Lamellar Arrangement in Facelift Procedures

Introduction: The aging process of the face involves: Skin
elastosis, lipodystrophy, gravitational effect and atrophy. For
decades while planning facelift procedures, the face was
divided into regions (upper, middle, lower face). Reflecting
on the etiology of aging it seems logic to plan facelift procedures
in horizontal fashion rather than traditional vertical
planning. In this study we are addressing the face in 3 lamellas:
Skin, subcutaneous fat and SMAS where we are combining
the advantages of both techniques: Traditional supra-SMAS
and deep composite facelift.
Material and Methods: Retrospective study from 2014
to 2017 included 52 cases. Procedures were done using sedation
and local anesthesia. Incisions followed by skin undermining
(1st lamella) and ligament release from superficial fat compartments
and SMAS. Thus, allowing repositioning of superficial
fat compartments (2nd lamella, e.g. malar pad of fat)
and SMAS plication in upward vector; in which composite
facelift lacks. Followed by sub-SMAS and sub-platysma
dissection (3rd lamella) giving advantage of platysma redraping
over the neck, enabling good pull and mobilization
of SMAS (re-enhancing our previous fat repositioning and
plication) and allowing SMAS excision (preventing lateral
cheek bulge). Plication, excision and SMAS anchoring. Skin
and SMAS pull in upward and lateral vector. Ancillary procedures
as chin augmentation and fat injection were used when
needed.
Results: Follow-up from 6 months to 2 years. 84.6%
complied to follow-up, 90.9% were satisfied, chin implant in
9%, lipo-injection in 22.7%. Complications 13.6%, early:
6.8% had tenderness and redness managed by antibiotic
ointment, 2.2% had hematoma collection which was surgically
evacuated and coagulation of bleeding vessels, 2.2% had
mandibular neuropraxia for 3 weeks; late: 6.8% hypertrophic
scarring.
Conclusion: Restoring the harmonious facial anatomy
during facelift procedure is crucial step. Lamellar facelift
ensures addressing all facial components as a safe, reliable
procedure that ensures long term desired aesthetic outcome