RSS-Feed abonnieren

DOI: 10.5935/2177-1235.2023RBCP0823-PT
From Surface to Depth: Learning Curve in Extended Deep Facelift - My First 100 Cases
Artikel in mehreren Sprachen: português | English
▪ ABSTRACT
Introduction:
Facial aging is a gradual, complex, and multifactorial process. It is the result of changes in the quality, volume, and positioning of tissues. Plastic surgeons have modified their approach to facial rejuvenation surgery, opting for the subaponeurotic plane (SMAS). The objective of this study is to analyze 100 cases of patients operated on using the deep SMAS technique, evaluating its applicability and effectiveness.
Method:
100 patients were evaluated, undergoing facial plastic surgery using the deep SMAS technique - “Deep Smas”, and followed up for 6 months. Patient satisfaction, number of complications, number of reoperations, risks, and advantages of the technique were observed.
Results:
100 patients were operated on over 3 years. Age ranged from 41 to 79 years, with 95% being female. The complications were 8 cases (8%) of injuries to branches of the facial nerve, of which 4 cases of zygomatic injury, 3 cases of mandibular injury, and 1 case of buccal injury; there was 1 case (1%) of post-auricular keloid; 1 case (1%) of hematoma. Regarding surgical revisions, there were 8 cases (8%) of surgical completion due to patient dissatisfaction. There were 15% of nerve injuries between the 1st and 40th surgery, 5% between the 41st and 80th, and no injuries between the 81st and 100th patient.
Conclusion:
Deep facial lifting or subSMAS has proven to be effective, providing good aesthetic results. It has a low recurrence rate and low morbidity rate; however, it requires a long learning curve.
Keywords:
Face - Plastic surgery procedures - Esthetics - Cosmetic techniques - Facial nerve - Learning curveInstitution: Clínica Privada de cirurgia Plástica, Curitiba, PR, Brazil.
Publikationsverlauf
Eingereicht: 05. Juni 2023
Angenommen: 20. August 2023
Artikel online veröffentlicht:
20. Mai 2025
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
LINCOLN GRAÇA NETO, ANA CLARA MINGUETTI GRAÇA, SUSANA PUGA RIBEIRO. Da superfície para a profundidade: Curva de aprendizado em lifting facial profundo estendido - meus primeiros 100 casos. Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Surgery 2024; 39: 217712352023rbcp0823pt.
DOI: 10.5935/2177-1235.2023RBCP0823-PT
-
REFERENCES
- 1 Jacono AA. A Novel Volumizing Extended Deep-Plane Facelift: Using Composite Flap Shifts to Volumize the Midface and Jawline. Facial Plast Surg Clin North Am 2020; 28 (03) 331-368
- 2 Warren R, Gartstein V, Kligman AM, Montagna W, Allendorf RA, Ridder GM. Age, sunlight, and facial skin: a histologic and quantitative study. J Am Acad Dermatol 1991; 25 (5 Pt 1): 751-760
- 3 Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet Surg J 2006; 26 (1S): S4-9
- 4 Ferreira LM, Horibe EK. Understanding the finger-assisted malar elevation technique in face lift. Plast Reconstr Surg 2006; 118 (03) 731-740
- 5 Furnas DW. The retaining ligments of the cheek. Plast Reconstr Surg 1989; 83 (01) 11-16
- 6 Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 2007; 119 (07) 2219-2227
- 7 Rohrich RJ, Pessa JE. The retaining system of the face: histologic evaluation of the septal boundaries of the subcutaneous fat compartments. Plast Reconstr Surg 2008; 121 (05) 1804-1809
- 8 Skoog T. Plastic Surgery: New Methods and Refinements. Philadelphia: Saunders; 1974: 300-330
- 9 Hamra ST. The deep-plane rhytidectomy. Plast Reconstr Surg 1990; 86 (01) 53-61
- 10 Hamra ST. Composite rhytidectomy. Plast Reconstr Surg 1992; 90 (01) 1-3
- 11 Barton FE Jr. The SMAS and the nasolabial fold. Plast Reconstr Surg 1992; 89 (06) 1054-1057
- 12 Barton FE Jr. The “high SMAS” face lift technique. Aesthet Surg J 2002; 22 (05) 481-486
- 13 Aston SJ. The FAME technique, presented at the Aging Face Symposium. Waldorf Astoria Hotel, New York; 1993
- 14 Mendelson BC, Muzaffar AR, Adams Jr. WP. Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg 2002; 110 (03) 885-896 ; discussion 897-91
- 15 Mendelson BC, Freeman ME, Wu W, Huggins RJ. Surgical anatomy of the lower face: the premasseter space, the jowl, and the labiomandibular fold. Aesthetic Plast Surg 2008; 32 (02) 185-195
- 16 Hashem AM, Couto RA, Duraes EFR, Çakmakoğlu Ç, Swanson M, Surek C. et al. Facelift Part I: History, Anatomy, and Clinical Assessment. Aesthet Surg J 2020; 40 (01) 1-8
- 17 Brandt MG, Hassa A, Roth K, Wehrli B, Moore CC. Biomechanical properties of the facial retaining ligaments. Arch Facial Plast Surg 2012; 14 (04) 289-294
- 18 Jacono AA, Parikh SS. The minimal access deep plane extended vertical facelift. Aesthet Surg J 2011; 31 (08) 874-890
- 19 Jacono AA, Malone MH. Characterization of the Cervical Retaining Ligaments During Subplatysmal Facelift Dissection and its Implications. Aesthet Surg J 2017; 37 (05) 495-501
- 20 Jacono AA, Bryant LM, Ahmedli NN. A Novel Extended Deep Plane Facelift Technique for Jawline Rejuvenation and Volumization. Aesthet Surg J 2019; 39 (12) 1265-1281
- 21 Graf R, Groth AK, Pace D, Graça Neto L.. Facial rejuvenation with SMASectomy and FAME using vertical vectors. Aesthetic Plast Surg 2008; 32 (04) 585-592
- 22 Graf R, Graça Neto L, Araújo LR, Bernardes A, Rippel R, Auersvald A. Vertical vectors in SMASectomy to reshape the aging face. Aesthet Surg J 2003; 23 (03) 198-201
- 23 Gassner HG, Rafii A, Young A, Murakami C, Moe KS, Larrabee Jr. WF. Surgical anatomy of the face: implications for modern face-lift techniques. Arch Facial Plast Surg 2008; 10 (01) 9-19
- 24 Hamra ST. The zygorbicular dissection in composite rhytidectomy: an ideal midface plane. Plast Reconstr Surg 1998; 102 (05) 1646-1657
- 25 Stuzin JM, Baker TJ, Gordon HL, Baker TM. Extended SMAS dissection as an approach to midface rejuvenation. Clin Plast Surg 1995; 22 (02) 295-311
- 26 Hamra ST. Deep plane facelift. In: American Society of Aesthetic Plastic Surgery Midwinter Symposium of Facial Rejuvenation; 1989 Jan 12-13; Santa Barbara; CA, USA
- 27 Hamra ST. Building the Composite Face Lift: A Personal Odyssey. Plast Reconstr Surg 2016; 138 (01) 85-96
- 28 Auersvald A, Auersvald LA. Anatomia Cirúrgica da Face e do Pescoço. In: Full Face & Neck Surgical Anatomy; 2020 Mar 6-8; São Paulo, SP, Brasil
- 29 Auersvald LA, Auersvald A. The Short Neck: Challenges and Techniques. Facial Plast Surg 2022; 38 (06) 650-667
- 30 Minelli L, Yang HM, van der Lei B, Mendelson B. The Surgical Anatomy of the Jowl and the Mandibular Ligament Reassessed. Aesthetic Plast Surg 2023; 47 (01) 170-180
- 31 Hopper AN, Jamison MH, Lewis WG. Learning curves in surgical practice. Postgrad Med J 2007; 83 (986) 777-779
- 32 Santos EG, Bravo Neto GP.. Curva de aprendizado e lesões iatrogênicas em colecistectomias videolaparoscópicas. Rev Col Bras Cir 2010; 37 (03) 184-189
- 33 Colégio Brasileiro de Cirurgiões. [acesso 2008 Jun 22]. Disponível em: www.cbc.org.br
- 34 Tapking C, Kowalewski KF, Hundeshagen G, Kneser U, Hirche C. A. Systematic Review of Learning Curves in Plastic and Reconstructive Surgery Procedures. Ann Plast Surg 2020; 85 (03) 324-331
- 35 Jacono AA, Alemi AS, Russell JL. A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques. Aesthet Surg J 2019; 39 (09) 927-942
- 36 Kamer FM, Frankel AS. SMAS rhytidectomy versus deep plane rhytidectomy: an objective comparison. Plast Reconstr Surg 1998; 102 (03) 878-881
- 37 Jones BM, Lo SJ. How long does a face lift last? Objective and subjective measurements over a 5-year period. Plast Reconstr Surg 2012; 130 (06) 1317-1327