Deep Neck Lift: Defining Anatomical Problems and Choosing Appropriate Treatment Strategies.

A well-contoured neck is an artistic imperative to an attractive and appealing appearance. A good neckline conveys a sense of youth, health, fitness, confidence, and vitality and lends an appearance of decisiveness, sensuality, and beauty. Neck improvement is of high priority to almost every patient seeking facial improvement, and the results of "face lift" procedures are judged largely by the outcome obtained in the neck.

High SMAS Facelift: Combined Single Flap Lifting of the Midface, Cheek, and Jawline.

The traditional deep plane and "low" cheek superficial musculoaponeurotic system (SMAS) flaps elevated below the zygomatic arch suffer the drawback that they cannot, by design, exert an effect on tissues of the midface and infra-orbital region. Traditional deep plane and low designs target the lower cheek and jowl only and produce no improvement in the upper anterior cheek and "midface" area. Planning the flap "higher," along the zygomatic arch, and extending the dissection medially in an "extended SMAS" fashion to release and mobilize midface tissue, overcomes this problem and allows a combined, simultaneous, single flap lifting of the jawline, cheek, and midface.

Male Facelift.

Increasing numbers of men are seeking surgical rejuvenation of their face and plastic surgeons have come to recognize that male facial aesthetics differ from those in women and that attractive masculinity is not as closely correlated with youth and beauty as is femininity. As a result, men generally seek a somewhat different outcome from facelift surgery. This has led to a rethinking of techniques that have evolved mainly to treat facial aging in women, and techniques have emerged that allow rejuvenation of the male face while preserving a natural, masculine appearance free of signs that surgery has been performed.

Periorbital Fat Grafting: A New Paradigm for Rejuvenation of the Eyelids.

Fat grafting represents the most important new addition to surgical procedures to rejuvenate the orbit since the inception of the "blepharoplasty" technique. Traditional blepharoplasty procedures do not always address the changes that occur with age in the orbital area and can actually degrade the appearance of the eye. Fat grafting allows treatment of age-associated loss of periorbital volume not addressed by traditional blepharoplasty procedures.

Short Scar Neck Lift: Neck Lift Using a Submental Incision Only.

For a subset of patients poor neck contour exists as a largely isolated problem and can be treated with a short scar neck lift procedure whereby no skin is removed. The procedure is performed through a submental incision without any removal of skin and relies on modification of deep-layer structures to improve neck contour. "Excess" skin is allowed to redistribute itself over the increased neck surface area created when deep-layer maneuvers are performed, neck contour is improved, and the cervicomental angle deepened.

Management of the Platysma in Neck Lift.

Traditional techniques to treat platysma bands relied on corset tightening of the anterior platysma muscle borders or rigid suspension of the lateral platysma borders to sternocleidomastoid or periauricular fascia. Although results seemed good, recurrence was common and the ultimate outcome was poor. Despite modifications, they have largely failed, and for surgeons seeking to rejuvenate the face, treating platysma bands remains a most frustrating and perplexing problem in neck surgery.

Neck Lift: Defining Anatomic Problems and Choosing Appropriate Treatment Strategies.

Success or failure in treating the neck lies in the diagnosis of underlying problems and the application of a logical surgical plan. Although it is a commonly advocated practice, it is not enough to perform submental liposuction and tighten the skin in most patients, as such an approach ignores a number of anatomic problems present in many patients seeking neck improvement. Removing subcutaneous fat and tightening skin over these problems does not correct them, and the presence or absence of each must be looked for to create and apply an appropriate surgical plan.

Facial Fat Grafting: Why, Where, How, and How Much.

Unlabelled: Although the importance of volume loss in the aging face is now well recognized and fat grafting has increasingly become an integral part of contemporary facelift procedures, general acceptance of the fat grafting technique is a relatively recent occurrence and many surgeons reluctance to adopt the technique can be traced back in part to questions they have as to how loss of volume contributes to how the face ages, how to specifically recognize those changes, and questions they have about how to perform the fat grafting procedure to correct them. In this article we attempt to answer the questions "why perform facial fat grafting during facelift procedures?", "where should fat be placed in the face?", "how should fat be injected?", and "how much should be injected in each area?".

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article.

Correction to: Discussion of Shue et al. "Fat Injection: A Systemic Review of Injection Volumes by Facial Subunit".

Dino Elyassnia was left off the original version of this article. The author line is correct here.

The Orbital Oval Balance Principle: A Morphometric Clinical Analysis.

Background: The aim of this study was to test the validity of the "orbital oval balance principle," a system of analysis and guideline that is used among aestheticians, artists, and makeup artists to create and design aesthetically pleasing eyebrows for optimal upper facial appearance. According to this principle, a face is optimally attractive when the eye is centered in an "oval" defined by the lid-cheek junction and the eyebrow.

Methods: One hundred participants were asked to rank digital morphed images of four female models with four different periorbital proportions: higher or lower lid-cheek junction versus higher or lower eyebrow position.

Fat grafting in facial rejuvenation.

Patients with significant facial atrophy and age-related loss of facial fat generally achieve suboptimal improvement from both surface treatments of facial skin and surgical lifts. Restoring lost facial volume by fat grafting is a powerful technique that is now acknowledged by most plastic surgeons and other physicians engaged in treating the aging face as one of the most important advances in aesthetic surgery. Properly performed, the addition of fat to areas of the face that have atrophied because of age or disease can produce a significant and sustained improvement in appearance that is unobtainable by other means.

High SMAS facelift: combined single flap lifting of the jawline, cheek, and midface.

The traditional low cheek SMAS flap elevated below the zygomatic arch suffers the drawback that it cannot, by design, exert an effect on tissues of the midface and infraorbital region. Low designs target the lower cheek and jaw only and produce little if any improvement in the upper anterior cheek and midface area. Planning the flap higher, along the superior border of the zygomatic arch, and extending the dissection medially to mobilize midface tissue overcomes this problem and allows a combined, simultaneous lift of the jawline, cheek, and midface with a single unified flap.

Closed, nonendoscopic, small-incision forehead lift.

As endoscopic techniques made inroads into surgery, one of the first procedures they were adapted to by plastic surgeons was the forehead lift. The "closed" forehead lift procedure has since achieved wide acceptance and exists as a viable alternative to open procedures for many patients. Experience has shown, however, that it is not necessary to use an endoscope to mobilize and release the forehead and modify the corrugator supercilii muscles in "closed" procedures if the anatomy is understood, the operation is appropriately planned, and the corrugator muscles are modified using a transpalpebral approach.