Bruce F. Connell

Longevity of SMAS facial rejuvenation and support.

Background: One of the most common questions asked by patients when they present for face lift surgery is “How long will this last?” The answer to this question is not clear from the literature. Methods: The purpose of the study was to review a series of secondary face lifts performed between 2001 and 2008 with both the primary and secondary face lift performed by a single surgeon. There were 42 patients with full records available for review. Data were collected with regard to timing, surgical technique, complications, and reasons for early revision. Results: The average age at the primary face lift was 50.2 years (range, 34.9 to 69.9 years) and the average age at the secondary face lift was 61.9 years (range, 43.6 to 77.2 years). The average length of time from the primary to secondary face lift was 11.9 years. Nine patients required a secondary face lift before it had been 5 years since the primary face lift (21.4 percent). Reasons for early secondary face lift (within 5 years of the primary) included loss of skin elasticity in five patients and increase in subplatysmal fat and skin neck folds due to weight gain, loss of elasticity secondary to protease inhibitors for human immunodeficiency virus infection, loss of skin elasticity due to corticosteroid use, and residual fullness of digastric and residual submental fat in one patient each. Conclusions: On average, a well-performed superficial musculoaponeurotic system flap face lift will last 12 years. Those patients who present with very poor skin elasticity secondary to sun damage may require an earlier secondary face lift.

The trifurcated SMAS flap: Three-part segmentation of the conventional flap for improved results in the midface, cheek, and neck

While SMAS surgery revolutionized facelift procedures, the single flap created by conventional dissections suffers the drawback that it can only be advanced in one direction and sutured in place under uniform tension. Division of the flap into three segments overcomes this problem and allows independent pull to be applied in different directions to the upper midface, cheek, and neck.

Pushing the Clock Back 15 to 20 Years with Facial Rejuvenation

The goal of rejuvenation is to restore the good looks present 15 to 18 years before without having signs of surgical improvement. Patients should look like themselves at a younger age with specific improvement not present when younger, such as nose or neck contour.

Male Face Lift

The author describes how to use the deep layer support technique for male face lift to achieve natural-looking results and virtually undetectable scars. He discusses incisions and neck contouring in detail and provides pointers on eliminating crows-feet. (Aesthetic Surg J 2002;22:385-396.).

Correcting Deformities of the Aged Earlobe

An earlobe that appears aged or malpositioned can sabotage the results of a well performed face lift. The most frequently noted sign of a naturally aged earlobe is increased length. Improper planning of face lift incisions may also result in disfigurement of the ear. The author suggests simple excisional techniques to correct the aged earlobe, as well as methods to avoid subsequent earlobe distortion when performing a face lift.

Lower Facial Rejuvenation in the Non-Caucasian Face

The goal would be similar to Caucasian patients in that all patients would like to have maximum improvement with minimal detectability of the surgical procedure. With regard to scars, the incisions must be no longer than necessary to accomplish the desired goal, and should be carefully placed so that color matches are ideal and there is no objectionable hair shift. In addition, the technique of making an incision for male patients should be made so that hairs will grow through the scars whenever possible. For non-Caucasian patients it is essential that attention be made to all of the known details and techniques, to avoid detection that surgery has been performed.

The difficult forehead.

Stanley Klatsky, MD Bruce F. Connell, MD Robert W. Bernard, MD Rollin K. Daniel, MD Dr. Klatsky: The first patient is a 58-year-old woman who is unhappy with her forehead and upper lid appearance (Figure 1). People tell her she looks angry. Note that she is blind in her right eye. Dr. Bernard, how would you improve her forehead, brow, and upper lid complex? Figure 1 This 58-year-old woman is unhappy with her forehead and upper eyelids. People tell her that she looks angry. Dr. Bernard: She does look angry and sad, but it is not just because of her upper face. Her blindness in one eye is an important consideration. I might hesitate to remove fat from her upper eyelids just to avoid the possibility of retrobulbar hematoma. She has a reasonably high forehead, and her brows appear relatively low. I would seriously consider an endoscopic brow lift despite her somewhat high forehead and a skin, only upper lid blepharoplasty. I would resect the procerus and corrugator muscles medially, and I would consider Botox to further improve the transverse forehead lines. Dr. Klatsky: Dr. Connell, how would you approach treatment? Dr. Connell: I always like to see an early photograph from a time when the patient was pleased with his or her appearance; from this I note the desired brow position. Brow placement is easier to determine in women because I simply strive to make them look as pretty as possible, but for men there are about 5 different acceptable brow locations. From this photograph, the height from her nasion to her hairline is 16 cm, and the height from her nose to her chin is 12 mm. She is about 30% higher on the upper third of her face than the lower third. I would avoid making her forehead look …

The Open Browlift

The eyes and periorbital areas are critical components for the harmonious treatment of the aging face. The authors prefer the open browlift for rejuvenation of the forehead area. The open browlift is the most versatile, effective, and long-lasting method for the treatment of the forehead. The analysis of the forehead area, alternative treatments, variations in incisions, and key components of the surgical procedure are to be reviewed.

Reoperative Surgery of the Face

There has been an acceptance of cosmetic surgical procedures in the general population. No longer is cosmetic surgery only for the wealthy and famous. Cosmetic surgery is now featured on television, the Internet, and openly discussed in tabloid magazines. This increased exposure is related to a significant increase in the amount of plastic surgical procedures being performed. The baby boomer generation has generally embraced plastic surgical procedures and many of these patients have had face-lift procedures performed. The American Society of Plastic Surgeons has estimated that there were 112,933 face-lift procedures performed in 2008 [1]. While this number is lower than in previous years, likely due to economic reasons, a substantial number of face-lift procedures are still being performed. This same population of patients continue to desire to maintain their more youthful appearance and therefore they are seeking rejuvenation following an initially successful procedure and thus the topic of secondary face-lifting is gaining significant importance.

Aesthetic Rejuvenation of the Face and Neck

Aesthetic rejuvenation of the face and neck / , Aesthetic rejuvenation of the face and neck / , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی