Asian Facelift

The Asian facelift requires an adaptation of current techniques to achieve a desired aesthetic outcome. Cultural differences and differences in anthropomorphologic features alter a patient's vision of beauty and youthfulness. Rejuvenation of the aging Asian face mandates a set of strategies, including understanding cultural aspects of Asian patients, anatomy of Asian patients, and appropriate techniques based on these cultural and anatomic considerations. For stable application and results, the surgeon must understand surgical facial anatomy. If performed properly, facelifts can improve facial balance and can yield aesthetically more appealing results. The deep plane facelift technique presented is well suited for Asian patients.

Cervicomental angle definition in the youthful patient (less than 40 years)

In clinical practice nowadays, one is faced with a group of patients still in their youth, demanding a more defined cervicomental angle. This specific group, aging less than 40 years of age, while the classical approach in this population addresses the osseous structures as per genioplasty or mental prosthesis, and for soft tissue definition, they frequently undergo submental liposuction. We noticed that in certain cases this is not enough and the patients can be still dissatisfied, these patients can highly benefit from our technique using the digastric corset in order to restore this congenital absence of cervicomental angle definition. This technique addresses and treats the anatomical malposition of the floor of the mouth, resulting in cervicomental angle widening in the youthful individual. In this technical note we will state the anatomical detail explaining its specific indication and benefit, specifically in this age group.

[Anatomical basis for rejuvenation surgery]

The understanding of the face anatomy is mandatory before to be able to appreciate the different surgical techniques of face lifting. Despite numerous controversies and anatomical variations, we can find in the literature several keystone works that allows us to understand that the soft tissues of the face are not only a superposition of layers but also a tridimensionnal structure with a fibrous system that links the different layers. This structures creates a mix loose spaces, fat and retaining ligament that can be describe in a quite systematic manner. This systematisation can help the surgeon during the surgical procedure to search and find the area where there is no danger and alert him around the retaining for example, which is where we can often find a vessel or a branch of the facial nerve that we want to avoid. This article summarizes these anatomical knowledge.

Presto lift-a facelift that preserves the retaining ligaments and SMAS tethering

Background

Producing youthful facial appearance by face-lifting often comes along with an undesired loss of patient’s individual phenotype. This may result from insufficient preservation of retaining ligaments, the “guardians of facial identify,” and from severance of the intersegmental connections of the superficial musculo-aponeurotic system (SMAS), which tether, structure, and compartmentalize facial soft tissue into defined, relevant anatomical zones.

Methods

The technique reported here preserves most retaining ligaments. They serve to fix the facial soft tissue mass in loco. With the possible exception of the zygomatic-cutaneous ligament, they are only carefully distended. The SMAS intersegmental connections and the zygomatic SMAS border are preserved to retain effective points of facial tissue fixture. Aging-associated thinning and lengthening of the lower eyelid are reduced by midfacial-submalar preparation (Aston 1996). Subplatysmal preparation and disconnection of the cranial-platysmal border permits optimal modeling of neck structure.

Results

The combination of preservation of retaining ligaments and SMAS tethering (“PRESTO facelift”) introduced here as a novel face-lifting technique conserves the individual esthetics of the patient by approaching her/his individual phenotype from decades ago. In addition, undesired outcomes of facelift surgery and common risks of facelift surgery are circumvented.

Conclusions

The PRESTO facelift technique generates optimal esthetic results that conserve a patient’s personal facial identity, besides restoring a more youthful appearance and being rapid and safe.