Objectives: Describe our technique of adipose grafting and facelifting with deep plane approach with hydro-dissection and cautery- the ABC Facelift
Introduction: Facelift surgery began in the early 1900’s after Hollander lifted the facial skin to improve the corners of the mouth and jowls in a Polish aristocrat. Since that time subcutaneous elevation of the skin has remained a key element in all facelift techniques. SMAS manipulation began in 1961 and was promoted by Skoog and developed into its various techniques by variety of surgeons. Most surgeons address the SMAS with a range of techniques, from plication to deep plane. Although fat grafting was introduced in 1893, large volume fat grafting during facelift was introduced in the early to mid-2000's
Materials / method: A technique of facial rejuvenation is described that consists of three steps: A. Adipose grafting using anatomic replacement of superficial and deep fat compartment and bone losses, nanofat microneedling and topical nanofat biocream (ITR2); B. Baraf elevator and hydro-dissection of the skin flaps with tumescent solution; and C. Cautery dissection of the SMAS into the deep facial planes and subplatysmal neck. Forty consecutive cases (37 females, 3 males) age 41-74 years underwent ABC Facelift.
Results: Dissection was faster compared to scissor dissection. Bleeding was reduced compared to sharp dissection. No patient developed a hematoma. Drains were not utilized. Because ischemia time to the flaps is minimized during the subcutaneous hydro-dissection, which is done with vibratory hydro-dissection through three small incisions along the facelift incision line, the skin flaps looked better perfused with less venous engorgement and ecchymosis compared to sharp scissor dissection. No patient developed flap necrosis.
Conclusion: The ABC Facelift is a simple idea that addresses facial laxity, volume loss and aging with three simple steps. The length of operative time has been reduced. Further improvement in layer separation using hydro-dissection are currently being investigated.
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