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All about plastic surgery facelift, face lift cost, Clinics, facelift before and after photos and pictures. The main facial nerve trunk emerges from the stylomastoid foramen to provide motor innervation to 20 paired muscles of facial expression as well as the posterior belly of the digastric, stylohyoid and stapedius muscles. The zygomatic branch provides motor fibers to the lower orbicularis oculi, procerus, some lip elevator and some nasal muscles.
Transection of the zygomatic and buccal branch leads to unpredictable defects because muscular innervation in the mid face is variable.
The tear trough is a depression near the medial palpebral fissure formed by the separation of the orbicularis oculi and levator labii superioris.
Invested by the deep fascia, 80% of the parotid gland lies between the mastoid process and the posterior border of the mandible. The submandibular glands, often referred to as the submaxillary glands because of the tendency of British anatomists to refer to the mandible as the submaxilla, lie in the submandibular triangles formed by the anterior and posterior bellies of the digastric muscles and the inferior border of the mandible. The lingual nerve wraps around Wharton’s duct, starting lateral and ending medial to the duct, while the hypoglossal nerve parallels the submandibular duct, just inferior to it. The retaining ligaments of the face support soft tissues in their youthful anatomic positions. In a youthful midface, the superior border of the triangular shaped malar fat pad lies along the orbital rim and extends laterally to the zygoma. The buccal fat pad lies over the masseter and buccinator muscles, deep to the plane of the parotid duct and facial nerve branches. All patients should receive a complete medical examination by the appropriate specialist, including complete blood counts, metabolic chemistries, EKG and, if indicated, a chest roentgenogram. The patient should refrain from using cosmetics, perfumes, aftershave, and moisturizers on the morning of surgery.
Incisions vary and depend on the technique, patient anatomy and hairline and surgeon preference. The subcutaneous facelift technique is simplest to perform, with the least risk of injury to the facial nerve branches. Dissection continues anteriorly to the nasolabial fold, remembering to change the level of dissection at the lateral border of the zygomaticus major muscle. In the neck, subplatysmal dissection can be performed to expose the triangular shaped subplatysmal fat pad.
After completing the dissection, the SMAS is lifted in a vector parallel to the zygomaticus major, trimmed and inset. Deep plane facelift refers to sub-SMAS dissection without significant undermining in the subcutaneous plane. The composite facelift is a modified deep plane facelift designed to additionally address the orbicularis oculi muscle.
As originally described, this dissection plane is then connected to the deep-plane dissection by an incision made between the inferior lateral border of the orbicularis oculi and the zygomaticus minor muscle.
In the recovery room following surgery, the patient should be evaluated for pain, nausea, or vomiting. For at least 2 weeks after surgery, the patient should refrain from physical exertion, bending or heavy lifting, sexual activity, driving and flying. Men generally have twice the incidence of hematoma after facelift surgery as women (8% versus 4%). Skin slough occurs most often in the postauricular region, and it is more common in patients who smoke. Patients undergoing a subcutaneous rhytidetomy have a facial nerve injury risk of 0.5-2% (mean of 1%). Infections occur very uncommonly (0.18%) during facelifting due to the robust blood supply of the face. A thorough understanding of the nerves encountered during rhytidectomy in the face and neck is essential for avoiding the most dreaded complications of this procedure. The marginal mandibular branch of the facial nerve usually is not visualized during facelifting. In the neck the cervical branch of the facial nerve lies deep to the platysma muscle and is in no danger in a supraplatysmal dissection. I sometimes find myself in a "monkey-mind" situation. This is a terrible condition wherein there are just too many things to keep your mind on that you end up not keeping anything on your mind at all!With all of our Who's got the time these days to wait out all the pain and anguish of a full-fledged surgical procedure?
Recognizing the elements of an aging face and neck are a prerequisite to planning any procedure. Since it is not possible to design a universal technique for all patients, facelifting must be preceded by a sound knowledge of the anatomy and a thorough understanding of the elements to be corrected.
While these layers are consistent throughout the face and neck, in some area such as over the zygomatic arch, the layers are highly compressed. Skin aging is accelerated by sunlight; this process is known as dermatohelisosis, solar elastosis, or photoageing. Above the zygoma, the SMAS is contiguous with the frontalis muscle and the superficial temporal fascia (or temporoparietal fascia). In the upper third of the face, the layer becomes the innominate fascia that blends into the subgaleal fascia over the scalp. In addition, the facial nerve provides sensory innervation to the anterior two-thirds of the tongue, external auditory meatus (nerve of Jacobsen), soft palate and pharynx. The buccal branch has tremendous overlap with the zygomatic branch and sends fibers to similar muscles, as well as the buccinator, orbicularis oris, depressor anguli oris and risorius muscles.
The platysma acts synchronously with other muscles of the lower lip to draw the oral commissure and lower lip downward. In a sense, the nasolabial fold may be considered a fasciocutaneous ligament necessary for lip elevating muscles to initiate a smile.
The depressor anguli oris superiorly and the mandibular ligaments inferiorly determine the labiomandibular crease, which similarly is converted into a fold as a result of the laxity of the masseteric ligaments that occurs with age. About 20% of the gland extends convexly forward over the masseter muscle occasionally as far as the zygomaticus major. The marginal mandibular branch of facial nerve courses superficial to the submandibular gland and deep to the platysma. The identification of the hypoglossal and lingual nerves as well as Wharton’s duct is important prior to resecting portions of the submandibular glands. The mandibular retaining ligaments arise from the parasymphysial mandibular body and insert into the skin inferior to the insertion of the depressor anguli oris. The lateral border can be identified by drawing a line from the lateral canthus to the lateral commissure. Patients with diabetes mellitus, hepatic, cardiovascular, renal, or thyroid disorders must have preoperative medical clearance. Postoperative nausea and vomiting (PONV) and hypertension are believed to be contributing factors. The temporal incision is generally marked in a curvilinear fashion, just within the temporal hairline and superior to the ear. The incision then curves tangentially into the occipital hairline at the level of the inferior crus of the antihelix.
The skin-only facelift produces good results for thin women with good skin tone and underlying bone structure. Classically, the SMAS is elevated in the preauricular area, from 1 finger breadth below the zygoma to the lower border of the mandible. The dissection plane remains superficial to the zygomaticus major muscle and extends inferiorly to the oral commissure. After resecting this fat pad under direct vision, the medial edges of the platysma can be trimmed and the diastasis closed. The subcutaneous dissection is carried approximately 2-3 cm in front of the tragus, from zygoma to the jaw line.

With the addition of a lower blepharoplasty incision, the orbicularis oculi is elevated off the malar prominence. A distinct division between these muscles is not always present because they lie in the same plane. The inferior aspect of the orbicularis oculi muscle is trimmed, and the muscle is repositioned in a superomedial vector.
Through a coronal approach, subperiosteal undermining is carried out around the orbital rims, over the zygomatic arch and body, over the maxilla and down to the piriform aperture. The patient should continue to abstain from alcohol and tobacco products, aspirin, nonsteroidal anti-inflammatory agents, anticoagulants, vitamin E, multivitamins, Alka Seltzer® and homeopathic remedies for 3 weeks.
Patients should refrain from smoking at least 3 weeks before and 2 weeks after the operation.
Patients who undergo a SMAS-based lift have a facial nerve injury risk of 2-9% (mean of 4%). In sub-SMAS dissection in the lower face, it is safer to stay above the mandible posterior to the facial vessels. The great auricular nerve lies deep to the superficial layer of the deep investing fascia on the sternocleidomastoid muscle as it traverses from posteroinferior to anterosuperior to emerge in the vicinity of the infra-aural region, where the skin is firmly attached to the sternocleidomastoid muscle. Not the Sage, I say!That's why I've decided to put together a bit of a primer for all of you who may be considering the wonderful world of mini lift procedures! Careful planning and good technique are necessary to precisely remove redundant skin, resuspend or resect fat and repairing lax musculature and fascia. Photoageing is accelerated by long and short wavelength ultraviolet radiation (UVA and UVB) injury to the epidermis and dermis. These ligaments transmit mimetic movements into facial expressions but also contribute to facial lines and wrinkles.
Over the parotid, it exists as a filmy, areolar layer called the parotideomasseteric fascia. As the zygomatic and buccal branches exit the medial portion of the parotid, they travel along the superficial surface of the buccal fat pad, just below the SMAS. The marginal mandibular nerve emerges from the inferior border of the parotid gland and crosses the inferior border of the mandible deep to the platysma to reach the face. Transection of the cervical branch is uncommon, but it does not result in significant functional or cosmetic deficits. The parotid duct (Stensen’s duct) and branches of the facial nerve emerge from the anterior border of the parotid, beneath the parotideomasseteric fascia. The submandibular ducts (Wharton’s ducts) exit the medial surface of each gland and run between the mylohyoid (lateral) and hyoglossus muscles along the genioglossus muscle to empty into the oral cavity lateral to the lingual frenulum. The platysma-auricular and the platysma-cutaneous ligaments are aponeurotic condensations attaching platysma to dermis.
The malar fat pad is located beneath the skin and subcutaneous fat, but it is superficial to the SMAS. Ptosis of the malar fat pad also empties the midface, producing a crescent-shaped hollow at the lower lid-cheek junction. It can be approached from a sub-SMAS dissection plane by separating the buccal branches of the facial nerve. Patients should be instructed to stop taking alcohol or tobacco products 3 weeks prior to surgery.
Pre- and postauricular flaps are extended into the neck over the sternocleidomastoid muscle. It is difficult to obtain a natural look in patients with heavier faces because high skin tension produces a pulled-appearance, wider scars and alopecia.
The parotideomasseteric fascia is left intact just below the dissection plane, protecting the facial nerve branches.
Sharp division of zygomatic and mandibular retaining ligaments allows full mobilization of the skin and soft tissue, facilitating redraping.
This frees the muscle of its attachments to the malar eminence, allowing mobilization and repositioning. The blood pressure must be frequently monitored and precisely controlled with antihypertensives. A shower and hair washing are permitted on the day after surgery, but no hair brushing or make-up applications are permitted for 10 days.
Elevation of the sideburn or notching of the postauricular hairline is more common, particularly during a secondary lift. Patients with a family or personal history of hypertrophic scarring or keloid formation or risk factors for excessive scarring after a facelift should be counseled preoperatively. In the subperiosteal approach, dissection should proceed deep to the deep layer of the temporal fascia. Use appropriate caution with electrocautery hemostasis around vessels in the SMAS since electricity may be transmitted to nerves causing injury.
Caution with the infraorbital nerve must be exercised during dissection in the subperiosteal plane in the region.
Studies suggest that UV light can activate enzymes that degrade collagen and elastin in skin. Collectively, this layer may be thought of as the platysma-SMAS-temporoparietal-galea layer. The anatomy here is critical because the frontal branch of the facial nerve (see below) pierces the innominate fascia at the level of the zygomatic arch and travels along the undersurface of the temporoparietal fascia.
The branches of the facial nerve travel just deep to the cervical-parotideomasseteric fascia to innervate all muscles of facial expression from their deep surface with three exceptions: (1) mentalis, (2) buccinator, and (3) levator anguli oris.
This position makes them susceptible to injury during facelift procedures, particularly at the lateral edge of the zygomaticus major. Studies suggest that posterior to the facial artery, the marginal mandibular branch may dip as far as 2 cm below the border of the mandible. The parotid duct (4-6 cm in length) travels parallel to the zygomatic arch, 1.5 cm (approximately 1 finger breadth) below its inferior border, passing over the masseter muscle and then turns medially 90? to pierce the buccinator muscle at the level of the second maxillary molar where it enters the oral cavity. Of greater significance are the osteocutaneous zygomatic and mandibular retaining ligaments.
The zygomatic and mandibular ligaments are obstacles to surgical maneuvers intended to lift the skin flap and, therefore, both are usually divided.
Alternatively, it can be approached through the mouth by penetrating the mucosa and buccinator muscle. Aspirin, nonsteroidal anti-inflammatory agents, anticoagulants, vitamin E, multivitamins, Alka Seltzer® and homeopathic remedies should also be discontinued 3 weeks prior to surgery. For example, preoperative odansetron (Zofran®), 4 mg IV, has been shown to significantly decrease the incidence of PONV.
The preauricular incision lies in the natural crease at the junction of the auricle and the face, following the curve of the helical root. The great auricular nerve emerges from the anterior border of the sternocleidomastoid muscle 6.5 cm inferior to the external auditory meatus.
In older patients with skin laxity, the procedure is combined with a preauricular incision. It showcases several great ways to achieve some of the benefits of mini lifting without all the stress of that scalpel. Repetitive solar damage can cause fine lines and wrinkles, telangiectasias, solar comedones, dryness and actinic lentigines (diffuse or mottled brown patches). Collectively, this fascia may be thought of as the cervical-parotideomasseteric-innominate-subgaleal layer.
These muscles lie deep to the facial nerve branches and are, therefore, innervated on their superficial surfaces.The frontal branch of the facial nerve leaves the parotid gland immediately beneath to the zygomatic arch. Anterior to the facial artery, the marginal mandibular nerve nearly always lies above the mandibular border.

Using surface landmarks, Stensen’s duct lies midway between the zygomatic arch and corner of the mouth along a line between the upper lip philtrum and the tragus. To a lesser extent, this displacement also results in the formation of labiomandibular folds (marionette lines) and jowls. There are few indications to remove this fat pad because it tends to hollow the cheek giving an aged appearance. A separate submental incision may be used to elevate the anterior portion of the cervical flap in a preplatysmal plane.
Moreover, since the lift is based on the SMAS, the skin can be trimmed and inset without tension. However, the major drawback to the deep plane operation is the development of persistent infraorbital and midface ecchymosis and edema that greatly prolong the convalescence. Patients frequently have marked facial edema for several weeks after surgery and a mask effect for several months.
Good judgment is necessary to determine the amount of skin undermining that can be safely performed in higher risk patients. Sub-SMAS dissection at this point causes trauma to the nerve, as does blind incision of the zygomatic ligaments. As it crosses the superficial surface of the zygomatic arch, the frontal branch pierces the innominate fascia to travel along the undersurface of the temporoparietal fascia (superficial temporal fascia). The marginal mandibular nerve has little cross-innervation as it enters the orbicularis oris and lip depressors. In addition, patients with hypertension should take their medications the morning of surgery. The dissection is limited superiorly by the inferior border of the mandible and inferiorly by the hyoid bone. There are many variations of this technique which include the limited SMAS, extended SMAS and lateral SMASectomy.
Risk of injury to the frontal branch of the facial nerve was high in the initial series but has been minimized with a deep approach to the zygomatic arch.
Facelifting cannot directly improve the quality of photoaged skin, but it can improve the appearance. Transection of this nerve results in paralysis of the muscles that depress the corner of the mouth; therefore, the paralyzed side of the mouth will appear higher than the innervated side! Any patient with even mild hypertension the morning of surgery, should be considered for antihypertensive therapy.
The preplatysmal plane serves to protect the marginal mandibular nerve as it courses below the mandible. The path of the frontal branch can be approximated by connecting a line 2 cm lateral to the edge of the eyebrow to the lower edge of the earlobe, termed Pitanguy’s line. The frontal branch innervates the muscles of the upper part of the face including the upper orbicularis oculi, frontalis and corrugator muscles. It reduces sagging around the jaw line, cheeks and neck, and it is a more economical alternative to your run-of-the-mill, standard facelift surgery. By taking the advantage of endoscopic face lifting and using small incisions, the cosmetic surgeon repositions, lifts and removes facial tissues to get the best possible results. After eliminating the factors responsible for drooping and sagging, the surgeon carefully repositions the skin using small stitches. Mini lifting is a relatively new technique and focuses on specific areas of the face including folds around the nose and neck. It works well in younger patients who have aging symptoms in the middle of their faces and do not have too much excess skin around their jaw line and neck.
This “light” surgery is also known by various names such as the mini lift, s-lift, limited-incision facelift or baby boomer facelift. It is also known as a weekend facelift because it can be performed quickly and its recovery period is very short. This will help you achieve better results! You are a non-smoker or have quit smoking at least 2 months back. NOTE: Heavy smokers are not ideal candidates for facelift surgery because they are at greater risk when undergoing general anesthetic Should I be Concerned About Any Mini Lift Surgery Risks? Follow your surgeon’s advice both prior to and after surgery to further reduce any risks or problems that may arise. Mini Facelift Surgery: Step-By-Step PreparationsHere are some simple things to take note of before taking the mini facelift plunge!
Mini Facelift Procedure: Say Goodbye to Saggy Skin The mini facelift procedure includes repositioning of the muscles in areas of the face that show symptoms of aging. In most cases, the incision will be about one-half the length of a standard facelift incision.
The main advantages of this method over traditional brow lift surgery are the lack of major scarring and a super quick recovery period.
This procedure involves an incision of about two inches that remains hidden at the back of the hairline.
Correcting your frown lines raises your eyebrows and improves the symmetry of your forehead and face. Since the incisions are quite small, there is so much less to be stressed out about and this is a good thing because you must have been stressed out for long enough to get those frown lines in the first place! NUDITY AHEAD!) A breast lift, more commonly known as mastopexy, is a surgery performed to reshape and lift sagging breasts. Factors such as pregnancy and nursing will inevitably change the appearance of your breasts.
As women age, there is no telling how the elasticity of their skin will change over the years and some women will lose the shape and firmness of their breasts. Best of all, the tiny scars left after your mastopexy will be covered easily by a bra or a bathing suit. You may be asking yourself, “how much is a mini facelift?” or “how much does a mini facelift cost?” Since only a local anesthetic is used in this surgery and it does not require any post-operative hospitalization and the cost of a mini face lift is therefore considerably lower than your standard facelift. If you decide to get the procedure, your mini facelift cost will depend on the number of threads used in the surgery and some other similar factors. In most cases, other charges such as anesthetics, hospital fees and after care charges are also incorporated in the package. Sure, this is a relatively simple adjustment that works wonders on your face but c'mon--it's still YOUR FACE. I emplore you to make sure you are dealing with experienced professionals!Whatever the case, mini face lift before and after photos will help give you a good idea of the results you can expect and you will finally be able to enter that operating room with some actual confidence!Here are some startling mini facelift before and after photos I found on Google Images.
It's like turning the clock back a few years, for sure: ConclusionSo there you have it! Mini lift procedures are super popular and much more affordable than your average surgical face lift or lift procedure. They really are professionals and they will be used to answering all sorts of questions you may have.
And let's be honest, a little bit of due diligence never hurt anyone!I hope this article has given you enough to take home and mull about on before taking your sagginess into your own hands. The price we pay for skin tight beauty.Awesome InfographicsLifting procedures are much more popular than you'd think. Explore the wonderful world of skin and beauty in the modern age with the help of your beloved Skin Tightening Sage!

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