E-Book, Englisch, 372 Seiten, ePub
Barton Facial Rejuvenation
1. Auflage 2008
ISBN: 978-1-63853-546-1
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark
E-Book, Englisch, 372 Seiten, ePub
ISBN: 978-1-63853-546-1
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Benefit from the experience and expertise of a skilled face-lift surgeon, Dr. Fritz E. Barton, in this outstanding book on facial rejuvenation. Written in a personal style that engages the reader, Dr. Barton shares his personal philosophy that a more extensive face lift is worth the effort if it delivers a highly consistent, long-lasting, and natural result. For him, that operation is the High-SMAS.
Step-By-Step Descriptions
This beautiful, four-color semi-atlas describes and illustrates every step leading to mastery of the High-SMAS face-lift procedure with tips and tricks scattered throughout. A detailed analysis of variations in different faces is provided, along with methods for approaching them surgically to help the surgeon individualize treatment.
Comprehensive Coverage
The book is divided into two parts. The first part, Basic Considerations, contains a wealth of information about topics ranging from office set-up and patient consultation to anatomy and anesthesia. The introductory chapter on the office contains valuable insights and suggestions to assist surgeons in dealing with issues of office planning, staffing, and effective office management. The second part, Procedures, includes step-by-step descriptions of operations for the forehead, eyes, face, and neck. To complement these technique chapters, the book also includes information on perioperative care and complications. Two extensive chapters on nonsurgical cosmetic treatments describe the various noninvasive treatments, such as lasers, botox and fillers, and various topical skin care options and how these can be combined with surgical rejuvenation to complete and enhance the overall result.
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
An Annotated History of Surgical Facial Rejuvenation
Part I Basic Considerations
1 The Office
2 Patient Consultation
3 Clinical Photography
4 Anatomy
5 Anesthesia
Part II Procedures
6 Forehead
7 Eyelids
8 The High SMAS Facelift
9 Neck
10 Adjunctive
11 Postoperative Care
12 Complications
13 Skin Care
INTRODUCTION
Attempts at documenting the history of facial rejuvenation are fraught with challenges and possible land mines. Over the past 30 years, I have attempted to create such a history and pay tribute to my colleagues and their significant contributions to rhytidectomy in The aim of this text, however, is not to be all inclusive, but rather to attempt to chronicle the contributions that have had the greatest impact on my personal approach to facial rejuvenation.
For historical completeness, I refer the reader to the meticulous early compiled by González-Ulloa and published in Aesthetic Plastic Surgery in 1980.1 The first well recorded effort to perform what we call the modern facelift apparently dates to the American physician Miller in 1907.2,3 This was followed by the reports of Lexer4 (see illustration below), Kolle,5 and Hollander,6 1910-1912.
Passot (1919),7 working in Paris, was probably the most famous and most active facelift surgeon of the early twentieth century. His method of multiple skin excisions without apparent undermining mimicked the common practice of hidden tape skin suspensions commonly employed by the rich and famous of the era.
Bettman (1920)8 was the first to publish comparative before-and-after photographs of his work. He also was the first to combine a single long temporal-preauricularmastoid incision for treatment of the entire cheek and neck.
With the exception of Lexer, early facelift surgeons depended on superficial excisions and tension closures in the skin to achieve their results. Bames9 recognized the limited benefit of these approaches and recommended wide subcutaneous undermining, as had been suggested by Lexer 17 years earlier.
The subcutaneous undermining technique was adopted by the growing number of American facelift surgeons, primarily in New York and Los Angeles, for the next 50 years.10,11
The concept of independently suspending the subcutaneous layer of the cheek with spanning sutures dates back at least to Pires in 1934.12 Pires apparently placed spanning sutures into the subcutaneous fat after limited skin undermining. Anteriorly placed plication sutures were also employed by Buttkewitz in 195613 and Aufricht in 1960.14
A looped “purse-string” version of subcutaneous plication sutures was then proposed by Saylan15,16 and later modified by Tonnard and Verpaele et al.17
It was probably Gustave Aufricht,14 the famous New York cosmetic surgeon recognized widely for his work in rhinoplasty, who first began to question the effectiveness of the subcutaneously undermined facelift, particularly in patients with prominent jowls, submental fat excess, and cervical bands. He recommended additional suture plication of the deep subcutaneous tissues—probably the superficial musculoaponeurotic system (SMAS)—to provide additional suspension.
It may have been Pangman and Wallace in 196118 who first undermined the subcutaneous fascial layer that has come to be known as the SMAS. These authors raised the skin and superficial fascia as a common (composite) layer, carrying the tension on the cheek flap on sutures placed above the zygomatic arch into the temporal fascia. As often happens, new ideas are often not widely accepted and tend to be buried in the medical literature.
It took the monumental work of Tord Skoog19 of Sweden to bring focus to the value of the superficial subcutaneous fascia. The problem with Skoog's composite skin/SMAS flap technique was that motion was limited, both in the cheek and the neck. Although most of the American plastic surgical world rejected the Skoog concept, a few visionaries explored it. The anatomy of the SMAS was then further delineated by Mitz and Peyronie,20 Jost and Levet,21 Wassef,22 and Barton.23
Most of the early methods cautiously elevated the SMAS layer proximally, over the parotid. These attempts were often timid and did not dissect beyond the parotid capsule. Because the SMAS fuses with the parotid capsule, the SMAS is fixed (fixed SMAS). Therefore, partial capsular elevation had little effect. This critical anatomic point was recognized by Webster et al in 1982.24
Owsley25 in San Francisco and Lemmon26 in Dallas were two of the first to explore ways to modify the Skoog skin/SMAS technique to allow greater mobility. Hamra27-30 joined Lemmon in Dallas and carried Lemmon's work forward into his “composite” version of the Skoog procedure.
These early SMAS imbrications focused on SMAS suspension below the zygomatic arch—I call them procedures. Working separately in Dallas, but influenced by the early work of Skoog, Lemmon, and Hamra, I focused on moving the entire cheek as a single unit. This variation became known as the technique (see illustration below).23,31-33 (An overview of the evolution of the High SMAS technique is given in Chapter 8.)
Working in San Diego, Connell34,35 chose to use the SMAS by dissecting it as a separate layer, after first elevating a skin flap. This two-layer dissection—a separate skin flap and SMAS flap—became known as the technique, and it was adopted by Aston36 and modified by Stuzin and Baker in Miami.37
Robbins et al38 in Miami proposed achieving greater anterior facial improvement by plicating the anterior subcutaneous tissue beneath an initial subcutaneous cheek flap dissection. At the same time, Hamra27 proposed penetrating the SMAS anterior to the parotid capsule, where the SMAS is mobile over the buccal areolar space (mobile SMAS). Modifying the Hamra anterior approach to SMAS penetration, Baker39,40 of New York excised a strip of SMAS at the junction of the fixed and mobile portions, in conjunction with skin flap dissection, calling his technique a
As came to be understood, the key to using the SMAS to achieve cheek mobilization was release of the deep attachments. The sentinel description of these attachments was the delineation of the retaining ligaments of the face by Furnas in 1989.41 Thereafter, Stuzin described additional retaining ligaments in the parotid area.42 In addition to retaining ligaments, the motion of the SMAS is restricted by its anterior attachment to the mimetic muscles, as we described in 1992.23 Effective repositioning of the subcutaneous cheek mass is facilitated by complete release of the extensions of the investing fascias of the mimetic muscles.
As craniofacial surgery began to burgeon, applications of those skills to facial rejuvenation were explored. Likely it was Tessier in 198043 who first suggested lifting the soft tissues of the forehead and cheek through a subperiosteal approach. Further contributions were made by Hinderer,44 Psillakis et al,45 Ramirez et al,46,47 Cornette de Saint Cyr et al,48 Krastinova-Lolov,49 and Heinrichs and Kaidi.50 A modification of the temporal subperiosteal technique—dissecting supraperiosteally—was advocated by Byrd and Andochick51 and de la Plaza and de la Cruz.52 Although the subperiosteal approach has a group of loyal followers, it has not achieved broad acceptance. Frequent canthal distortion and inability to correct the jowl-mandibular area limit its usefulness.
Finally, the concept that loss of facial fat volume is an integral component of facial aging has been emphasized by Coleman53 and Lambros.54 Correction by autologous fat reinjection was described by Guerrerosantos55,56 and Coleman,57 but the ability to reproduce these corrections consistently has been elusive thus far.
Passot7 is credited with initial attempts to correct aging neck deformities with a submental incision. In the modern era, the development of cervicoplasty developed along two parallel paths: defatting and platysma myoplasty.
It was Millard et al58 of Miami who brought attention to submental defatting of the neck as a routine part of facial rejuvenation. The analysis, role of hyoid position, and surgical goals were then defined by Ellenbogen and Karlin.59
CRITERIA FOR A YOUTHFUL NECK
1. Distinct inferior mandibular border
2. Subhyoid depression
3. Visible thyroid cartilage bulge
4. Visible anterior sternocleidomastoid border
5. SM-SM angle of 90 degrees (cervicomental angle is between 105 and 120 degrees)
As in the cheek, the Skoog composite platysma/skin flap in the neck gave limited mobility. As a result, surgeons began to explore how to manipulate the platysma to achieve cervical contouring. Most concluded that a two layer approach—that is, skin flap and platysma separately dissected—was preferable in the neck, so that differential directions of movement could be employed.
Interest in correction of the platysmal deformities of the neck was stimulated by...
