plastic surgery

1. Dr Subhakanta Mohapatra
Mch Plastic surgery , IPGME&R & SSKM Hospital,kolkata

2.  Facial aging is a panfacial phenomenon
 Changes in all layers of face including bone
 It converts inverted cone (heart shaped) of
face in to rectangular shape
 Facelift reposition the ptotic tissue
 Age for facelift – in 40s

10. 75% 15 % 10%

17.  Uncontrolled hypertension is a C/I for Surgery
 Smoking , NSAIDs , HRT , anticoagulants - to be
stopped 3 wks prior to surgery
 Photographic documentation of face. Pt’s youth
time photograph can be helpful.
 Clinical assessment of facial nerve function
 Ptosis of sub-mandibular gland to be noted
 Patient counselling

18.  Subcutaneous facelift
 SMAS plication
 MACS facelift
 Supraplatysmal plane facelift
 Lateral SMASectomy
 Deep plane facelift
 Dual plane facelift
 Subperiosteal facelift

19.  Temporal hair incision
 Anterior hairline incision
 Incision in the hair + a transverse extension at
the base of sideburn
 Pretragal
 Tragal edge incision
 Short scar technique(limited to retro auricular
sulcus,no occipital incision)

24. Short scar
incision

25. Incorrect submental Correct submental
incision incision

28.  1st facelift
 Still used today
 Basis of other facelift techniques
 Subcutaneous dissection
 Leaving 2 mm of fat in dermis
 Large random pattern skin flap
 Shifted in superolateral direction
(perpendicular to nasolabial fold , along the
line of zygomaticus major muscle)

34.  Normal (long axis of
lobule is 15 ° Posterior
to long axis of ear)

35.  Adv
 Relatively safe
 Easy to do
 Rapid recovery
 Disadv
 Ineffective in heavier
patients with significant
ptosis of deep tissue
 Skin will stretch with time
leading to a loss of effect
 Distortion of facial shape

36.  Incision - vertical temporal +/- post auricular
extension
 Vector of traction - Postero – superior
 SMAS – SMAS fixation
 SMAS is sutured directly
(no purse string fashion)
 Platysmaplasty – direct (infralobular excision)

41. ADV
 Easy
 Safe
 Autologous malar
augmentation
DISADV
 Cheese wire effect
 No release of
ligaments
 Limited effect in
heavy jowls

42.  Based on specialised suture suspension
 Suture loops placed in purse string fashion
 Anchoring point – Deep temporal fascia
(SMAS – DTF)
 Vertical vector of traction
 No dissection in neck.(Liposuction in >95%)
 Types – 1. basic
2. extended

44. Temporal branch of facial nerve

48. ADV
 No deep plane dissection
 Less dissection – faster
recovery
 No dissection over SCM
muscle
 Reversible during surgery
 Easy to learn
DISADV
 Loss of effect if
sutures pull through
 No ligament release
 Less effective for
heavy jowls
 Relative lack of
malar
augmentation

49.  Resection of a portion of SMAS - at the
interface of mobile & fixed SMAS
(directly overlying the anterior edge of
parotid gland).
 Extends from tail of parotid to lateral canthus

53. ADV
 No SMAS flap elevation , so
lesser tearing of superficial
fascia & better holding of
suture fixation
 Facial nerve injury is less , as
majority of dissection carried
over parotid gland
 Rapid,safe,durable & with less
complications
DISADV
 Not applicable
for thin face,
where fat needs
to be preserved

54.  Also known as dual plane facelift
 Subcutaneous facelift with separate SMAS
flap
 SMAS flap shifted more vertically than the
skin flap

57.  Adv
 2 different vector is
more effective
 No skin tension
 Excellent
mobilisation &
advancement of
SMAS (ligament
release)
 Disadv
 More time
consuming
 More chance of
damage to deep
structures
 Thin skin flap

58.  Deep subcutaneous dissection immediately
superficial to SMAS & platysma
 Raising skin & superficial fat as a single layer
 SMAS layer untouched
 Adv
 Thick robust flap
 No facial nerve injury
 Disadv
 Flap is unidirectional
 Skin tension at suture line

60.  Formerly known as deep plane facelift
 Composite musculo cutaneous flap
 Dissection – deep to SMAS platysma plane
(avascular plane so less hematoma)
 Robust flap (so indicated in secondary facelift, in
smokers )
 Particularly effective for deep nasolabial fold &
midface
 Disadv- facial nerve injury, single vector

62.  For central oval of the face (forehead , periorbita , midface ,
chin )
 Most suitable plane for implant placement
 Biplanar ( subperiosteal + subcutaneous )
 Midface gets maximum benefit
 Open / endoscopic technique
 One cosmetic unit
 Forehead & upper eye lid
 Lower eye lid & mid face
 Lower face & neck

67. Adv
 en bloc mobilisation(no tension on
skin)
 Short incision
 Implant placement
 Better visibility & orientation
 Safe plane
 More durable
 More balanced & natural
rejuvenation (no windswept/
motorcyclist appearance)
Disadv
 Additional
equipments
needed
 Limited effect in
lower face &
neck

68.  Flap along the superior border of zygomatic
arch . (unlike traditional low cheek SMAS flap
elevated below arch )
 Extending the dissection medially to mobilise
midface soft tissue
 Improves midface , upper anterior cheek
 Allows simultaneous lift of jaw line , cheek &
mid face

70. Corset ( Feldman platysmaplasty )

71.  Light dressings
 Rest with head end of bed elevated
 No neck flexion (no pillow)
 Control of blood pressure (pain, anxiety,urinary
retention)
 Cool packs to face
 Drain removal on 1st post op morning
 Suture removal in 7-9th day
 Photographic documentation of result – after 6
months of surgery.

72.  Hematoma –
 most common
 Localised & worsening pain
 T/t – evacuation (rather than giving analgesic )
 Nerve injury(facial & great auricular)
 Skin slough (retro auricular area)
 Unsatisfactory scars
 Alopecia
 Infection(rare)

73.  Goals-
 To relift the face & neck
 Remove primary facelift scars
 Preserve maximum temporal & sideburn
 Less skin resection
 Time consuming, technically demanding
 Intra op bleeding & postop hematoma – less
 Risk of nerve injury is slightly higher

74.  The worst of all outcomes is to look operated
 Surgical disharmony compromises the result