ANTI-AGE #37

lift is always performed at the same time as a face lift, for
anatomical continuity.
A la carte treatment according to each case
The aim of this article is to describe a surgical process that
combines various techniques to rejuvenate the lower half of
the face and neck.
Set-up: The operation is carried out under general or local
anaesthetic. Adrenaline serum is dripped through a cannula
into the detachment planes to make them easier to dissect
and to reduce bleeding. The approach first follows that of a
classic face lift. I tend to perform intra-auricular incisions as
opposed to making incisions in front of the ear.
Sub-mental lipectomy: The neck lift procedure starts with
a lipectomy through an incision under the chin. It goes right
up to the basilar edge of the horizontal branches of the mandible
so as to reshape its contours. The procedure is monitored
visually as it is being carried out and has become much
less traumatic over time.
Medial and lateral platysmplasty: The platysma muscle is
detached on the surface side (and, if necessary, on its internal
side), laterally and starting from the inner edge, through a
submental incision. If they are hypertrophic and prolapsed,
the submandibular glands are repaired from underneath the
chin. In this case, I carry out a partial submandiblectomy
then immediately inject botulinum toxin into the rest of the
gland to avoid any mucocele. If the platysma cords are too
prominent or a secondary lift is required, I horizontally section
the whole platysma, then I stitch the mid platysma to
the upper edge of the thyroid cartilage. The back part of this
hammock is then fixed to the side. Since I have been performing
André Auersvald’s technique, I no longer need to use
Redon drains and no bruising is caused (2).
Cervicojugal face lift
At the top, my incision stops behind the tragus, goes around
the ear lobe, then up the retro-auricular fold to the projection
of the tragus and back down 90° into the scalp for 5-6cm, or
just before the hairline. When making an incision into the
skin, I pay careful attention to the anterior face of the tragus
cartilage. Then I start to detach the skin from the face using
Trepsa spatula-tipped scissors, close along the subcutaneous
plane, above the SMAS. Then, I detach it from the lower back
of the neck, again using large Trepsa spatula-tipped scissors,
from the retro-auricular incision line. I detach the skin in
front of the ear and the SMAS. After separating these two
parts, the SMAS is pulled up and behind the mastoid in order
to erase the jowls and highlight the mandibular angle. My skin
resections are surprisingly straightforward, rarely more than
a centimetre. I make the skin sutures fairly loose.
Sectioning the DAO: This is a useful procedure for treating
severe expression lines. I pull the lower lip inside out and cut
into the labial mucous membrane around a centimetre inside
the vermillion border. I then dissect the submucous plane
horizontally up to the orbicularis muscle. The change in direction
of the more oblique muscle fibres allows us to identify
LE LIFTING ASSOCIE DÉSORMAIS
DES TECHNIQUES
DE MÉDECINE RÉGÉNÉRATIVE.
A FACE LIFT NOW INCLUDES REGENERATIVE
MEDICINE TECHNIQUES.
and section the DAO. This is confirmed either by the appearance
of subdermal fat, which is irregular, or of the dermis.
From dermabrasion to blanching
In the case of wrinkles around the mouth and nasolabial folds,
and if the patient so wishes, I perform blanching along with
nanofat. I use a monophasic, polydensified hyaluronic acid
that can be injected into the superficial reticular dermis without
any risk of the Tyndall effect. Clinical studies using
a blend of HA and platelet-rich plasma are currently being
carried out. I use 32 to 34G needles that are 13mm long. The
needle is held almost parallel to the skin, with the bevel facing
downwards. The gesture is made easier if the needle is 2 or
3G larger and a miniaturised electric syringe is used, which
is both powerful and precise. The success of the treatment
relies on an immediate blanching effect, which, conversely, is
a sign of alarm if we are injecting more deeply.
Regenerative medicine techniques: Needling techniques
have proven to be effective tissue inducers. After using a pen
for a long time, I now prefer to use a roller or stamp, which are
great for enriched lipofilling and nanofat. These techniques
are mainly used for their trophic effect. Laser techniques can
be used during and before the operation to stimulate healing.
I prefer to personalise the settings (wavelength, fluency,
etc.). LED techniques are routinely used after the operation
to manage inflammation and bruising.
In this article, we have only mentioned the connected procedures
(5). Depending on the case, transversal or sagittal or
combined genioplasty could also be useful. Malar implants
might also be required in the case of severe atrophy with
a contraindication to lipofilling. The mandibular angles are
mainly treated at the expense of the masseters and not the
bone. In short, there is plenty of scope for creativity that
enables us to both rejuvenate and beautify. Finally, and this
is the conclusion of the conclusion, we must not lose sight of
the anti-aging techniques that allow us to act at cellular and
intracellular level (glycation, mitochondrial economy, etc.)
which are worth including.
1. Ellenbogen, R., and Karlin, J. V. Visual criteria for success in restoring youthful neck. Plast. Reconstr. Surg. 1980 ;66:
826.
2. Auersvald A, Auersvald LA. He-mostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma
in 405 consecutive patients. Aesthetic Plast Surg. 2014 Feb;38(1):1-9.
3. Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr
Surg. 1976 Jul;58(1):80-8.
4. Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat grafting: basic research and clinical
applications. Plast Reconstr Surg. 2013 Oct;132(4):1017-26.
5. Ruiz R, Hersant B, La Padula S, Meningaud JP. Facelifts: Improving the long-term outcomes of lower face and neck
rejuvenation surgery: The lower face and neck rejuvenation combined method. J Craniomaxillofac Surg. 2018;46:697-704.
2020 ANTI AGE MAGAZINE #37 • 47