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J Cosmet Med 2021; 5(2): 57-66

Published online December 31, 2021

https://doi.org/10.25056/JCM.2021.5.2.57

Difficulties of facelift in patients with scar after treatment of facial liposuction or thread lift sutures

Zhi-Jun Wang, MD, PhD1 , Guanyi Li, MD1 , Shuzhong Guo, MD, PhD2 , DongQing Fu, MD3 , Bozhang Shen, MD3 , Chengxin Bai, MD1

1Institute of Facial Rejuvenation, Plastic Surgery Hospital of Xi’an International Medical Center, Xi’an, China
2Plastic Surgery Hospital Ear in Manufacturing Center, Xi’an International Medical Center, Xi’an, China
3Medical School of Yanbian University, Ji Ling, China

Correspondence to :
Zhi-Jun Wang
E-mail: 13998552625@163.com

Received: July 1, 2021; Revised: November 24, 2021; Accepted: November 24, 2021

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: To explore the methods and safety of general abnormal anatomical layers and structure in rhytidectomy, which is also of clinical significance. In this group, 39 patients with static and dynamic deformities formed at different levels after liposuction and thread technique more than one time were treated with stable and active separation skills in high SMAS facelift operation. The results showed that the patients of this group could get the same effect of younger postoperative operation as “initial face” and solve dynamic adhesion deformity.
Methods: Magnetic resonance imaging and ultrasound were performed before operation, focusing on the abnormal changes of facial soft tissue. The results showed that the signal of the foreign body, the position and texture of scar, the relationship between scar and masseter fascia, buccal fat pad, and whether there was tissue defect or hyperplasia. In the operation, the normal separation was made in the second and fourth layers of the previously safe and easy to separate plane, instead of in the dense one or two layers of the scar. It is an alternative microsurgical separation technique. The key point is to separate the incomplete SMAS flap to achieve the expected good effect of rhytidectomy, release the scar adhesion and facial spasm. At the same time, the severed injury of facial nerve branches should be strictly prevented.
Results: 74 cases of facelift were taken in recent eight months and 67 patients were treated with micro plastic surgery. Among them, 39 patients received more than one facial liposuction and more than one thread lift. In the scar formed by liposuction and thread technology, liposuction is especially serious; liposuction can still absorb the structural layer, and scar directly involves the SMAS and buccal fat pad envelope containing facial nerve branches, one of which directly causes the injury of the mandibular marginal branch. Most of the chronic granuloma scar formed after the degradation of the thread technology is in the facial space, which causes the scar atresia of the space. The flap and SMAS flap of 39 cases were separated, most of which were facial nerve branches in scar. All of them were difficult to separate and form the SMAS flap of superficial temporal fascia-Orbicularis oculi-platysma, and 89.6% of the excellent facelift effect was obtained. Facial nerve injury was found in 2 cases, 1 case was right mandible marginal branch traction injury, and the other side was left corner nerve injury. In the process of recovery.
Conclusion: For patients with facial liposuction and thread technique, doctors must be prepared for the difficult separation of scar adhesion and have a high risk of facial nerve branch disconnection. If we don’t pursue the rejuvenation effect, it will lead to the existence of surgical effect discount, bilateral asymmetry, and dynamic adhesion deformity.

Keywords: aspiration lipectomy, cicatrix, facial nerve, rhytidoplasty, scar, sutures

Fig. 1.Platysma plasty.
  1. Barton FE Jr. The “high SMAS” face lift technique. Aesthet Surg J 2002;22:481-6.
    Pubmed CrossRef
  2. Wang ZJ, Bai C, Li G, Wang Y, Teng X, Gao J. [Compartmentalization and local structural anatomy of the face and neck: facial layers anatomy]. Chin J Aesthet Plast Surg 2020;31:128-33. Chinese.
  3. Zhang C, Wu L, Wang J. [Depressor orbicularis lateralis: concept, anatomy and clinical relevance]. Chin J Plast Surg 2018;34:977-80. Chinese.
  4. Wang ZJ, Gao J, Li J. [Study on the anatomy of superficial musculo aponeurotic system related to rhytidectomy]. Chin J Pract Aesthet Plast Surg 1992;3:127-30. Chinese.
  5. Wang ZJ, Wang N, Hu G, Zhang C, Wang J, Gao J. [The anatomy study and clinical signification of the branches of the facial nerve out of the parotid gland]. J Tissue Eng Reconstr Surg 2006;2:31-4. Chinese.
  6. Aston SJ, Steinbrech DS, Walden JL. Aesthetic plastic surgery. Li J, Dai Q, Qiu K, translators. Beijing: Peking University Medical Press; 2012. p. 57-8. Chinese.
  7. Mendelson BC, Jacobson SR. Surgical anatomy of the midcheek: facial layers, spaces, and the midcheek segments. Clin Plast Surg 2008;35:395-404; discussion 393.
    Pubmed CrossRef
  8. Wang ZJ, Ma X, Yang L, Wang Y, Chen L, Lv H. High SMAS face lift: clinical experience. J Cosmet Med 2017;1:112-9.
    CrossRef
  9. Alpert BS. High SMAS face lift. In: Frame JD, Bagheri SC, Smith DJ Jr, Khan HA, editors. Aesthetic surgery techniques: a case-based approach. Edinburgh: Elsevier; 2019. p. 81-9.
    CrossRef
  10. Guyuron B, Seyed Forootan NS, Katira K. The super-high SMAS facelift technique with tailor tack plication. Aesthetic Plast Surg 2018;42:1531-9.
    Pubmed CrossRef
  11. Wang ZJ, Wang Y, Shi H, Fan W, Dang N, Ma X, et al. [Key points of high SMAS facelift]. Chin J Plast Surg 2018;34:809-13. Chinese.
  12. Yang N, Wang Z, Wang B, Su X, Lu N. [Anatomic study of malar fat pad and aging analysis]. Chin J Plast Surg 2012;5:28:212-7. Chinese.
  13. Swift A, Remington K. BeautiPHIcationTM: a global approach to facial beauty. Clin Plast Surg 2011;38:347-77.
    Pubmed CrossRef
  14. Wang ZJ, Bai C, Li G, Teng X, Yang L, Li Y, et al. [Compartmentalization and local structural anatomy of the face and neck including the midface area, buccal fat pad, and modiolus]. Chin J Aesthet Plast Surg 2019;30:640-6. Chinese.
  15. Wang ZJ. [Compartmentalization and local structural anatomy of the face and neck: superficial musculoaponeurotic system]. Chin J Aesthet Plast Surg 2020;31:531-4. Chinese.
  16. Wang ZJ, Wang N, Tian H, Zhang C, Gao J. [Mixed tumor of parotid gland excised by retrograde dissection of facial nerve under full exposure]. Chin J Aesthet Plast Surg 2010;21:464-7. Chinese.

Article

Original Article

J Cosmet Med 2021; 5(2): 57-66

Published online December 31, 2021 https://doi.org/10.25056/JCM.2021.5.2.57

Copyright © Korean Society of Korean Cosmetic Surgery.

Difficulties of facelift in patients with scar after treatment of facial liposuction or thread lift sutures

Zhi-Jun Wang, MD, PhD1 , Guanyi Li, MD1 , Shuzhong Guo, MD, PhD2 , DongQing Fu, MD3 , Bozhang Shen, MD3 , Chengxin Bai, MD1

1Institute of Facial Rejuvenation, Plastic Surgery Hospital of Xi’an International Medical Center, Xi’an, China
2Plastic Surgery Hospital Ear in Manufacturing Center, Xi’an International Medical Center, Xi’an, China
3Medical School of Yanbian University, Ji Ling, China

Correspondence to:Zhi-Jun Wang
E-mail: 13998552625@163.com

Received: July 1, 2021; Revised: November 24, 2021; Accepted: November 24, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective: To explore the methods and safety of general abnormal anatomical layers and structure in rhytidectomy, which is also of clinical significance. In this group, 39 patients with static and dynamic deformities formed at different levels after liposuction and thread technique more than one time were treated with stable and active separation skills in high SMAS facelift operation. The results showed that the patients of this group could get the same effect of younger postoperative operation as “initial face” and solve dynamic adhesion deformity.
Methods: Magnetic resonance imaging and ultrasound were performed before operation, focusing on the abnormal changes of facial soft tissue. The results showed that the signal of the foreign body, the position and texture of scar, the relationship between scar and masseter fascia, buccal fat pad, and whether there was tissue defect or hyperplasia. In the operation, the normal separation was made in the second and fourth layers of the previously safe and easy to separate plane, instead of in the dense one or two layers of the scar. It is an alternative microsurgical separation technique. The key point is to separate the incomplete SMAS flap to achieve the expected good effect of rhytidectomy, release the scar adhesion and facial spasm. At the same time, the severed injury of facial nerve branches should be strictly prevented.
Results: 74 cases of facelift were taken in recent eight months and 67 patients were treated with micro plastic surgery. Among them, 39 patients received more than one facial liposuction and more than one thread lift. In the scar formed by liposuction and thread technology, liposuction is especially serious; liposuction can still absorb the structural layer, and scar directly involves the SMAS and buccal fat pad envelope containing facial nerve branches, one of which directly causes the injury of the mandibular marginal branch. Most of the chronic granuloma scar formed after the degradation of the thread technology is in the facial space, which causes the scar atresia of the space. The flap and SMAS flap of 39 cases were separated, most of which were facial nerve branches in scar. All of them were difficult to separate and form the SMAS flap of superficial temporal fascia-Orbicularis oculi-platysma, and 89.6% of the excellent facelift effect was obtained. Facial nerve injury was found in 2 cases, 1 case was right mandible marginal branch traction injury, and the other side was left corner nerve injury. In the process of recovery.
Conclusion: For patients with facial liposuction and thread technique, doctors must be prepared for the difficult separation of scar adhesion and have a high risk of facial nerve branch disconnection. If we don’t pursue the rejuvenation effect, it will lead to the existence of surgical effect discount, bilateral asymmetry, and dynamic adhesion deformity.

Keywords: aspiration lipectomy, cicatrix, facial nerve, rhytidoplasty, scar, sutures

Fig 1.

Figure 1.Platysma plasty.
Journal of Cosmetic Medicine 2021; 5: 57-66https://doi.org/10.25056/JCM.2021.5.2.57

References

  1. Barton FE Jr. The “high SMAS” face lift technique. Aesthet Surg J 2002;22:481-6.
    Pubmed CrossRef
  2. Wang ZJ, Bai C, Li G, Wang Y, Teng X, Gao J. [Compartmentalization and local structural anatomy of the face and neck: facial layers anatomy]. Chin J Aesthet Plast Surg 2020;31:128-33. Chinese.
  3. Zhang C, Wu L, Wang J. [Depressor orbicularis lateralis: concept, anatomy and clinical relevance]. Chin J Plast Surg 2018;34:977-80. Chinese.
  4. Wang ZJ, Gao J, Li J. [Study on the anatomy of superficial musculo aponeurotic system related to rhytidectomy]. Chin J Pract Aesthet Plast Surg 1992;3:127-30. Chinese.
  5. Wang ZJ, Wang N, Hu G, Zhang C, Wang J, Gao J. [The anatomy study and clinical signification of the branches of the facial nerve out of the parotid gland]. J Tissue Eng Reconstr Surg 2006;2:31-4. Chinese.
  6. Aston SJ, Steinbrech DS, Walden JL. Aesthetic plastic surgery. Li J, Dai Q, Qiu K, translators. Beijing: Peking University Medical Press; 2012. p. 57-8. Chinese.
  7. Mendelson BC, Jacobson SR. Surgical anatomy of the midcheek: facial layers, spaces, and the midcheek segments. Clin Plast Surg 2008;35:395-404; discussion 393.
    Pubmed CrossRef
  8. Wang ZJ, Ma X, Yang L, Wang Y, Chen L, Lv H. High SMAS face lift: clinical experience. J Cosmet Med 2017;1:112-9.
    CrossRef
  9. Alpert BS. High SMAS face lift. In: Frame JD, Bagheri SC, Smith DJ Jr, Khan HA, editors. Aesthetic surgery techniques: a case-based approach. Edinburgh: Elsevier; 2019. p. 81-9.
    CrossRef
  10. Guyuron B, Seyed Forootan NS, Katira K. The super-high SMAS facelift technique with tailor tack plication. Aesthetic Plast Surg 2018;42:1531-9.
    Pubmed CrossRef
  11. Wang ZJ, Wang Y, Shi H, Fan W, Dang N, Ma X, et al. [Key points of high SMAS facelift]. Chin J Plast Surg 2018;34:809-13. Chinese.
  12. Yang N, Wang Z, Wang B, Su X, Lu N. [Anatomic study of malar fat pad and aging analysis]. Chin J Plast Surg 2012;5:28:212-7. Chinese.
  13. Swift A, Remington K. BeautiPHIcationTM: a global approach to facial beauty. Clin Plast Surg 2011;38:347-77.
    Pubmed CrossRef
  14. Wang ZJ, Bai C, Li G, Teng X, Yang L, Li Y, et al. [Compartmentalization and local structural anatomy of the face and neck including the midface area, buccal fat pad, and modiolus]. Chin J Aesthet Plast Surg 2019;30:640-6. Chinese.
  15. Wang ZJ. [Compartmentalization and local structural anatomy of the face and neck: superficial musculoaponeurotic system]. Chin J Aesthet Plast Surg 2020;31:531-4. Chinese.
  16. Wang ZJ, Wang N, Tian H, Zhang C, Gao J. [Mixed tumor of parotid gland excised by retrograde dissection of facial nerve under full exposure]. Chin J Aesthet Plast Surg 2010;21:464-7. Chinese.

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