What is a Short Scar Composite Facelift Technique?

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As we have previously discussed, our recognition of self is intimately associated with our faces. This intricate anatomical organ helps us not only in vital life requirements of breathing and eating but in people it is the most important organ of higher social function. Facial expressions, our speech and gestures define and give context to our life experiences and our relationships with others. This is also reflected in the way others and society sees us.

As we have seen over the last 40 years, our increased knowledge of facial anatomy as well as the ageing process has allowed us to establish scientific and anatomically sound techniques for achieving facial rejuvenation through facelift surgery. In this practiced manipulation of the

Superfical Musculo-Aponeurotic System (SMAS) layer using one of a multitude of facelift surgeries is vital in achieving natural and long lasting outcome techniques. We have previously discussed through our blog series the facelift techniques; the classic, SMAS-ecomty, SMAS plication, extended SMAS as well as high SMAS surgical techniques which involve wide undermining of the skin prior to manipulation of the SMAS in accordance to the facelift technique being utilised.

Composite Facelift Technique

The composite facelift surgery technique seeks to reduce the amount of skin undermining and to manipulate the skin and SMAS layer as a single unit. There are a number of advantages to this technique which when performed correctly, yields arguably the most natural long lasting results as well as the quickest recovery period. In this technique, a short scar incision is performed to gain access to the face and subsequently, the deep plane to the SMAS is entered whilst protecting the facial nerve branches (Figure 1 & 2). By dividing the ligaments that connect the overlying skin and SMAS to the underlying skeleton, the composite unit is advanced as a whole. With permanent retaining sutures put in place, both the amount of skin undermining as well as skin excision become minimal. The skin is closed without a dead space or tension resulting in better wound healing, less post-operative oedema and faster recovery.

In entering the spaces of the face, a detailed understanding of the facial nerve anatomy and its path is vital to this technique. The composite facelift technique offers the most anatomically sound approach to facial rejuvenation surgery whilst arguably providing the most natural long lasting facial rejuvenation results.

Figure 1 (72 year old woman undergoing total facial rejuvenation including composite facelift, neck lift, upper and lower blepharoplasties).

Figure 2 (Minimal dissection composite facelift. Skin flap undermining is limited to the cross‐hatched area. Sub‐SMAS dissection only is employed forward of this, and is limited to the premasseter spaces. No dissection is required forward of the yellow line at the anterior border of the masseter).

 

All illustrations are reproduced with permission Farhadieh RD, Bulstrode N, Cugno S: Plastic and Reconstructive Surgery: Approaches and Techniques,Wiley & Blackwell, London, UK, 2015.

Ross Farhadieh
Mr Farhadieh is an internationally renowned Australian qualified and trained Plastic Surgery. He holds fellowship qualifications in Plastic Surgery from Royal Australian College of Surgeons, Royal College of Surgeons (England) as well the European Board of Plastic Reconstructive Aesthetic Surgery. He has multiple clinical subspecialty fellowships in Cosmetic, Pediatrics as well as Microsurgery from World Leading institutes in London.
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