By APS
Facial rejuvenation procedures can be roughly divided into face lift surgery and nonoperative, less invasive procedures, such as fat grafts, fillers, botulinum toxin injections, thread lifts, or laserbrasion. Face lift surgery or rhytidectomy is the procedure most directly associated with rejuvenation, due to its fundamental ability to restore the anatomical changes caused by aging. Various methods of face lift surgery have been developed over the last hundred years, thanks to advances in the understanding of facial anatomy and the mechanisms of aging, as well as the dedication of innovative surgeons. However, no generally applicable standard method exists, because the condition of each patient is different, and each operative method has advantages and disadvantages. Specific characteristics of the skin of Asians and their skeletal anatomy should be considered when determining the operative method to be used on Asian patients. Plastic surgeons should improve their ability to analyze the original aesthetic properties and problem areas of each patient, drawing on scientific knowledge about the aging process, and they should develop the skills necessary to perform various rejuvenative techniques. In the present article, we reviewed various face lift procedures and the current methods of modified double plane face lift, based on our clinical experience of over 30 years.
The demand for a youthful and attractive appearance has recently increased as the population has aged and mass media have promoted the desire for beauty. Facial rejuvenation is different from other aesthetic procedures in that it directly restores a younger appearance in patients; therefore, proper knowledge of the anatomical aspects of the aging process is mandatory. The severity of the aging process, the areas of major involvement, the character of the skin, and skeletal appearance vary among patients. Individual factors, such as the patient’s expectations, the recovery time required until the patient can return to daily social activities, and the patient’s economic status also influence the choice of rejuvenation method. Hence, one of the greatest difficulties surgeons face in approaching facial rejuvenation is individual diversity, in light of the plethora of technical approaches available for improving the appearance of aging faces.
Early works describing face lift surgery date from the early twentieth century. In the early stage, procedures were limited to simple skin excision and primary closure without subcutaneous undermining or deep tissue manipulation [1,2,3,4]. Subsequently, more elaborate surgical methods were developed to achieve longer lasting and more aesthetically satisfactory results. A number of studies regarding facial structure and the aging process have been conducted [5,6,7,8,9]. Bames [10] described subcutaneous undermining and skin redraping, and Skoog [11,12] presented the dissection of the superficial fascial layer and platysma as a single myofascial unit. Since these early studies by the pioneers of the field, face lift procedures have evolved from subcutaneous face lifts to deeper plane face lifts (e.g., the superficial musculoaponeurotic system (SMAS), composite, subperiosteal, and double planes), as surgical procedures were technically refined and knowledge of facial anatomy accumulated [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28].
A number of face lift procedures and their modifications have been introduced by many surgeons, but no consensus has yet been established regarding a generally superior procedure or clear indications for various surgical methods. In the field of plastic surgery, the personal viewpoint of each surgeon still strongly influences the choice of surgical method. Therefore, it is important for surgeons to be aware of the advantages and disadvantages of each operative technique, in order to ensure that they use the optimal face lift methods for their patients (Table 1).
