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Cosmetic Surgery for the Aging Neck and Face


Key Points

  • 1.

    Facelift is a cosmetic procedure that involves elevating the tissues of the lower face and neck into a more youthful position.

  • 2.

    There are several possible complications from facelift, including hematoma, nerve injury, skin necrosis, and contour irregularities.

  • 3.

    Numerous facelift techniques have been described, each with their own risks and benefits.

Pearls

  • 1.

    The most common complication from facelift surgery is hematoma. It occurs in up to 10% of cases and is more common in men.

  • 2.

    The rate-limiting anatomy in facelift surgery is the position of the hyoid bone. A congenitally anterior hyoid bone relative to the chin forces the mentocervical angle (MCA) and lower face-throat angle (LFTA) to be more obtuse.

  • 3.

    The most commonly injured nerve in facelift surgery is the great auricular nerve.

  • 4.

    The most commonly injured motor nerve in facelift surgery is the marginal mandibular nerve.

  • 5.

    The superficial musculoaponeurotic system (SMAS) contains the muscles of facial expression and is the tissue layer that is lifted in most facelift techniques.

Questions

1

What is a facelift?

Facelift, or cervicofacial rhytidectomy, is a surgery that elevates the skin and soft tissues of the lower facial third and neck. The procedure involves elevating a skin flap around the ear, drawing the deeper tissues up superiorly, and fixating them to strong fascia. Facelift is generally considered a cosmetic procedure and is performed in the outpatient setting.

2

What type of anesthesia is required?

Facelift can be performed under general anesthesia, IV sedation, or local anesthesia only.

3

What aging stigmata are addressed with facelift?

When examining the aging face patient interested in facelift, it is useful to know what areas can be corrected with this procedure. The following aging issues can be addressed ( Fig. 64.1 ):

Fig. 64.1, Areas of the lower face and neck that can be improved with facelift surgery.

Sagging neck skin

Platysmal bands

Jowls

Excess cervical fat

A combination of facelift, liposuction, and platysmaplasty (see below) is used to correct these problems. Fine wrinkles are not treated by facelift.

4

What is the SMAS?

The Superficial Musculoaponeurotic System (SMAS) is a continuous layer of the face that contains the muscles of facial expression. The SMAS layer is connected to the dermis, which allows these muscles to move the skin and convey emotion. These are the only muscles in the body that attach directly to skin, which highlights the importance of facial expression in social species such as our own.

5

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