in office facial rejuvenation part i short scar mini-facelift

aocoohns.org

in office facial rejuvenation part i short scar mini-facelift

IN OFFICE FACIAL REJUVENATION PART I

SHORT SCAR MINI-FACELIFT

Kevin S. Sadati, D.O. ,FAACS

, ,

Newport Beach, California


SHORT SCAR MINI MINI-FACELIFT FACELIFT USING LOCAL ANESTHESIA

Minimally yinvasive facial rejuvenation j for lower

face and neck

Office procedure p

Good results

Less complex p with fewer complications p

More affordable

Selected patients/not for everyone


PATHOPHYSIOLOGY OF THE AGING FACE

Courtesy of Romo & Millman

Facial aging characteristics

Gravitational migration of tissues

Skin

Subcutaneous fat

Superficial fascia

Increasing prominence of NLFs

Downward-drooping jowls

Laxity y of submental and anterior

neck tissues

Perioral and periorbital changes


PATIENT SELECTION FOR IN IN-OFFICE IN OFFICE PROCEDURES

Health

Stable BP and cardiac status

CAD, CVD, PVC

SStable bl respiratory i status

COPD, OSA, Smokers

DM Skin disorder Keloid formation

DM, Skin disorder, Keloid formation

Epinephrine sensitivity/Lidocaine allergy

Anti coagulation therapies

g p

Medicine use: ASA/NSAIDs, vitamin E,

OTC herbal supplements (gingko biloba, fish oil)


PATIENT SELECTION FOR IN IN-OFFICE IN OFFICE PROCEDURES

Psychological y g status

Find patient desires/motivations

Realistic expectation

Rejuvenation / not beautification

Not overly y anxious

Prefer local anesthesia surgery

Compliance

Don’t operate, if you don’t feel positive


PERTINENT PREOPERATIVE FACIAL EXAM

Anatomical evaluation

Extend of skin laxity

Buccal and submental fatty deposit

Chin and neck position

Asymmetries and facial weaknesses

Mirror demonstration


SHORT SCAR MINI-FACELIFT MINI FACELIFT IN OFFICE

Ideal Candidate Not a good candidate


NECK POSITION


MIRROR DEMONSTRATION


PHOTO DOCUMENTATION


PATIENT MARKING


SEDATION

Oral Benzodiazepam

Valium, Ativan, Xanax, Halcion

IM Versed

Benadryl


LOCAL ANESTHESIA

Warmed tumescent local anesthesia solution.

4 cc 1% lidocaine with epi, 2cc sodium

bicarbonate, 4cc of normal saline in a 10 cc

syringe. i

60 to 80 cc infiltration (24-32 cc of Lido with epi)

WWarmed d MMarcaine i tumescent infiltration i fil i to

submental and jowl area.

9 9cc 0.25% 0 25% Marcaine M i with ith epi i and d 21cc 21 of f normal l

saline

Small needles


LOCAL ANESTHESIA

Warm Dilute Lidocaine solution Warm Marcaine tumescent solution


BASIC FACELIFT INSTRUMENT


WHAT IS SMAS?

Superficial Musculo-Aponeurotic System y

Distinct fibromuscular layer envelops face and neck

Extends from Galea to the platysma

Temporoprietall facial l SMAS Platysma l

Divides the subcutaneous fat into deep and

superficial

Connects to the Dermis by fibrous septa

Facial Nerve runs under it

Firmly attached to Zygoma and mandible by

ligaments


SMAS S S PLICATION C O IS S A PREFERRED METHOD O FOR O MINI-FACELIFT C

Plication

Folding the SMAS and

suturing it together


VARIOUS PLICATION TECHNIQUES AND METHODS:

Simple interrupted

Horizontal mattress

Purse string

Figure Figure-of-eight of eight

Running locking sutures

DDouble bl “C” plication li ti n ttechnique hni


MY PREFERRED METHOD

Double “C” C Plication

Two layers of

plication

Interlocking running

sutures

Durability

Smooth contouring


FACIAL INTERLOCKING RUNNING SUTURES

Drawing by Charles Guy, D.O.


NECK INTERLOCKING RUNNING SUTURES

Drawing by Charles Guy, D.O.


COMPLETION OF PLICATION

Drawing by Charles Guy, D.O.


SUBMENTAL LIPOSUCTION


PLAYSMAPLASTY


SKIN TRIMMING & CLOSURE


SKIN TRIMMING & CLOSURE


TABLE 1: COMPLICATION OF “C” PLICATIONS (TOTAL PATIENTS 1532)

Complication Female Male Total Percentages

Major Hematoma 13/1445 (0.9%) 7/87 (8%) 20/1532 (1.3%)

Minor Hematoma 67/1445 (4.6%) 12/87 (13.7%) 79/1532 (5%)

Mersilene Extrusion 11/581 (1.9%) 1/33 (3%) 12/614 (1.9%)

Vicryl Extrusion 0/864 (0% ) 0/54 (0%) 0/918 (0%)

Infection 7/1445 (0.5%) 1/87 (1%) 8/1532 (0.5%)

Greater Auricular Nerve Injury 2/1445 (0.1%) (0 1%) 0/87 (0%) 2/1532 (0.1%) (0 1%)

Facial Nerve Injury 0/1445 (0%) 0/87 (0%) 0/1532 (0%)

Post Auricular Skin Necrosis

(>2cm)

Major Revision for

unsatisfactory results

12/1445 (0.8%) 0/87 (0%) 12/1532 (0.8%)

10/1445 (0.7%) 1/87 (1%) 11/1532 (0.7%)

Female Patients- 1445, Male Patients- 87, Mersilene- 614, Vicryl- 918


PATIENT’S PATIENT S PHOTO


PATIENT’S PATIENT S PHOTO


PATIENT’S PATIENT S PHOTO


PATIENT’S PATIENT S PHOTO


PATIENT’S PATIENT S PHOTO


PATIENT’S PATIENT S PHOTO


PATIENT’S PATIENT S PHOTO


PATIENT’S PATIENT S PHOTO

More magazines by this user
Similar magazines