This document discusses preoperative evaluation and clinical evaluation for facelift surgery. It explores patient motivations and potential contraindications like diabetes or smoking. Ideal candidates are described as having elastic skin and good bone structure. The anatomy of the superficial musculoaponeurotic system (SMAS) is explained in detail. Various facelift techniques are outlined like subcutaneous lift, SMAS lift, and deep-plane lift. Incision sites, platysma muscle positioning, and suturing techniques are shown. Potential complications of facelift surgery are also listed.

1. Naranjargalan.N M.S
July 15, 2015
15th
presentation
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2. Preoperative evaluation
Explore patient’s desires and motivations
SAFE
 Self-image
 Anxiety
 Fear
 Expectation
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3. Potential contraindications
 Diabetes
 Smoking
 Collagen-vascular disease
 Psychiatric history
 Steroid use
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4. Clinical Evaluation
“Face-lift”
Chin/neck lift
Nasolabial fold
Fine or deep rhytids
Ideal patient
Elastic and not too much
skin
Little fat
Good bone structure (hyoid)
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5. Clinical Evaluation
Less than ideal
candidates
Discuss expectations in
detail
Need for other
procedures
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6. Clinical Evaluation
Important to assess
hyoid position
High hyoid is ideal for
cervicomental angle
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7. Clinical Evaluation
Adjunctive
Techniques
Laser peel
Dermabrasion
Chemical peel
Neck treatment
Implants
Blepharoplasty
Forehead lift
Rhinoplasty
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8. Anatomy (SMAS)
Superficial Musculoaponeurotic System

9. SMAS
Facial nerve lies deep to the SMAS
Posteriorly, the SMAS fuses with the fascia overlying
the sternocleidomastoid muscle, but it is a distinct
layer superficial to the parotid fascia
Anterosuperiorly, the SMAS invests the facial
mimetic muscles of the mid-face (i.e., orbicularis
oculi, zygomatic major/minor, levator labii superioris)
the melolabial crease and upper lip

11.  Scalp
 galea
 Upper face
 continuous with frontalis and
orbicularis oculi
 Temporal region
 temporoparietal fascia (superficial
temporal fascia)
 Parotid region
 dense fibrous layer overlying parotid
gland
 Cheek
 thin layer invests superficial mimetic
muscles
 Lower face
 continuous with platysma
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12. 12

13. Facial Artery and Nerve
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14. The most dangerous places
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15. Temporal branch is most
superficial
Crosses junction of anterior
1/3 and posterior 2/3 of
zygomatic arch
Above the arch it travels in
the temporoparietal fascia
to innervate frontalis and
orbicularis oculi
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16. Platysma
Origin: clavicles and 1st
rib and 5 cm below the
angle of the mandible
Insertion: blends with
the SMAS and lip
depressors
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17. Techniques
Subcutaneous lift
SMAS lift
Deep-plane lift
Composite lift
Subperiosteal lift
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18. Incisions
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19. Incision technique
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20. Subcutaneous lift (full tickness skin graft)
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21. 21

22. Subcutaneous lift
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23. Subcutaneous lift
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24. Subcutaneous lift
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25. Subcutaneous lift
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26. Subcutaneous lift
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27. Subcutaneous lift
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28. Subcutaneous lift
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29. SMAS Facelift
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30. 30

31. SMAS Facelift Rotation of the SMAS-
platysma flap
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32. 32

33. 33

34. SMAS Facelift
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35. SMAS Facelift
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36. SMAS Facelift
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37. SMAS Facelift Usually with liposuction
and submental incision
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38. SMAS Facelift
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39. SMAS incision
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40. 40

41. 41

42. Differences
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43. Skin reduction and platysma
muscle repositioning
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44. 44

45. Deep plane rhytidectomy
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46. 46

47. 47

48. 48

49. Deep Plane Facelift
Skin reduction, platysma
muscle repositioning and
cheek fat repositioning
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50. Composite Face Lift
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51. Composite Face Lift
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Elevates and repositions the m.orbicular, the cheek
fat and platysma muscle

52. MACS lift
Minimal access cranial suspension
Insicion is including skin fold of front of the ear and
following hairline
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53. Suturing
First suture is going from deep temporalis fascia to
angle between the mandible and the neck.
Second suture is going from deep temporalis fascia to
cyrcle between the cheek . It is parallel with
nasolabial fold.
Third suture lift the lower eyelid and malar.
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54. 54

55. Complications
Hematoma
Skin flap necrosis
Nerve injury
Greater auricular
Frontal
Pixie ear
Hairline changes
Hypertrophic scar and widening of scar
Alopecia
Infection
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