this procedure should not be routinely performed in all cases of rhytidoplasty. One has to be highly selective in performing this procedure.

Esthetics↗

PubMed1986

Cigarette smoking and face lift: conservative versus wide undermining.

The effects of cigarette smoking on the skin flaps of the face lift procedure are discussed. Reported elsewhere is a significant incidence of skin slough in smokers with use of wide undermining techniques. This complication is thought to be due to the vasoconstrictive effects of nicotine on the peripheral circulation. Our group has employed a conservative bilateral undermining technique in 407 face lifts. Of these, 32.4 percent were smokers and 67.6 percent were nonsmokers. No cases of skin slough were encountered. Our conservative undermining technique is briefly discussed. Among its advantages are shorter operative time, use of less local and/or general anesthesia, less intraoperative bleeding, adequate exposure for SMAS and platysmal surgery, and snugger skin closure without the risk of flap necrosis. As shown by our statistics, it is a safer procedure in smokers than the usually performed more radical procedure.

Face↗

PubMed1988

Fascial anchoring technique in medial thigh lifts.

The medical thigh lift has not gained widespread acceptance since its introduction 20 years ago because of problems such as inferior scar migration, labial separation, and early recurrence of ptosis. Anchoring of the inferior skin flap to the tough, inelastic deep layer of the superficial perineal fascia has reduced such complications. Originally described by Colles in 1811, this fascial layer helps define the perineal-thigh crease. Eighteen patients having medial thigh lifts in combination with liposuction were followed for 6 to 24 months. The technique involves initial liposuction followed by resection of a crescent of redundant skin and fat at the superior medial thigh. The inferior skin flap is suspended from Colles' fascia of the perineum with subdermal PDS sutures. No undermining or deepithelialization of flaps is performed. Complications are few, and patient satisfaction is high.

Adipose Tissue↗

PubMed1990

Depth of the facial nerve in face lift dissections.

Facial nerve depth was measured in 12 cadaver face halves after bilateral face lift dissections. The main nerve trunk emerged anterior to the midearlobe and was 20.1 +/- 3.1 mm deep. Nerve exit from the parotid edge also was deep, averaging 9.1 +/- 2.8 mm for temporal, 9.2 +/- 2.2 mm for zygomatic, 9.6 +/- 2.0 mm for buccal, and 10.6 +/- 2.7 mm for mandibular branches. Distal to the parotid gland, danger areas where nerve branches became superficial were distal temporal, lower buccal, and upper mandibular branches over the masseter muscle and marginal mandibular as it crossed the facial artery. Some protection in these danger areas was provided by fascia, especially superficial temporal and masseteric, while platysma provided some protection for the mandibular branch. Fascial and muscle protection was less in thin cadavers. Face lift dissection can be rapid in areas where facial nerve branches are deep or absent, such as postauricular, inferior to the zygomatic prominence, and near the earlobe.

Facial Nerve↗

PubMed1996

A new addition to face lift surgery: the argon gas surgical unit.

In the quest to improve the technique of performing face lift surgery, we have encountered a device, the argon gas surgical unit, that offers a number of advantages over current techniques. These advantages include significant reductions in the amount of both intraoperative and postoperative blood loss, depth of tissue damage, amount of postoperative swelling, and amount of postoperative pain. This paper describes our experience with the use of the argon gas surgical unit compared with conventional electrocautery in 30 patients undergoing face lift. On histologic examination of the skin specimens, there was a consistent decrease in the depth of tissue damage with the argon gas surgical unit. With regard to blood loss, as a whole there was a marked decrease in the argon gas surgical unit group. Additionally, there is a clinically significant decrease in postoperative swelling in the patients in whom the argon gas surgical unit was employed that contributes to improved wound healing and an overall improved postoperative course.

Argon↗

PubMed1996

Biodegradable positive fixation for the endoscopic brow lift.

Development of endoscopic techniques allows the separation and repositioning of the periosteum of the orbital rims and zygomaxilla for a brow lift without skin excision. Questions have been raised about the permanence of this repositioning without fixation. We have developed a technique using biodegradable polylactide pericranial pins that serve as fixation points to allow specific suspension of the periosteum with positive positioning until the third phase of wound healing is complete. Through two inconspicuous incisions near the midportion of the scalp, subperiosteal dissection is carried to the orbital rims and the zygomatic arch anteriorly and all the way to the base of the occiput posteriorly. This allows for contracture of the occipitalis muscle to contribute to the repositioning and lifting of the brow. Up to seven sutures are then placed through and through the pericranium of the periosteum and frontalis along the superior and lateral border of the orbital rim. These stitches of long-acting polylactide acid are secured to two pins placed in the outer table of the cranium to maintain positive fixation for more than 6 weeks. In this way precise, positive positioning is maintained until wound healing and reattachment of the structures are complete. We began these procedures in 1993; our results at 24 months are promising.

Endoscopy↗

PubMed1997

A comparison between parallel hairline incisions and perpendicular incisions when performing a face lift.

Our profession has not decided if it is better to incise parallel or perpendicular (at an angle) to hair follicles when performing a brow lift or a face lift. Thirty patients had one side incised parallel and the other side incised perpendicular to hair follicles. Neither the patients nor the examiners knew how each side was incised. By comparing the invisibility, the nonlinearity, the absence of hypopigmentation, and the abundance of hair into and in front of the scar, we obtained statistical proof that if we incised perpendicular to hair follicles (to preserve the deep follicles in the proximal flap), scars were better in 95 percent of patients.

Cell Movement↗

PubMed1998

Lifting of the upper two-thirds of the face: supraperiosteal-subSMAS versus subperiosteal approach. The quest for physiologic surgery.

The supraperiosteal-subSMAS lifting technique, which has been performed since 1985, for the rejuvenation of the upper two-thirds of the face is described, and the results obtained in a series of 128 cases treated, emphasizing the attainment of an effective rejuvenation together with a minimum of complications and undesired effects is presented. A discussion on the two dissection planes (supraperiosteal-subSMAS versus subperiosteal) used most commonly in the lifting of the upper two-thirds of the face is presented. From an anatomohistophysiologic basis, the tissue manipulations that the two techniques mandate are discussed and evaluated. Based on these facts, the supraperiosteal-subSMAS technique is the most logical physiologically, because it produces less tissue trauma, which leads to fewer complications and a more rapid recovery to a normal social life.

Adult↗

PubMed1999

A simplified transblepharoplasty subperiosteal cheek lift.

Surgical treatment of the aging face is continuing to evolve. Recent emphasis has focused on managing the malar region, specifically ptosis of the cheek pad. Several authors have described techniques for correcting facial aging changes in the midface through an endoscopic approach or transblepharoplasty approach. The latter procedure requires a lateral canthoplasty, which adds technical difficulty and potential complications to the procedure. We have modified these procedures and now perform a simplified transblepharoplasty subperiosteal cheek lift without routine canthoplasty or canthopexy. Sixty patients who had this procedure were evaluated. Analysis of these patients revealed that our simplified approach to transblepharoplasty subperiosteal cheek lift provides excellent correction of midfacial aging changes with a low incidence of postoperative complications. This article describes this technique and reviews our results.

Adult↗

PubMed1999

Elicitation of the oculocardiac reflex during endoscopic forehead lift surgery.

Elicitation of the oculocardiac reflex is a well-documented phenomenon encountered during ophthalmologic surgical procedures. Familiarity with and prompt recognition of this entity has significantly reduced the morbidity associated with it; however, potentially lethal arrhythmias and cardiac arrest still occur. We report elicitation of the reflex during manipulation of the supraorbital nerve during endoscopic forehead lift surgery. To our knowledge this is the first case of elicitation of the oculocardiac reflex reported during endoscopic forehead lift surgery.

Bradycardia↗

PubMed2000

Refinements in face lifting: enhanced facial contour using vicryl mesh incorporated into SMAS fixation.

As we have gained experience with the extended superficial musculoaponeurotic system (SMAS) technique in face lifting, refinements in our procedure have led to increased consistency in results. The important factors that have led to our technical modifications include the following: (1) the significance of the retaining ligaments of the midface, which determine the degree of surgical dissection required for both skin and SMAS in rhytidectomy; (2) the changes in facial shape that occur with aging, secondary to the descent of facial fat; (3) the possibility of modifying facial shape through the repositioning of facial fat in an extended SMAS face lift; (4) the improved longevity of result to be obtained by incorporating Vicryl mesh into SMAS fixation; (5) the artistic nuances of incision design that help to minimize scar perceptibility. Understanding these factors enables surgeons to use the extended SMAS technique successfully with more challenging cases, enhancing facial appearance while minimizing signs that the patient has undergone a surgical procedure.

Adult↗

PubMed2000

Face lifting: problems, solutions, and an outcome study.

The superficial musculoaponeurotic system (SMAS) platysma rotation flap with platysmal transection from the deep surface has been the author's face-lift technique to correct jowls, submental laxity, and platysma bands since 1982. An outcome study of 10 consecutive face-lift operations is presented to demonstrate the efficacy of correction of lower face and neck aging and the duration of the improvement. Reappearance of platysma bands has been the earliest and most frequent sign of recurrent aging changes. A technique for directly dealing with platysma bands in the submental and cervicomental location is described, and follow-up results up to 3 years are shown.

Adult↗

PubMed2000

Lateral subcutaneous brow lift and interbrow muscle resection: clinical experience and anatomic studies.

The authors report consistent improvement in 65 patients with lateral brow ptosis by using a lateral subcutaneous brow lift at the temporal hairline. In 48 of these patients, vertical glabellar wrinkles were improved by the direct excision of procerus, corrugator, and orbicularis muscles through 3-mm medial brow incisions. Anatomic dissections in 10 cadavers and examinations of 50 skulls were used to study the location of the supraorbital and supratrochlear nerves. Dissections revealed that the supratrochlear nerve was never closer than 1.6 cm to the midline at the level of the supraorbital ridge. In no dissection was a supratrochlear foramen noted. Lateral subcutaneous brow lift was consistently successful in elevating the lateral brow. In no patient was nerve damage to the supraorbital nerve noted. In most patients, the temporal hairline was improved by excising a triangle of balding scalp. Through 3-mm medial brow incisions, the interbrow musculature can be excised by using a small rongeur in an area 3.2 cm wide without risk of nerve damage, improving vertical glabellar wrinkles.

Facial Muscles↗

PubMed1979

Surgical face lift.

The growing importance of the face lift and related procedures to improve the aging face and the increasing demand by both men and women for these procedures is largely due to the prolonged good health, active life, and extended working years of many people. The technic described emphasizes support of the facial tissues upward and backward, leaving the resulting scars in the least obvious locations. Illustrative cases show improvement in appearance by upper and lower blepharoplasty and by the temple, cheek, and neck lift. The importance of a "segmental approach" is mentioned and other accessory procedures which may contribute further to improvement of the aging face are described, including rhinoplasty, mentoplasty, surgical abrasion, and chemical peel.

Aging↗

PubMedDate not supplied

Back muscle strength and weight limits in lifting burdens.

When lifting loads, the muscles of the back, rather than the ligaments and the bony structures of the spine, should overcome the gravitational forces. Formulas, based on measurements of the back muscle strength for prediction of maximum loads to be lifted, have been worked out and tested in practical situations. From tests with 50 male and female subjects, the simplest prediction formulas for maximum loads were as follows: for men, maximum load = 1.10 X isometric back muscles strength; for women, maximum load = 0.95 x isometric back muscle strength minus 8 kg.

Adult↗

PubMedDate not supplied

Can the lumbar spine be crushed in heavy lifting?

Cadaveric lumbar intervertebral joints were wedged to simulate forward flexion and then compressed to failure. The compressive strengths of the young male specimens tested were compared with the forces calculated to act when average young men perform maximum lifts from the flexed posture. It is concluded that the spine has a considerable margin of safety when such lifts are performed.

Adult↗

PubMed1986

Partitioning of the L4-L5 dynamic moment into disc, ligamentous, and muscular components during lifting.

This work describes a dynamic model of the low back that incorporates extensive anatomical detail of a three-dimensional musculo-ligamentous-skeletal system. The reactive moment about L4-L5, determined from sagittal plane lifts, was partitioned into restorative components provided by the disc in bending, ligament strain, and active muscle contraction. Skeletal kinematics were obtained from cine analysis of markers on the rib cage and pelvis. The musculature was driven from surface EMG collected from six sites. When compared with past models, features of this model included improved anatomical modeling, improved monitoring of vertebral motion unit kinematics, improved estimation of neural activation of the musculature, and consideration of the effects of muscle length, velocity, cross-sectional area and passive elasticity in force estimation. Estimations of L4-L5 disc compression and shear were, on average, 16.2% and 42.5% lower, respectively, than those calculated from a simple 5 cm erector tissue moment arm length. There was no need to invoke intra-abdominal pressure or other contentious compression-reducing mechanisms. Muscle activity, particularly that of the sacrospinalis, dominated the generation of the restorative moment. Ligaments played a very minor role in the lifts studied. High muscle loads are consistent with the common clinical observation of muscle strain often produced by load handling.

Biomechanical Phenomena↗