Braunschweig, Private Lecturer Dr. Dr. Eduard Keese & Braunschweig, Dr. Christa Siemermann-Kaminski

Facelifting

The atony of the face skin and the increasing formation of wrinkles are external features of aging. These are very various and are frequently understood as an expression of the personality. By the strain of the mimic musculature wrinkles, like e.g. the so-called anger folds between the eyebrows are formed. By the influence of the gravity soft parts of the face sag. Examples are the inferior eyebrows, the so-called hamster cheeks at the lower jaw and the so-called nasolabial sulcus (nose upper lip fold). The dropping of the cheek fat causes a curvature which causes the shade throw and the depth of the nasolabial sulcus. The loss of the elasticity of the skin finally causes a skin surplus which primarily appears at the neck and at the cheeks.

The first facelifting in 1906 was not carried out in America what might be presumed by the name but by the famous German surgeon Erich Lexer. He published that much later, as operations to improve beauty were not accepted at that time. The intervention confined itself to a removal of the surplus skin and its streamlining, particularly since there were no dissolving seam materials available at that time . Today, this procedure is still used today in the so-called S-facelifting or mini-facelifting.

Another milestone started from Skoog who was the first one to indroduce the subcutaneous muscle aponeurotic system (SMAS) in 1974 which included the operative treatment. It is it a fibre rich connective tissue layer, dividing the fatty tissue of the sub-skin in a superficial and a low layer.

The problem zone of the conventional facelifting remains the middle face, i.e. the region below the sub-eyelid up to the nose lip furrow. At the conventional techniques of the facelifting a sloping pull to behind above region is performed by the streamlining. For the middle part of the face, a vertical pull, similar like for the facelift would be desirable.For that reason, Paul Tessier introduced the so-called Mask-Facelifting in 1982 in which all of the cheek soft parts taken off below the periosteum, and were then able to be fixed by a vertical pull.

Since this technique leads to a too strongly restricted facial expression after our conviction, we depreciate this technique. The success of an aesthetic correction operation depends quite particularly what the expectation of the patient is like, in which way heagrees with the later operation result. An optimal result then has to be expected if the patient understands the operation steps individually necessary for him and is informed about the possible improvements and the complications. Unrealistic expectations should be discussed in a detailed consultation so that, later, the patient is not disappointed.

Two examples of Facelifting