Services 》Face Lift
In 2022, Dr. Jong went to US to visit Dr. Marten(left) 及Elyassnia(right) to study whole face lift, neck lift and whole face fat injection.
Aging process involves from skin to deep inside. Not only the skin becomes loose, but also bone structure becomes atrophic. There are two main aging processes. One is atrophy. The other is laxity of tissue. Atrophy occurred in temple, eyelid or cheek, etc , so that sunken temples, eyelids or cheeks were noted. Injection of fat or fillers (such as hyaluronic acid) is one way to augment the atrophic parts.
There are several ways to lift the laxity of facial tissue. Non-invasive ways are Thermage, Botox lift, Thread lift, etc. There will be some minor change after treatment. They are suitable for patients in their 40s to 50s who are not willing to undergo face lift surgery. Invasive way is face lift surgery. Study showed that lifting effect lasted longer when face lift was done in early age than in late age. Face lift is a better option if he or she is willing to undergo surgery, even in their 40s.
There are several ways of classification of face lift surgery. One is by location , the other is by depth of surgical dissection.
(1) Location: face is divided into three parts: upper, middle and lower face.
- Upper face includes forehead and temples. Brows get dropped when aging. The distance between eyebrows and eyelids becomes narrower, so that face looks tired and old. The eyelids looks puffy when eyebrows dropped. By forehead lift, eyebrows are lifted up.
- Mid face is the area below zygoma and oral commissure. The aging signs are midcheek depression and nasolabila fold.
- Lower face is the area below oral commissure to mandible margin. The aging signs are marionette line and jowl.
(2) Depth of surgical dissection:
- Skin lift: The dissection plane is below skin. After wide skin dissection, the skin is lifted then redundant skin is excised. It is the original way of face lift. The result may end with unnatural and tight appearance and short-lived.
- SMAS lift: SMAS is a tissue below skin above facial muscles. In SMAS lift procedure, SMAS is dissected as a sheet and is lifted. SMAS is a tough tissue. It provides a better support to the sagging tissue, so that SMAS lift is a standard procedure of contemporary midface and lower face lift.
- Subperiosteal lift: Periosteum is a tissue above bone. In subperiosteal lift, the dissection plane is below periosteum. It is a standard lift for forehead lift.
Below is the introduction of face lift.
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(1) Forehead lift: The purpose of the procedure is to elevate eyebrows. Traditional way is to make a long scar from one ear to the other ear, shown at the below left picture. Contemporary way is endoscopic forehead lif t(shown in the below right picture). Through four to five small incisions (about 1.5 cm), subperiosteal dissection is performed and dropped forehead tissue is lifted and fixed with screws or Endotine (Endotine will be introduced in the following section). Hyperactive frown muscles could be weakened in the same time. Because endoforehead lift is less invasive than traditional forhead lift, recovery is quicker and less pain.
Below case showed the result of endoforehead lift (before: left, after: right). She looked more delighted after surgery.
(2) Lateral hooding of upper eyelid: Lateral hooding is caused not only by laxity of upper eyelid skin, but also dropping of lateral eyebrow. So that the best way to correct lateral hooding is to elevate eyebrow with forehead lift and excision of upper eyelid skin. Both procedure can be done simulateously or in two sections (forehead lift firstly and then upper blepharoplasty).
Below upper left is before picture. Upper right is picture after endoforehead lift. Lower left is picture after upper blepharoplasty. Lower right is picture of scalp scar. It is quite unnoticeable.
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(3) Endotine: Endotine is a absorbable material which is used to fix the lifted structure in face lift surgery. It lasts about 6 months. Below left is Endotine used in forehead lift. There are fine pins which provides stronger fixation to the lifted forehead tissue than traditional screw fixation.
The other facial area which is indicated for Endotine is midface. The appearance of Endotine for midface is showed on above right picture. The strap of Endotine is buried under temple area and tins of Endotine is fixed with drooped midface tissue. Lifting up the strap of Endotine will lift up the drooped midface tissue, so that nasolabial fold and midcheek groove will be improved. The force of midface Endotine is not enough for jowl and neck. Below is a case showing the result of Endotine midface lift. The midcheek groove become smoother after surgery.
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(4) SMAS lift: There is a thin muscle below facial skin and cover lower face and neck , called Platysma.
Platysma is part of SMAS. Loose SMAS and Platysma are related with formation of jowl and loose neck. Lifting up SMAS and Platysma is the most effective way to improve jowl and restore neck line. Below demenstrated how the SMAS lift is done.
There will be a scar in front of ear, showed in the below pictures. The scar is quited unnoticeable.
Face looks square with the existence of jowl. After SMAS lift, face becomes more V-shaped and younger after treatment of jowl.
Below showed the result of SMAS lift.
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Fat injection: As mentioned above, atrophy is one sign of aging. Fat, which is harvested from the trunk, can be injected into the atrophic part of face (such as temple, cheek, etc.) to improve aging sign. The article is presented in another chapter. Filler injection is a good choose for persons presented with nasolabial fold or marionette line without jowl or midcheek depression. There are some nonsurgical methods to improve aging signs if patients do not prepare surgical methods.
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Turkey Gobbler neck: Turkey Gobbler neck is a disturbance, especially when tie the necktie for male. The other way to treat the neck problem is by direct skin excision in midline of neck. The scar in midneck is not obvious.
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1. Take three sachets (for three days) after meals, three meals, and before going to bed. The medicament contains a painkiller (white pill, ingredient Acetaminophen 500mg, does not hurt the stomach), and an antibiotic (green-white capsule, ingredient Cephalexin 500 mg).
Eye ointment (composed of Chlorotetracycline): After removing the head bandage, apply it to the wound once in the morning and evening.
2. Forehead skin lifters: Do not pull the drainage tube, and keep the drainage ball flattened and record the drainage flow. When the drainage volume is low, return to the clinic to remove the drainage tube and remove the head bandage.
Middle and lower face skin lifters: You can remove the head bandage by yourself after three days. After removing the head bandage, you can gently wash your hair.
3. When cleaning the face, the action should be cleaned from bottom to top.
4. Three days before the operation, ice can be applied to reduce swelling and pain. Warm compresses may cause burns. Use with care.
＊ The time of ice application is 30 minutes and rest 30 minutes. When you sit up a little while sleeping, you can reduce edema.
5. Smoking after the wound is removed and healed.
6. Return to the clinic and remove the thread according to time.
7. Don't do Zhang Dayong's actions such as laughter in the first six weeks after the operation. -
Q: What is eyebrow incision surgery?
A: The purpose of forehead lift is to raise eyebrows. There are several procedures for raising eyebrows, and there are also methods for making an incision above the eyebrows. Some people call it eyebrow cutting surgery. You can refer to the article on cutting double eyelids on the website.
Q: Is it because the cheeks are drooping and skin-lifting? Cut around the ears, isn't that scar obvious? How long does it take to recover?
A: The sagging cheek is to do a face lift (the wound is around the ear, and the scar will not be visible after healing). After one to two weeks, it will naturally become a lot.
Q: My mother has troubles with drooping eyelids and her forehead is quite high. She has cut her eyelids before! Does the doctor know a kind of forehead lift combined with shrinkage surgery?
A: At present, it is recommended to use an endoscope for forehead lift surgery. The biggest benefit is that the scar is very small. But for patients with high foreheads, if they use five small wounds in the hair for endoscopic skin resection, the patient's forehead will be higher after surgery. The patient's scar will be recommended to be placed on the hairline of the forehead (a scar, not obvious behind the ear), and part of the skin of the forehead will be removed so that the forehead will be lowered after the operation.
Q: My decree lines and tear grooves are very obvious, and the face is also drooping a little bit serious. May I ask whether lifting the face can improve these problems?
A: Facial sagging can be improved by skin lifting, but the effect of skin lifting for decree lines and tear grooves is not obvious. Injecting fillers such as hyaluronic acid for decree lines are more effective, and surgery or hyaluronic acid for tear grooves are more effective.
Q: What is the fixation of the endoscope pulling, is it a five-claw? Is it something else? Will there be a draining ball just after the surgery?
A: The way of fixing after pulling the skin is to use a five-claw hook, or use a small screw. Drainage tubes can reduce bruising and edema, and we usually place them.
If you live abroad, you may send your questions and pictures (such as eyes, etc) to mail@LRclinic.com.tw .
We will reply you as soon as possible.
