The anatomy of a facelift

November 1, 2006

Failing to preserve the natural look of the tragus and the pretragal depression can betray the best and most innovative cosmetic procedure.

Istanbul - Patients are more than ever inclined and even primed to visit their aesthetic physician to try to reanimate and restore their long faded, once youthful look.

German dermatologist Alina Fratila, M.D., says, "The aging process with the development of wrinkles and furrows is a complex phenomenon in which many intrinsic and extrinsic factors play a role. Well-known harmful extrinsic factors that speed up the natural skin aging process include years of extensive exposure to the sun, smoking and gravity, to name a few. A very important aspect as an intrinsic factor and mainly responsible for facial aging, is the fatty atrophy which causes a three dimensional loss in volume. This fatty tissue atrophy with the concomitant and continual influence of gravity creates a laxity and ptosis of the connective tissue structure, causing an emergence and evidence of the subcutaneous superficial musculoaponeurotic system."

Fat tissue transplant

"Sometimes though, this procedure is not sufficient, depending on the extent of aging. In a more advanced stage of skin aging with marked droopy and saggy skin, a repositioning of the sunken soft parts by means of a subcutaneous superficial musculoaponeurotic system facelift is necessary. Furthermore in my experience, to achieve optimal aesthetic results and a natural, even younger looking face, we recommend to combine the two procedures," Dr. Fratila says.

Understanding physiology

Cosmetic surgeons would agree that the human face is an incredibly complex structure and can be challenging for any surgeon. A solid knowledge and understanding of the blood supply and its rapport with the skin, fascia, fat, musculature and periosteum in the cervicofacial area is of paramount importance.

Dr. Fratila says that there were many other different facelift techniques that could be performed by the cosmetic surgeon, their implementation depending on each patient's individual characteristics and anatomical particularities. Dr. Fratila says that it is important to carefully analyze the hairline and brow level preoperatively to determine if the placement of a temporal incision will result in a more youthful looking appearance of the periorbital unit, also eliminating crow's feet.

She says that the dissection of the subcutaneous superficial musculoaponeurotic system and platysma is performed in order to achieve an optimal and natural contouring of the neck with a normal appearance of the earlobes. Failing to preserve the natural look of the tragus and the pretragal depression can betray the best and most innovative cosmetic procedure. Most surgeons would agree though that a pretragal incision is preferable in men to avoid shifting the sideburn. Dr. Fratila prefers to place the incision behind the tragus both in female and male patients. In men she recommends to thin out the flap to destroy all the hair follicles as well as postoperatively to perform laser epilation of the remaining hairs. According to Dr.Fratila, whether a pretragal or retrotragal incision is the preferred choice in a given patient is still contested among expert surgeons.

Other enhancements

"Other procedures that are welcomed by the patient and can enhance a facial rhytidectomy include liposuction of the neck (rather than removal of the adipose tissue with scissors, which can result in concavity and multiple irregularities in this area) and submental incision to correct laxity of the skin and muscle, the corner lift (because a sad mouth cannot be corrected by a facelift), lipofilling to correct skeletonization of the cheek and temple areas and deep infraorbital creases, as well as UltraPulse CO2 laser skin resurfacing to eliminate the perioral wrinkles." Dr. Fratila says.