Rhytidectomy or facelift (also falsely facelift , Latin technical term: rhytidectomy ) refers to a procedure of plastic and aesthetic surgery ( plastic surgery ) on the face of a man. The aim of such an operation is to tighten the facial skin and the underlying tissue and to give it greater tension. Often this procedure is done to make the patient's face look younger. The first documented facelift apparently took place at the beginning of the 20th century. Reports from ancient cultures of the Egyptians show that they already performed cosmetic operations. Nowadays, a facelift is part of the expanded repertoire of surgeons specializing in aesthetics .
Lack of medical standards
In Germany, leading plastic surgeons, otolaryngologists , ophthalmologists , oral and maxillofacial surgeons , dermatologists and other specialists facelift operations. In the advanced training guidelines of the individual specialists (even those for plastic and aesthetic surgeons), the implementation of facelifts is not listed as binding for the specialist title. In addition, the public display of image material has been prohibited since April 1, 2006 by the amendment of the Medicines Act and the Medicines Advertising Act and is therefore no longer shown on the websites of the relevant practices or clinics.
A facelift usually takes place deep in the subcutaneous tissue. For a cheek lift can above the cheekbone to the periosteum be penetrated. In the neck area or if particularly long-term effects are to be achieved, structures below the subcutis such as z. B. the platysma (skin muscle of the neck) tightened.
To lift an area, the already mentioned skin and muscle structures are tightened with the help of sutures and anchored to solid structures. The tightening of different areas of this layer takes place in different directions . Finally, the resulting excess skin is removed and the skin is sutured as inconspicuously as possible and without tension. Both absorbable and non-absorbable threads are used.
Facelifts can be performed endoscopically or with incisions several centimeters long. The smaller incisions of the minimally invasive technique mean smaller scars . However, this technique cannot remove excess skin, which is why it is only used for lifts in the forehead area .
Methods that get by without incisions, such as thread lifting with gold threads or threads made of plastic with or without barbs, are based on the basic problem that excess skin cannot be removed and its applicability should be limited to young people. The effectiveness is assessed very differently.
- SMAS-Lift : SMAS stands for Superficial Muscular Aponeurosis System. With an SMAS lift, special attention is paid to this structure. There is a broad consensus among experts that this layer of tissue must be tightened in order to achieve long-lasting and effective results. There are many different methods of how this structure is ultimately prepared, repositioned, reduced and / or doubled and ultimately tightened using sutures. Depending on the effect to be achieved, the surgical preparation and reattachment are individually adjusted. a. also by customizing the direction in which the tissue is reattached.
- There are various techniques for an SMAS lift:
- The S-Lift , first described by Passot in 1917, got its name from the S-shaped cut that begins with an upper arch in the hairline in front of the ear, continues in a more or less straight line in front of the ear and ends with a lower arch that runs back behind the ear. The Fogli-Lift , the Soft-Lift and the MACS Lift (Minimal Access Cranial Suspension) are characterized by a defined arrangement of the holding sutures and the access incisions.
- Mini-Lift : Here only the skin is tightened. There is broad consensus among experts that the result of such a lift is generally not durable.
- Liquid-Lift : This term describes procedures in which various liquid, partially resorbable injection materials are used. These placeholders fill lost volume and thereby minimize the folds of the large static folds on the face (nasolabial folds, marionette folds, ...). The biological effects of the fillers introduced have not been fully clarified. Ultimately, the injected material has its own volume, which often also binds water and thus creates a volume effect. Inflammatory processes are also held responsible for the local increase in volume.
Typical resorbable filling materials are, for example, hyaluronic acid , collagen , calcium hydroxylapatite and autologous fat. These are broken down by the body after varying lengths of time and more or less without leaving any residue. Documentation of complications and the histological examinations resulting therefrom indicate that the tissue composition after such interventions sometimes differs significantly from untreated tissue. The liquid lift technique is less effective than surgical facelifts, as the tissue is only filled up and not mechanically tightened. In individual cases, however, areas of age-related loss of volume can also be compensated, which is sometimes not reached by facelift methods (perioral zone around the mouth, temple area, etc.)
In addition to liquid placeholders, botulinum toxin A is also used to reduce wrinkling caused by the activity of the facial muscles.
Another option is the implantation of usually silicone-based solid implants to model a face. These are used by a. with receding chin, with no projection in the area of the cheekbones or the lower jaw angle.
- Thread lifting: This technique was developed in Korea, originally for acupuncture . PDO threads (Polydioxanone) are placed under the skin in order to correct sagging and wrinkles (without cuts). The individual threads are brought in with the help of micro needles. The PDO threads dissolve completely in the body, they have been used as sutures for years. On the one hand, they are intended to stimulate the body's own collagen production and, on the other hand, to promote cell regeneration. The duration of the thread lifting effect is approx. 15 months.
The healing time is individual and depends, among other things, on the size of the operated areas and the surgical method. A social ability is i. d. Usually given after 1–8 weeks. The restriction of social ability is mainly based on swelling and discoloration from blood components.
As part of a facelift, the upper and lower eyelids are often tightened at the same time (blepharoplasty) so that these areas also show reduced aging effects. Is a liposuction of the neck often carried out in combination with a facelift, in order to intensify the effect on the neck or chin line.
A facelift is performed under local anesthesia with or without accompanying general anesthesia . The local injection of anesthetic liquid is used in general anesthesia to make handling of the different layers of tissue easier and safer during preparation and to avoid perioperative pain. The injected liquid (10–50 ml per side) is completely absorbed by the body during and finally after the operation.
The complications that may arise in the course of any operation should also be mentioned in the operation of a face. In general, swelling, bruises, infection and wound healing disorders with a prolonged healing phase and possibly unsightly scarring should be mentioned here. The latter is v. a. through careful incision, tension-free adaptation of the wound edges and sterile caution. If there is a known tendency to hypertrophic scarring or even keloids, postoperative local treatment with scar ointment is usually an accepted procedure.
There are specific risks associated with facial surgery a. in the formation of asymmetries. Since every face has a certain degree of asymmetry, these can appear balanced or even emphasized after an operation. The care taken in the implementation and the surgeon's experience are essential to avoid this aspect.
A specific complication would be injury to nerve branches of the so-called facial nerve ( facial paralysis ). This nerve is the nerve that innervates the facial muscles and is therefore necessary for facial expressions, has several cross-connections under the individual branches and can compensate for the restricted function of a certain muscle group more quickly than with nerve severing, even in the event of irritation or damage to smaller nerve branches otherwise it is the case. If a terminal branch is injured, the function of a certain muscle group can be temporarily (up to about 6 months) or permanently prevented. Then it comes v. a. wrinkles on the face when laughing. Avoiding this complication is essential and is flanked by many anatomical studies in order to impart the necessary knowledge about this to the surgeon.
In the area of the operation, the severing of small, sensitive skin nerves (especially the trigeminal nerve ), swelling, bruising , tissue tension or sutures can lead to numbness. V. a. the area around the incision, the earlobe and the area in front of the ear can be temporarily affected.
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