Publications by authors named "Andrew A Jacono"

35 Publications

The Effect of a Novel Platysma Hammock Flap During Extended Deep Plane Facelift on the Signs of Aging in the Neck.

Aesthet Surg J 2022 Aug;42(8):845-857

Department of Otorhinolaryngology/Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Montefiore Medical Center, Bronx, NY, USA.

Background: Aging changes in the neck, including platysma banding (PB), skin laxity (SL), and submandibular gland visibility (SGV), have a high degree of recurrence after rhytidectomy.

Objectives: The authors sought to assess the long-term improvement in PB, SL, and SGV with addition of aplatysmal hammock flap to the extended deep-plane facelift and assess patient satisfaction.

Methods: This was a prospective study of 123 consecutive patients undergoing extended deep-plane facelift incorporating platysma hammock flap with or without midline platysmaplasty. Standard 2-dimensional patient photographs were employed to assess PB, SL, and SGV preoperative and >12 months postoperative. A 1-year postoperative patient satisfaction survey was conducted.

Results: The platysmal hammock flap without midline platysmaplasty cohort had a significant (P < 0.01) reduction in mean preoperative PB, SL, and SGV scores from 1.03, 1.88, and 1.21 to 0.06, 0.03, and 0.15 at 21 months. The platysmal hammock flap with midline platysmaplasty cohort had a significant (P < 0.01) reduction in preoperative PB, SL, and SGV scores from 1.81, 2.43, and 1.81 to 0.10, 0.15, and 0.48 at 18 months. The platysmal hammock flap with and without midline platysmaplasty cohorts had 96.2% and 88.9% satisfaction, respectively.

Conclusions: Extended deep-plane facelift with a platysmal hammock flap achieves long-term, sustained improvements in PB, SL, and SGV; is well-tolerated; and results in substantial patient satisfaction.

Level Of Evidence: 4:
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/asj/sjac086DOI Listing
August 2022

Transcutaneous Blepharoplasty with Volume Preservation: Indications, Advantages, Technique, Contraindications, and Alternatives.

Authors:
Andrew A Jacono

Facial Plast Surg Clin North Am 2021 May 24;29(2):209-228. Epub 2021 Apr 24.

Department of Otolaryngology-Head & Neck Surgery, Division of Facial Plastic Surgery, Albert Einstein College of Medicine, New York, NY, USA; Department of Facial Plastic and Reconstructive Surgery, Northwell Health (North Shore LIJ), Manhasset, NY, USA. Electronic address:

The aging appearance of the lower eyelids is multifactorial, involving changes in the skin, orbital fat, orbicularis muscle, soft tissue of the midface, and tear trough. The extent of these changes differs in each case and happens in a background of volume loss that occurs with facial aging. We present the indications, advantages, and technique for volumizing transcutaneous lower blepharoplasty with fat transposition. The absolute and relative contraindications to transcutaneous surgery are discussed, and surgical details of transconjunctival blepharoplasty with fat repositioning and autologous fat grafting as alternative approaches are included.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fsc.2021.01.008DOI Listing
May 2021

Face-Lift Surgical Techniques.

Authors:
Andrew A Jacono

Facial Plast Surg Clin North Am 2020 Aug;28(3):xv-xvi

NY Center for Facial Plastic & Laser Surgery/JSpa Medical Spa 630 Park Avenue, New York, NY 10065, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fsc.2020.03.013DOI Listing
August 2020

A Novel Volumizing Extended Deep-Plane Facelift: Using Composite Flap Shifts to Volumize the Midface and Jawline.

Authors:
Andrew A Jacono

Facial Plast Surg Clin North Am 2020 Aug;28(3):331-368

NY Center for Facial Plastic & Laser Surgery/JSpa Medical Spa, 630 Park Avenue, New York, NY 10065, USA. Electronic address:

Traditional superficial musculoaponeurotic system (SMAS) facelifting surgery uses a laminar surgical dissection. This approach does not treat areas of facial volume loss, and requires additional volume supplementation with fat grafting or fillers. The novel volumizing extended deep-plane facelift uses a composite approach to the facelift flap. By incorporating a platysma myotomy in the extended deep-plane flap, a novel composite transposition flap can be created that revolumizes the posterior jawline, recreating a defined convex jawline of youth. Special attention is paid to the deep anatomy of the face, and the need for release of the facial ligaments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fsc.2020.03.001DOI Listing
August 2020

Optimal Facelift Vector and its Relation to Zygomaticus Major Orientation.

Aesthet Surg J 2020 03;40(4):351-356

private facial plastic surgery practice in New York, NY.

Background: The vector of superficial musculoaponeurotic system (SMAS) redraping in rhytidectomy is often described in relation to the zygomaticus major muscle (ZMM), so that suspension prevents distortion of the mimetic musculature and a "facelifted appearance." There are no data describing the true orientation of this muscle in the midface.

Objectives: The aim of this study was to define the vector of the ZMM relative to the Frankfort horizontal plane.

Methods: One hundred patients underwent deep plane rhytidectomy. As part of this procedure the tissues overlying the ZMM are elevated, allowing muscle orientation to be measured as an angle relative to the Frankfort horizontal plane.

Results: Data for 200 hemifaces were aggregated. The average ZMM angle was 59° (standard deviation, 6°; range, 41-72°) relative to the Frankfort horizontal plane, and showed a statistically significant pattern of change with advancing age, becoming more acute with increasing age below the age of 60 years and more obtuse with age over 60 years.

Conclusions: The native vector of the ZMM varies significantly between rhytidectomy patients as demonstrated by the high variance in this cohort. Assumptions about its orientation should not be made in rhytidectomy techniques that do not identify its course. Standard vectors of SMAS redraping, such as superior-lateral, vertically oblique, and purely vertical, should be reconsidered and a customized vector implemented in each case. Aging affects the orientation of the muscle, which can potentially be explained by soft tissue and bony changes at its attachments. This furthers the variability of the SMAS vector in each individual case.

Level Of Evidence: 4:
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/asj/sjz114DOI Listing
March 2020

A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques.

Aesthet Surg J 2019 08;39(9):927-942

Facial plastic surgeon in private practice in North Charleston, SC.

Background: Sub-superficial musculo-aponeurotic system (SMAS) rhytidectomy techniques are considered to have a higher complication profile, especially for facial nerve injury, compared with less invasive SMAS techniques. This results in surgeons avoiding sub-SMAS dissection.

Objectives: The authors sought to aggregate and summarize data on complications among different SMAS facelift techniques.

Methods: A broad systematic search was performed. All included studies: (1) described a SMAS facelifting technique categorized as SMAS plication, SMASectomy/imbrication, SMAS flap, high lateral SMAS flap, deep plane, and composite; and (2) reported the number of postoperative complications in participants. Meta-analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: A total 183 studies were included. High lateral SMAS (1.85%) and composite rhytidectomy (1.52%) had the highest rates of temporary nerve injury and were the only techniques to show a statistically significant difference compared with SMAS plication (odds ratio [OR] = 2.71 and 2.22, respectively, P < 0.05). Risk of permanent injury did not differ among techniques. An increase in major hematoma was found for the deep plane (1.22%, OR = 1.67, P < 0.05) and SMAS imbrication (1.92%, OR = 2.65, P < 0.01). Skin necrosis was higher with the SMAS flap (1.57%, OR = 2.29, P < 0.01).

Conclusions: There are statistically significant differences in complication rates between SMAS facelifting techniques for temporary facial nerve injury, hematoma, seroma, necrosis, and infection. Technique should be selected based on quality of results and not the complication profile.

Level Of Evidence: 2:
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/asj/sjz045DOI Listing
August 2019

A Novel Extended Deep Plane Facelift Technique for Jawline Rejuvenation and Volumization.

Aesthet Surg J 2019 11;39(12):1265-1281

Department of Otolaryngology, Head and Neck Surgery, Albert Einstein College of Medicine, New York, NY.

Background: Jawline aging is a complex process. We believe loss of posterior jawline definition and volume depletion is an underappreciated factor in the aging face.

Objectives: The aim of this study was to describe a novel composite, rotational flap modification of an extended deep-plane rhytidectomy. We evaluated long-term efficacy on improving jawline contour and volumization of the posterior mandibular region overlying the gonial angle.

Methods: We performed a prospective study on patients who underwent our modification of extended deep-plane rhytidectomy. We define and introduce the mandibular defining line, a new anatomic metric in evaluating the mandibular contour. We define the area of the posterior lower face overlying the gonion and mandibular angle as the gonial area. Using 3-dimensional photography, we quantify contour changes along the mandibular border and volume change along the gonial area.

Results: Eighty-nine patients (178 hemifaces) were analyzed. The mean gonial area volume gained was 3.5 cc. Average follow-up was 19 months. There was a statistically significant change in the mean mandibular defining line from 7.1 cm preoperatively to 9.8 cm postoperatively. This represents a lengthening of the visual perspective of the mandibular contour of 2.7 cm.

Conclusions: Composite, rotational flap modification of extended deep-plane rhytidectomy provides significant long-term augmentation of volume to the posterior mandibular region and lengthens the visual perspective of the inferior mandibular contour, creating a more youthful jawline. In selected cases, this may obviate the need for other volumization procedures used to improve jawline contour, such as autologous fat grafting.

Level Of Evidence: 4:
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/asj/sjy292DOI Listing
November 2019

Characterization of the Cervical Retaining Ligaments During Subplatysmal Facelift Dissection and its Implications.

Aesthet Surg J 2017 05;37(5):495-501

Assistant Professor of Facial Plastic Surgery, Albert Einstein College of Medicine, New York, NY, USA.

Background: The cervical retaining ligaments anchor the platysma and soft tissues of the neck to the deep cervical fascia and deeper skeletal structures. The cervical retaining ligaments tether the platysma and prohibit free mobilization and redraping of the platysma muscle in rhytidectomy. This ligament system has previously been described in the literature only qualitatively.

Objectives: To define the anatomic dimensions of the cervical retaining ligaments and their relation to the platysma muscle in order to better understand the cervical retaining ligament system and how it limits motion of the platysma during rhytidectomy.

Methods: Extended deep plane rhytidectomy was performed on 20 fresh cadaveric hemifaces. The extent cervical retaining ligaments were dissected and measured. The anterior extent (width) of the cervical ligament were recorded at three anatomic points on each hemiface: (1) at the level of the inferior border of the mandible; (2) at the top of the thyroid cartilage at the thyroid notch; and (3) at the level of the cricoid.

Results: The average width of the cervical retaining ligaments in the neck was 15.3 mm. The width significantly decreased as they became more inferiorly positioned from the top of the neck at the anatomic measurement points, measuring 17.1 mm, 16.1 mm, and 12.6 mm (P < 0.05).

Conclusions: The cervical retaining ligaments are the support mechanisms of the platysma muscle in the neck. While previously described in only a qualitative manner, this study quantifies the anterior extent of these ligaments and how they invest the lateral platysma muscle. As these ligaments tether the platysma for an average of 1.5 cm, lateral platysma elevation of this distance during rhytidectomy surgery can improve platysmal redraping during rhytidectomy and potentially improve neck rejuvenation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/asj/sjw274DOI Listing
May 2017

Vertical Sweep Deformity After Face-lift.

JAMA Facial Plast Surg 2017 03;19(2):155-156

New York Center for Facial Plastic and Laser Surgery, New York.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2016.1602DOI Listing
March 2017

Nonsurgical Facial Rejuvenation Procedures in Patients Under 50 Prior to Undergoing Facelift: Habits, Costs, and Results.

Aesthet Surg J 2017 04;37(4):448-453

Medical Student, New York Institute of Technology, College of Osteopathic Medicine, New York, USA.

Background: Facial rejuvenation in patients younger than 50 years of age has experienced an unprecedented growth with multimodality nonsurgical and less invasive rhytidectomy techniques.

Objectives: To analyze the nonsurgical treatment habits of patients prior to undergoing rhytidectomy at <50 years of age.

Methods: Retrospective study to enlist patients who underwent primary rhytidectomy at age <50 years between January 1, 2003 and December 31, 2013 by the senior author (AAJ) to complete a survey.

Results: One hundred and fifty-seven patients were surveyed. Patients had nonsurgical rejuvenation starting at an average age of 37 years and rhytidectomy at an average age of 44 years. Thirty-two percent of responders had injectable treatments prior to their facelift, reporting a mean of 7 rounds of injectable treatments prior to pursuing rhytidectomy. Sixteen percent of responders had laser skin resurfacing undergoing 4 separate treatments prior to rhytidectomy, and 10% had energy-based facial tightening treatments one time prior to their rhytidectomy. Average expenditure on nonsurgical treatments prior to rhytidectomy was $7000 cumulatively. Fifty-nine percent of patients who went on to rhytidectomy did not report regret over this cost expenditure. Patients reported that they appeared 4 years younger after nonsurgical intervention, and 8 years younger after their facelift, a statistically significant difference (P = .048).

Conclusions: Patients undergoing rhytidectomy <50 years old begin less invasive facial rejuvenation treatments at an even earlier age. The majority of these patients did not regret the costs associated with noninvasive treatments, even though they saw that rhytidectomy provided a greater rejuvenation effect. Rhytidectomy surgeons should incorporate nonsurgical techniques into their practice to best serve the needs of the modern aging face patient.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/asj/sjw217DOI Listing
April 2017

Extended Submuscular Blepharoplasty With Orbitomalar Ligament Release and Orbital Fat Repositioning.

JAMA Facial Plast Surg 2017 Jan;19(1):72-73

New York Center for Facial Plastic and Laser Surgery, New York, New York.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2016.1047DOI Listing
January 2017

Use of FACE-Q to Measure Quality of Life Following Aesthetic Facial Treatments-Reply.

JAMA Facial Plast Surg 2016 Mar-Apr;18(2):149

Columbia University Medical Center, New York, New York.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2016.0004DOI Listing
July 2016

The Effect of Midline Corset Platysmaplasty on Degree of Face-lift Flap Elevation During Concomitant Deep-Plane Face-lift: A Cadaveric Study.

JAMA Facial Plast Surg 2016 May;18(3):183-7

New York Center for Facial Plastic and Laser Surgery, New York.

Importance: The evaluation of the effects of midline platysmaplasty concomitant with rhytidectomy.

Objective: To determine whether midline platysmaplasty limits the degree of lift during deep-plane face-lift.

Design, Setting, And Participants: Deep-plane rhytidectomy was performed on 10 cadaveric hemifaces. The redundant skin for excision after performing the face-lift was measured with and without midline platymaplasty.

Exposures: Deep-plane rhytidectomy.

Main Outcomes And Measures: The redundant skin was measured preauricularly in the vertical and horizontal dimension, and postauricularly after deep-plane face-lift and after adding a midline platysmaplasty.

Results: Concomitant midline platysmaplasty significantly reduced the amount of lift during concomitant deep-plane rhytidectomy preauricularly in the vertical dimension by 40.5% (from 37.0 mm excess skin redraped to 22.0 mm) and postauricularly by 23.9% (from 40.6 mm excess skin redraped to 30.9 mm) (P < .001 and P < .001, respectively). The 19.7% reduction in the horizontal skin redraping after midline platysmaplasty (from 14.7 mm excess skin redraped to 11.8 mm) did not reach statistical significance (P = .15).

Conclusions And Relevance: Concomitant midline corset platysmaplasty significantly limits the ability to lift the neck as well as the jawline and midface during rhytidectomy.

Level Of Evidence: NA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2015.2174DOI Listing
May 2016

Response to "Does a Deep-Plane Facelift Restore Malar Volume Without Simultaneous Fat Injection?".

Aesthet Surg J 2016 Jan 15;36(1):NP32-6. Epub 2015 Sep 15.

Dr Jacono is the Section Head of Facial Plastic and Reconstructive Surgery, North Shore University Hospital, Manhasset, New York; Assistant Clinical Professor, Division of Facial Plastic and Reconstructive Surgery, New York Eye and Ear Infirmary, New York, New York; and Assistant Clinical Professor, Department of Otorhinolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, New York, New York. Dr Malone is a fellow at a private facial plastic surgery practice in New York, New York.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/asj/sjv169DOI Listing
January 2016

Three-Dimensional Analysis of Long-Term Midface Volume Change After Vertical Vector Deep-Plane Rhytidectomy.

Aesthet Surg J 2015 Jul 10;35(5):491-503. Epub 2015 Jun 10.

Dr Jacono is the Section Head of Facial Plastic and Reconstructive Surgery at North Shore University Hospital, Manhasset, New York; and Assistant Clinical Professor in the Division of Facial Plastic and Reconstructive Surgery, New York Eye and Ear Infirmary, New York and the Albert Einstein College of Medicine, New York. Dr Malone is a Resident at New York Presbyterian Hospital, Department of Otolaryngology-Head and Neck Surgery, Columbia and Cornell Universities, New York. Dr Talei is a Fellow at a private facial plastic surgery practice in New York.

Background: Facial aging is a complicated process that includes volume loss and soft tissue descent. This study provides quantitative 3-dimensional (3D) data on the long-term effect of vertical vector deep-plane rhytidectomy on restoring volume to the midface.

Objective: To determine if primary vertical vector deep-plane rhytidectomy resulted in long-term volume change in the midface.

Methods: We performed a prospective study on patients undergoing primary vertical vector deep-plane rhytidectomy to quantitate 3D volume changes in the midface. Quantitative analysis of volume changes was made using the Vectra 3D imaging software (Canfield Scientific, Inc, Fairfield, New Jersey) at a minimum follow-up of 1 year.

Results: Forty-three patients (86 hemifaces) were analyzed. The average volume gained in each hemi-midface after vertical vector deep-plane rhytidectomy was 3.2 mL.

Conclusions: Vertical vector deep-plane rhytidectomy provides significant long-term augmentation of volume in the midface. These quantitative data demonstrate that some midface volume loss is related to gravitational descent of the cheek fat compartments and that vertical vector deep-plane rhytidectomy may obviate the need for other volumization procedures such as autologous fat grafting in selected cases.

Level Of Evidence: 4 Therapeutic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/asj/sju171DOI Listing
July 2015

Bilateral Transposition Lip Flaps: A Novel Single-Stage Reconstruction of Central Upper Lip Defects Involving Cupid's Bow.

JAMA Facial Plast Surg 2015 May-Jun;17(3):219-23

Department of Otolaryngology/Head and Neck Surgery, North Shore University Hospital, Manhasset, New York5Department of Otolaryngology/Head and Neck Surgery, Long Island Jewish Medical Center, Manhasset, New York.

Importance: Defects of the central upper lip present a challenge. A variety of techniques have been described, but most tend to efface the natural contours present in the philtrum and the cutaneous-mucosal vermilion border (Cupid's bow). Furthermore, the techniques typically require a second-stage procedure to improve the upper lip aesthetic. We discuss a novel technique using bilateral transposition flaps to reconstruct central defects of the upper lip that violate Cupid's bow while maintaining normal aesthetic landmarks in a single stage. The mean angle of the transposition flaps was calculated.

Observations: A retrospective review of 7 patients was performed to identify those who underwent reconstruction of central upper lip defects at a Mohs reconstruction referral practice. Medical records from January 2009 to December 2013 were evaluated. The mean diameter of the final defect was 1.4 cm (range, 1.2-2.1 cm). The mean angle of the transposition flaps used was 50°. All defects were closed in a single stage with no secondary defect remaining. There was no need for a second-stage procedure.

Conclusions And Relevance: The use of bilateral transposition flaps is a viable and preferred method for a single-stage reconstruction of the Cupid's bow and philtrum in central defects of the upper lip.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2015.18DOI Listing
March 2016

An algorithmic approach to multimodality midfacial rejuvenation using a new classification system for midfacial aging.

Clin Plast Surg 2015 Jan;42(1):17-32

New York Center for Facial Plastic & Laser Surgery, New York, NY, USA; New York Center for Facial Plastic & Laser Surgery, Great Neck, NY, USA.

Midfacial aging is the result of the complex interplay between the osseous skeleton, facial retaining ligaments, soft tissues envelope, facial fat compartments, and the overlying skin elasticity. As a result of the many anatomic components involved in midfacial aging, the authors proposed a classification system based on distinct anatomic factors to direct surgical treatment. Evidence based data suggest that midface rejuvenation often requires a multimodality approach to obtain desired results, especially in patients with more advanced aging and poor tissue elasticity, or those with hypoplastic midfacial skeletal structure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cps.2014.08.002DOI Listing
January 2015

Vertical neck lifting.

Facial Plast Surg Clin North Am 2014 May;22(2):285-316

Facial Plastic Surgery, The New York Center for Facial Plastic and Laser Surgery, 5th Avenue, New York, NY 10075, USA; Facial Plastic Surgery, The Beverly Hills Center for Plastic and Laser Surgery, Beverly Hills, CA 90210, USA.

The authors' vertical neck lifting procedure is an extended deep plane facelift, which elevates the skin and SMAS-platysma complex as a composite unit. The goal is to redrape cervicomental laxity vertically onto the face rather than laterally and postauricularly. The authors consider this an extended technique because it lengthens the deep plane flap from the angle of the mandible into the neck to release the cervical retaining ligaments that limit platysmal redraping. This technique does not routinely use midline platysmal surgery because it counteracts the extent of vertical redraping. A majority of aging face patients are good candidates for this procedure in isolation, but indications for combining vertical neck lifting with submental surgery are elucidated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fsc.2014.01.006DOI Listing
May 2014

Comparing rates of distal edge necrosis in deep-plane vs subcutaneous cervicofacial rotation-advancement flaps for facial cutaneous Mohs defects.

JAMA Facial Plast Surg 2014 Jan-Feb;16(1):31-5

New York Center for Facial Plastic and Laser Surgery, Great Neck 7currently a medical student, Hofstra University School of Health Sciences and Human Services, Hempstead, New York.

Importance: The cervicofacial rotation-advancement flap is commonly used for facial defects. Decreasing the rate of distal edge necrosis (DEN) encountered with this flap would help prevent complications in sensitive areas such as the eyelid, lip, and nose.

Objective: To compare the untoward occurrence of DEN between 2 surgical dissection methods for reconstructive cervicofacial rotation-advancement flaps. DESIGN, SETTING, PARTICIPANTS, AND EXPOSURE: A review was conducted of 88 patients who underwent cervicofacial flap reconstruction for Mohs ablative surgery between January 1, 2003, and June 30, 2012, by the senior author (A.A.J.). All patients had periorbital, midfacial, cervical, and/or lateral temporal/forehead defects following Mohs surgical ablation. Patients were categorized into 1 of 2 groups on the basis of the surgical technique used: subcutaneous (SC) cervicofacial elevation or deep-plane (DP) cervicofacial elevation. Subcategories of smokers and nonsmokers within each group were further reviewed. Statistical analysis of DEN between categories and subcategories was performed.

Results: Sixty-nine patients were in the SC group and 19 were in the DP group. The mean defect size among both groups was 14.3 cm(2). The rate of active or recent smokers was 23% in the SC group and 11% in the DP group. The rate of DEN among nonsmokers in the SC group was 23% (n = 53) compared with 0% in the 17 DP nonsmokers (P = .03). The rate of smokers with DEN in the SC group was 75% and 0% in the DP group (P = .09). The mean area of DEN in the SC group was 0.8 cm(2).

Conclusions And Relevance: Our statistically significant data indicate that DP dissection is a superior technique for avoiding DEN in nonsmokers. We found better outcomes in smokers as well. Thus, we strongly advocate the use of the DP approach as the criterion standard in cervicofacial flap elevation.

Level Of Evidence: 3.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2013.20DOI Listing
January 2015

The modern minimally invasive face lift: has it replaced the traditional access approach?

Facial Plast Surg Clin North Am 2013 May;21(2):171-89

Facial Plastic and Reconstructive Surgery, North Shore University Hospital, Manhasset, NY, USA.

Because modern facelift patients desire a less-invasive approach or minimally invasive approach to reduce visible scarring and decrease the recovery phase, achieving the surgeon's goal of optimal, reliable, and long-term aesthetic results with few complications becomes a challenge. The authors use the terms minimal access and traditional access to describe rhytidectomy approaches based solely on incision size. A short-incision, minimal-access approach with a deep-plane extended dissection is presented. A preoperative physical examination maneuver to evaluate a patient's candidacy for a minimal-access approach and guidelines for when to include platysmaplasty with the procedure to further improve cervicomental contour are described.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.fsc.2013.02.002DOI Listing
May 2013

Anatomic predictors of unsatisfactory outcomes in surgical rejuvenation of the midface.

JAMA Facial Plast Surg 2013 Mar;15(2):101-9

New York Centerfor Facial Plastic and Laser Surgery, 440 Northern Blvd,Great Neck, NY 11021, USA.

Objective: To aid the aesthetic surgeon in midface analysis and selection of treatment plans offering the greatest likelihood of success in midface rejuvenation.

Methods: We performed a retrospective review of all patients who underwent surgical midface rejuvenation by a single surgeon. We recorded demographics, history, procedures, outcomes, and complications. Results of physical examination and photography were used to classify patients by volume loss, midface ptosis, skin elasticity, and skeletal anatomy. Outcome was determined by patient satisfaction at the 12-month follow-up; unsatisfactory results were further analyzed by a blinded independent expert with more than 15 years' experience.

Results: We included 150 patients. Mean patient age was 51 years; 93.3% were women, and 20.7% had undergone previous procedures, including malar implants, autologous fat grafting, rhytidectomy, midface-lift, and extended lower blepharoplasty. Multimodality treatment was used in 34.0%. Patient dissatisfaction was encountered in 14.0% of cases; the expert concurred in each case. Autologous fat grafting alone demonstrated the greatest propensity for dissatisfaction (4 of 12 cases [33%]). Rate of dissatisfaction was significantly higher with malar hypoplasia (41% vs 7%; P < .001) or loss of elasticity (16% vs 3%; P = .01) but was not highly correlated with age (r = 0.15).

Conclusions: Successful midface rejuvenation requires accurate diagnosis and avoidance of anatomic pitfalls. Many patients require multimodality therapy, including lifting and volumizing techniques. Unsatisfactory results are most common when midfacial aging is accompanied by skeletal insufficiency or loss of elasticity. Respective consideration of these defects should be given to placement of malar implants and rhytidectomy approaches targeting the midface.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamafacial.2013.443DOI Listing
March 2013

Double-opposing rotation-advancement flaps for closure of forehead defects.

Arch Facial Plast Surg 2012 Sep-Oct;14(5):342-5

Divisions of Facial Plastic and Reconstructive Surgery, Departments of Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York 11021, USA.

Objective: To describe a local flap for closure of forehead defects of all sizes that does not alter the brow position or hairline.

Methods: Retrospective review of 16 cases in which the double-opposing rotation-advancement flaps were used for closure of small (<10 cm2), medium (10-20 cm2), and large (>20 cm2) forehead defects. This technique was developed from Orticochea's method for closure of large scalp wounds.

Results: All 16 patients underwent single-stage closure of forehead defects using our design. Six patients were men, 8 were women (mean age, 71 years). Preoperative defect sizes ranged from 3 to 30 cm2 (mean, 18 cm2). All wounds resulted from Mohs surgery for cutaneous malignant neoplasms; 2 were adjacent to previous reconstructions. No recurrence of tumor was seen during the study period. No permanent frontal branch injuries occurred. One patient developed a moderate cellulitis. Photographic analysis showed that brow position and hairline contour were maintained in all cases.

Conclusions: The double-opposing rotation-advancement flap closure is a versatile reconstructive option for small, medium, and large forehead defects. The technique involves elevation of opposing, asymmetric flaps, with subsequent rotation of one side and advancement of the contralateral side. Single-stage closure may be accomplished without unappealing changes to the brow position or hairline.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/archfacial.2012.7DOI Listing
March 2013

Patient-specific rhytidectomy: finding the angle of maximal rejuvenation.

Aesthet Surg J 2012 Sep;32(7):804-13

Facial Plastic and Reconstructive Surgery Department, North Shore University Hospital, Manhasset, New York, USA.

Background: Rhytidectomy is fundamentally an operation of tissue release and resuspension, although the manner and direction of suspension are subject to perpetual debate.

Objectives: The authors describe a method for identifying the angle of maximal rejuvenation during rhytidectomy and quantify the resulting angle and its relationship to patient age.

Methods: Patients were prospectively enrolled; demographic data, history, and operative details were recorded. Rhytidectomies were performed by the senior author (AAJ). After complete elevation, the face-lift flap was rotated in a medially-based arc (0-90°) while attention was given to the submental area, jawline, and midface. The angle of maximal rejuvenation for each hemiface was identified as described, and the flap was resuspended. During redraping, measurements of vertical and horizontal skin excess were recorded in situ. The resulting angle of lift was then calculated for each hemiface using trigonometry. Symmetry between sides was determined, and the effect of patient age on this angle was assessed.

Results: Three hundred hemifaces were operated (147 women; 3 men). Mean age was 60 years (range, 37-80 years). Mean resulting angle for the cohort was 60° from horizontal (range, 46-77°). This was inversely correlated with patient age (r = -.3). Younger patients (<50 years, 64°) had a significantly more vertical angle than older patients (≥70 years, 56°; P < .0002). No significant intersubject difference was found between hemifaces (P = .53).

Conclusions: The authors present a method for identifying the angle of maximal rejuvenation during rhytidectomy. This angle was more superior than posterior in all cases and is intimately related to patient age. Lasting results demand a detailed anatomical understanding and strict attention to the direction and degree of laxity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1090820X12455826DOI Listing
September 2012

Persistent improvement in lower eyelid-cheek contour after a transtemporal midface lift.

Aesthetic Plast Surg 2012 Dec 31;36(6):1277-82. Epub 2012 Aug 31.

Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.

Background: This study aimed to assess quantitative changes in lower-eyelid aesthetics after a transtemporal midface lift concomitant with transconjunctival blepharoplasty and lower-eyelid skin pinch.

Methods: The study enrolled 55 consecutive patients who underwent a transtemporal midface lift and concurrent transconjunctival blepharoplasty with lower-eyelid skin pinch. All the surgeries were performed over a 2-year period by the senior author (A.A.J.). Patient demographics and surgical details were recorded. Standardized digital photographs were taken at baseline and then 12 months postoperatively. These were analyzed to assess changes in the vertical height of the lower eyelid and compared using within-subject analysis.

Results: The study cohort consisted of 50 women with a mean age of 54 years (range, 28-76 years). Five patients were lost to follow-up evaluation. The mean vertical height of the lower eyelid was 11.8 mm preoperatively and 9.3 mm postoperatively, giving an average difference of 2.5 mm at the 12-month follow-up assessment. The changes in lower-eyelid height were statistically significant (p = 0.0002), and the lower eyelid-cheek contour was improved in all cases. No major complications occurred during the study period, and no revision surgery was performed. Lower-eyelid height changes did not vary significantly with patient age.

Conclusions: Age-related changes to the midface are marked by increased vertical height of the lower eyelid and a concomitant appearance of infraorbital hollowing. Separation of the lower eyelid-cheek complex causes the typical double-contour deformity. To the authors' knowledge, no study to date has reported the long-term effect of a midface lift on lower-eyelid aesthetics. The transtemporal midface lift not only repositions the malar fat pad but importantly also provides significant shortening of the lower eyelid at 12 months. This results in an improved midface contour.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00266-012-9963-5DOI Listing
December 2012

Anatomical comparison of platysmal tightening using superficial musculoaponeurotic system plication vs deep-plane rhytidectomy techniques.

Arch Facial Plast Surg 2011 Nov-Dec;13(6):395-7

Division of Facial Plastic and Reconstructive Surgery, North Shore University Hospital, Long Island Jewish Medical Center, New Hyde Park, USA.

Objectives: To quantify the degree of submental platysmal tightening that can be accomplished with superficial musculoaponeurotic system (SMAS) plication vs deep-plane rhytidectomy techniques in a cadaveric anatomical study to help dictate the need for midline platysmal surgery when using different rhytidectomy techniques.

Methods: The lateral distraction of the medial edge of the platysma muscle was measured during tightening of the SMAS-platysmal complex on 5 cadaver heads. The measurements were taken after the following 3 rhytidectomy techniques: SMAS-platysmal plication, deep-plane rhytidectomy, and extended deep-plane rhytidectomy continuing the flap below the angle of the mandible into the neck with release of the platysma and cervical retaining ligaments.

Results: The medial edge of the platysma muscle was distracted laterally 427% more with deep-plane rhytidectomy compared with SMAS-platysmal plication (P < .001). Extending the deep-plane rhytidectomy flap into the neck to release the cervical retaining ligaments resulted in 554% greater lateral distraction of the medial edge of the platysma muscle compared with SMAS-platysmal plication (P < .001). This represents 30% greater advancement compared with the traditional deep-plane technique (P = .05).

Conclusions: Extending a traditional deep-plane rhytidectomy inferiorly to release the lateral platysma and cervical retaining ligaments to the sternocleidomastoid muscle achieves the greatest lateral motion of the midline platysma, theoretically obviating the need for midline platysmal plication except in cases of severe platysmal laxity and banding. Because of the limited platysmal motion during SMAS plication, midline platysmal plication should routinely be used as an adjunct procedure except in cases of no or minimal platysmal laxity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/archfacial.2011.69DOI Listing
April 2012

The minimal access deep plane extended vertical facelift.

Aesthet Surg J 2011 Nov;31(8):874-90

North Shore University Hospital, Manhasset, New York, USA.

Background: Modern facelift techniques have benefited from a "repopularization" of shorter incisions, limited skin elevation, and more limited dissection of the superficial musculoaponeurotic system (SMAS) and platysma in order to shorten postoperative recovery times and reduce surgical risks for patients.

Objectives: The authors describe their minimal access deep plane extended (MADE) vertical vector facelift, which is a hybrid technique combining the optimal features of the deep plane facelift and the short scar, minimal access cranial suspension (MACS) lift.

Methods: The authors retrospectively reviewed the case records of 181 patients who underwent facelift procedures performed by the senior author (AAJ) during a two year period between March 2008 and March 2010. Of those patients, 153 underwent facelifting with the MADE vertical technique. With this technique, deep plane dissection releases the zygomatico-cutaneous ligaments, allowing for more significant vertical motion of the midface and jawline during suspension. Extended platysmal dissection was utilized with a lateral platysmal myotomy, which is not traditionally included in a deep plane facelift. The lateral platysmal myotomy allowed for separation of the vertical vector of suspension in the midface and jawline from the superolateral vector of suspension that is required for neck rejuvenation, obviating the need for additional anterior platysmal surgery.

Results: The average age of the patients was 57.8 years. The average length of follow-up was 12.7 months. In 69 consecutive patients from this series, average vertical skin excision measured 3.02 cm on each side of the face at the junction of the pre auricular and temporal hair tuft incision (resulting in a total excision of 6.04 cm of skin). Data from the entire series revealed a revision rate of 3.9%, a hematoma rate of 1.9%, and a temporary facial nerve injury rate of 1.3%.

Conclusions: The common goal of all facelifting procedures is to provide a long-lasting, natural, balanced, rejuvenated aesthetic result with few complications and minimal downtime. The MADE vertical facelift fulfills these criteria and often yields superior results in the midface and neck areas, where many short scar techniques fail. Furthermore, this procedure can be performed under local anesthesia, which is a benefit to both patients and surgeons.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1090820X11424146DOI Listing
November 2011

Deep-plane face-lift as an alternative in the smoking patient.

Arch Facial Plast Surg 2011 Jul-Aug;13(4):283-5

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/archfacial.2011.39DOI Listing
February 2012

Anatomic comparison of the deep-plane face-lift and the transtemporal midface-lift.

Arch Facial Plast Surg 2010 Sep-Oct;12(5):339-41

Section of Facial Plastic and Reconstructive Surgery, North Shore University Hospital, Manhasset, New York, USA.

Objective: To identify whether the deep-plane face-lift or the extended transtemporal subperiosteal midface-lift is more effective in correcting midfacial ptosis.

Methods: Five cadaveric dissections were performed with a unilateral transtemporal subperiosteal midface-lift followed by a deep-plane face-lift on the same hemihead. Three suspension sutures were evaluated-transtemporal midface-lift, zygomaticofacial and melolabial sutures, and a deep-plane face-lift suture-to determine the degree of elevation on the nasolabial fold. Statistical analysis was performed to compare their effectiveness.

Results: The melolabial suture elevates the nasolabial fold 43.2% more than the deep-plane suture (P = .03) and 29.2% more than the zygomaticofacial suture (P = .10). At no point did the deep-plane suture offer more elevation than either the zygomaticofacial or melolabial suture.

Conclusions: Midface-lifting surgery is challenging owing to the difficulty of adequately releasing the soft tissues overlying the zygomaticomaxillary region and resuspending them effectively. A comparison of the extended transtemporal midface-lift and deep-plane face-lift demonstrates the statistically significant advantage of the transtemporal midface-lift on elevating the nasolabial fold, particularly the melolabial suspension suture.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/archfaci.12.5.339DOI Listing
January 2011
-->