Original Investigation |

Anatomic Evaluation of the Vertical Face-lift in Cadavers

Rizwan Siwani, MBBS1; Oren Friedman, MD2
[+] Author Affiliations
1Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
2Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia
JAMA Facial Plast Surg. 2013;15(6):422-427. doi:10.1001/jamafacial.2013.1275.
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Importance  This study investigates how different orientations of tension vectors affect the amount of soft-tissue lift in specific cervicofacial regions.

Objectives  To compare differences in cosmetic neck and face changes generated by 3 different face-lift techniques, to quantify the amount of lift across different points on the face, and to quantify changes in platysmal dehiscence in each of 3 standard superficial musculoaponeurotic system plication face-lift techniques applied to fresh-frozen cadaver heads.

Design, Setting, and Participants  Ten cadaver heads in an academic tertiary care center.

Intervention(s)  Three different superficial musculoaponeurotic system plication rhytidectomy procedures were conducted in the following sequence: (1) vertical tension vector plication (vertical lift), (2) superolateral tension vector plication (superolateral lift), and (3) superolateral tension vector plication combined with midline platysmal plication (superolateral lift with platysmal plication).

Main Outcomes and Measures  After completion of each technique, the amount of lift at 4 standard key points was measured and recorded, and differences in lift at the key points were analyzed.

Results  Vertical lift was associated with greater total lift than superolateral lift alone or superolateral lift with platysmal plication (P < .001 for both). Platysmal dehiscence increased from baseline measurements after superolateral lift and decreased after vertical lift (P = .002 for both).

Conclusions and Relevance  Our findings establish how different orientations of tension vectors applied during face-lift surgery achieve different structural changes to various key points across the face. This study helps the face-lift surgeon and student understand the underlying structural anatomic changes associated with different face-lift techniques, which ultimately result in different cosmetic outcomes.

Level of Evidence  NA.

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Figure 1.
Points of Reference Where Lift Was Measured

Point A is the angle of the mandible; B, midpoint; C, lateral canthus; and D, site 4 cm from the mental symphysis. (Used with permission of Mayo Foundation for Medical Education and Research.)

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Figure 2.
Reference Lines Used to Carry Out Face-lift Procedures

A shows the lines from ear lobes to nasal ala for vertical lift. B, Lines are drawn from the malar eminence to the angle of the mandible for superolateral lift. (Illustration at top of Figure 2A and 2B used with permission of Mayo Foundation for Medical Education and Research.)

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Figure 3.
Midline Platysmal Plication After Superolateral Lift

The medial edges of the platysma were plicated in each cadaver specimen as shown following application of sutures exerting the superolateral lift.

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Figure 4.
Estimated Overall Lift With 95% CI for the 3 Types of Face-lift

P indicates superolateral lift with platysmal plication; S, superolateral lift; and V, vertical lift. Squares indicate mean value; bars, 95% CI.

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Figure 5.
Changes in Platysmal Dehiscence After Vertical Lift and Superolateral Lift

The impact on the degree of platysmal dehiscence (measured in millimeters [x-axis]) as measured in individual cadaver specimens (y-axis) prior to any kind of surgical intervention, following the vertical lift, and following the superolateral lift.

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