Clinical Investigation On Skin Changes After Face Lift Involving Extensive And Multi-plane Dissection And Suspension

Objective1.Forehead aging is charaterized by wrinkles, skin laxity, brow ptosis and volume loss. Glabellar wrinkle is caused by constant contraction of the brow depressor complex. Corrugator muscle resection is a surgical goal of forehead lift,which can cause or aggravate glabellar depression, a sign of forhead aging. Instead of corrugator muscle resection, a reversed periosteum or dermal fat graft was used to cover the corrugator muscle to efface the glabellar wrinkle as well as avoid glabellar depression. The surgical method was reviewed and evaluated.2.Management of SMAS has been the work horse since its description. However, it is related to the undercorrection of midface ptosis and nasolabial groove. Meanwhile,it is underdiscussed on the management of orbicularis ocluli muslce. A modified technique involving SMAS dissection and multiple parallel suspension of SMAS and orbicularis oculi muscle was introduced and evaluated.3.It has not been investigated on the skin changes after face lift. A prospective study was conducted to explore skin condition and histological changes after face lift.4.The essence of skin aging improvement lies in the production of collagen. Extensive subcutaneous dissection can stimulate dermal fibroblasts to produce collagen through the process of wound healing. However, it is still unclear on what effects can tissue tension produce on collagen, which has been investigated in this article.Methods1. A retrospective study was conducted on patients that underwent forehead lift during January 2005 and December 2014. A follow-up more than 6 months was set as an inclusion criterion and second forehead lift was excluded. Preoperative and postoperative glabellar wrinkles were scored based on the classification by Lemperle to evaluate the clinical result.2. A retrospective study was established on patients that received modified SMAS face lift between January 2011 and December 2014. A telephone interview was done with Owsley questionnaire to evaluate the clinical result and patient satisfaction.3. A prospective study was designed to investigate the change of skin condition after face lift. Patients that underwent face lift from November 2014 to April 2015 were included according to the inclusion and exclusion criterion. Objective, subjective and histological evaluations were used in this study.4. Effects of tissue tension on collagen arrangement and production were explored through an animal experiment in which tension was allocated differently to the elevated skin flap. Skin biopsies and histological evaluations were done at one and three months after the surgeryResult1. A total of 206 patients underwent forehead lift during the period. The score of glabellar wrinkles decreased from 2.95 preoperatively to 0.25 postoperatively with a statistical significance (p<0.05). There was no depression or irregularity in the glabellar region with well survival of dermal fat graft.2. Complete questionnaires were obtained from 59 patients while there were 128 face lifts with a follow-up of 3.61 years on average. Satisfactory result was achieved with minimal complications.3. Skin condition improved significantly after face lift from the objective and subjective results. Histological evaluation revealed that epidermal thickness increased along with dermal collagen content. Collagen and elastic fibers were more condensed after surgery than before, suggesting the dermal regeneration after face lift.4. Compared with the control group, the collagen and elastic fibers were coarser with significant production in the experimental groups. The most significant changes were observed in the group with the maximum tension.Conclusion1. The modified technique can achieve the effacement of glabellar wrinkles as well correction of glabellar depression. Glabellar rejuvenation can be achieved.2. Satisfactory results can be obtained in dealing with midface ptosis and nasolabial groove by face lift incorporating extensive dissection and suspension of SMAS and orbicularis oculi muscle.3. Skin regeneration after face lift can help maintain the postoperative result. Extended subcutaneous dissection along with removal of lax skin as much as possible are the key points of face lift.4. Tissue tension can stimulate the production of collagen which is of utmost importance in skin regeneration. Therefore, wide subcutaneous dissection with optimal flap tension can enhance the postoperative results.