Wound tension in rhytidectomy. Effects of skin-flap undermining and superficial musculoaponeurotic system suspension

Analysis of flap tension in surgical rejuvenation of the midface: a cadaver study

OBJECTIVE

To determine the flap tension present for 2 different surgical approaches for midface lifts and whether a gingivobuccal incision for release of the midface periosteum will diminish the resultant load on the midface flap.

STUDY DESIGN

Cadaver study.

SETTING

Anatomy laboratory at the University of Florida.

SUBJECTS AND METHODS

Twelve fresh-frozen cadaver heads are subjected to a transblepharoplasty (TB) approach on one side of the cadaver head while a transtemporal (TT) approach is performed on the contralateral side. The tension (grams) generated by moving the midface flap a distance of 1.03 cm is recorded by a digital load cell. A gingivobuccal incision is made on each side to allow transoral periosteal release (TOPR) of the midface flap, and the experiment is repeated. Three trials are performed for each operation, and the average load is calculated. A paired t test is applied.

RESULTS

The tension resulting from the TT approach (172 g) was not found to be significantly different from that of the TB approach (179 g; P = .75). Significant differences in the resultant tension were not appreciated when comparing standard techniques to TT with TOPR (141.5 g; P = .27) or for TB with TOPR (164.1 g; P = .45).

DISCUSSION

An experimental method is described for determining flap tension in facial rejuvenation surgery. No significant difference is found between flap tensions generated in the TB and TT approaches to the midface.

Evolution of Rhytidectomy Techniques

Rhytidectomy techniques have advanced greatly since their inception a century ago. Today, a rich array of procedures is available, ranging from limited and minimally invasive approaches to extensive dissections. The evolution of rhytidectomy is outlined herein, along with a review of the relative indications and advantages of commonly practiced procedures.

Management of large surgical defects of the forehead and scalp by imbrication of deep tissues

BACKGROUND

When facing surgical defects, the dermatologic surgeon follows certain basic principles that help reduce the inherent tension to allow for a better cosmetic outcome. These commonly include the use of undermining, releasing technique such as galeotomy if applicable, selection of suture material of appropriate tensile strength, and closure along relaxed skin tension lines.

OBJECTIVE

To review the imbrication of deep tissues, another surgical principle aimed at wound tension reduction and widely utilized by cosmetic surgeons in forehead lifts and scalp reductions, as it applies to dermatologic surgeons in the repair of large surgical defects of the upper face and scalp. The latter may be utilized both with primary closure and with local flaps.

METHODS

We describe in detail the technique of imbrication of deep tissues and provide illustrations for a better understanding of how to correctly use this surgical principle.

RESULTS

The dermatologic surgeon has an additional tool, termed imbrication of deep tissues, available to aid in the closure of sizable wounds of the forehead and scalp as seen following Mohs surgery for cutaneous malignancies by providing deep tissue support.

CONCLUSION

Imbrication of deep tissue is an effective tool that may be used by dermatologic surgeons in conjunction with the more commonly utilized basic surgical principles to enhance the cosmetic outcome in the closure of large, high-tension defects of the forehead and scalp.

The Webster-type face and neck lift: an extensive cervico-facial rhytidectomy employing a minimally invasive technique

BACKGROUND

Facelifting has incorporated a wide range of new techniques and developments over the past few decades. Many techniques employ a more aggressive surgical approach that may be advocated for seeming advantage, yet upon closer review may be unwarranted for the average patient seeking facial rejuvenation. The Webster-type face and neck lift utilizes a minimally invasive approach to thoroughly resupport the face and neck substructure and skin. This approach affords the patient excellent results while limiting untoward complications.

OBJECTIVE

To evaluate the efficacy of the Webster-type face and neck lift.

METHODS

The Webster-type face and neck lift was utilized in 200 facelift patients. We reviewed these cases for aesthetic results and associated complications.

RESULTS

The great majority of patients have been uniformly pleased with the aesthetic restoration via the Webster-type lift. Postoperative courses have been routinely uneventful and major complications have been avoided.

CONCLUSION

The evolution of more invasive approaches to cervicofacial rhytidectomy has not been shown to produce consistently better or longer-lasting results. Many of these aggressive techniques have extended the operating time, heightened the potential morbidity of the operation, and prolonged the duration of convalescence. The Webster-type lift is a proven, modern approach that provides comparable and lasting results while limiting risk and avoiding serious complications.