Objectives: 1. Present a simplified approach to access and treat facial aging
2. Rationale for multi-modality approach
3. Key anatomic and regenerative issues of modern facelifting
4. The deep neck
5. Cpmplimentary facial procedures to enhance rejuvenation
Introduction: Facial aging and its treatment is undergoing seismic changes, bringing about tremendous advances in many aspects of facial surgery. Facial rejuvenation and face and neck surgery in particular have seen marked improvements in care with exceptional outcomes that over time may improve.
Materials / method: To summarize a 20 year experience in multi-modality care of facial aging. The main aspects of facial aging are addressed, including sun damage, volume loss and pre-existing soft tissue and bony deficiency and laxity with a continuum of care approach, selecting the best combinations of modalities to improve outcomes. Newer techniques in deep plane, preservation facelift, jawline shaping, including fat grafting and the "Crevasse Procedure" will be presented as will an approach to the deep neck and its contents. Fat grafting is used for anatomic replacement and tissue regeneration.
Results: Over the past 5 years, 505 patients underwent anatomic and regenerative facial fat grafting in combination with deep plane, vertical lifting, jawline shaping with and without deep neck surgery. Approximately 30 percent of patients had submandibular gland reduction. Temporal brow lift, upper and lower blepheroplasty and upper lip lift were frequently performed. In addition, osseous genioplasty was carried out in those patients with severe retrogenia. Laser resurfacing was used in the majority of patients at some time during their treatment. All patients were placed on maintenance treatments.
Conclusion: Multimodality treatment of facial aging with the introduction of proven regenerative medicine and newer skin care longevity agents is our preferred approach.
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