Surgical midface lift. A safe rejuvenation technique - endoscopic facelift How to choose the most effective technique for eyebrow and forehead lifting

A midface lift is a plastic surgery that, if performed correctly, will please a woman with excellent results for a long time. Of course, there are more humane methods of rejuvenation (for example, mesotherapy and biorevitalization). However, getting rid of excess skin folds and layers of fat is possible only with the help of deep invasive methods. In some cases, unfortunately, one cannot do without “plastic surgery”.

What is an endoscopic midface lift?

A midface lift is performed on patients between 30 and 50 years of age. It is effective before the development of serious age-related changes. The main purpose of this operation is anti-aging; in addition, it helps to improve natural facial features.

The intervention can be carried out both in individual parts of the face and throughout its entire area -. The meaning of the method is that all manipulations are controlled by a doctor with the obligatory use of an endoscope. The device displays images on the screen, making it possible to clearly see all the subtleties of the manipulations taking place.

It is for this reason that there is no need for wide incisions in order to provide access to a particular tissue. The width of the incisions is no more than two centimeters, and special surgical instruments are carefully inserted into the cavity. They peel off those areas that have already sunk by moving them upward. Each stage is strictly controlled.

Indications and contraindications

The middle zone of the face is performed for the following cosmetic defects:

pronounced ptosis on the forehead;
sagging skin in the eyebrow area;
the presence of straight and transverse wrinkles (ibid.);
"crow's feet";
when the tissues of the cheeks and neck move downwards with age;
in the presence of deep nasolabial folds;
with a general decrease in the tone of the facial muscles caused by various reasons.

You should be aware that the changes should not be too pronounced, and the operation is carried out only if the skin has a certain degree of elasticity. Therefore, there is an age limit - up to 50 years. There are also a number of contraindications that should be taken into account:

cardiovascular pathologies;
presence of diabetes mellitus;
mental illness;
pregnancy;
period of feeding a child;
kidney and liver diseases;
chronic diseases in the acute stage;
traumatic defects;
poor blood clotting.

How is it carried out?

A midface lift, like any surgical intervention, includes patient preparation, and the operation is carried out in several stages.

Preparation

There are no special requirements here, but you will have to pass a number of routine tests and undergo a medical examination. This helps avoid complications in the future. In addition, several days before the operation you will have to refrain from drinking alcohol and taking medications, and on the day of the lifting, drink less and not eat.

Carrying out the operation

In general, a facelift consists of several stages, which the doctor will always tell the patient about. First of all, general anesthesia is administered, then the skin is treated with antiseptics. After treatment, the surgeon uses a scalpel to make several incisions in those places that are carefully marked in advance. Excess tissue is excised through these holes and stretched.

The doctor also carries out redistribution and removal of the fat layer if necessary. This is followed by suturing and another antiseptic treatment, and the final stage is the application of a fixing bandage.

After surgery, patients remain in the hospital for several days. Doctors monitor your current state of health in order to provide timely assistance in the first days and prevent the occurrence of possible complications.

Rehabilitation

After a midface lift, the rehabilitation process lasts about 30 days, provided there are no complications and the patient follows all the doctor’s recommendations.

For the first seven days, be sure to wear a lightly compressive bandage to prevent the stitches from coming apart. It can be removed periodically to give the skin a rest. Washing your hair is allowed only after the next examination and permission from the doctor. Patients will be prescribed special medications to prevent serious swelling and bruising. Of course, you will have to deprive yourself of pleasure in the form of a bathhouse, sauna and solarium for at least a month. Also, do not engage in physical training or lifting heavy objects.

You will need to visit a doctor regularly so that he can assess the condition and monitor the healing process of the skin. If necessary, additional medications and procedures may be prescribed.

Possible complications after the procedure

A midface lift in the postoperative period is always accompanied by the appearance of swelling and bruising. This, unfortunately, cannot be avoided, but it is important to set yourself up positively, knowing that they represent a temporary nuisance that will soon pass. With proper care and lifestyle, all hematomas and swelling will resolve within two weeks. If the skin turns out to be too sensitive, the doctor may prescribe a vascular coagulation procedure. Sometimes hematomas are removed by using simple punctures.

In the initial stage of the rehabilitation period, patients may experience a feeling of numbness. This occurs because, due to surgical displacement of tissues, their nerve conduction and blood flow are disrupted. Symptoms usually go away on their own.

As for inflammatory processes, as a rule, they occur in rare cases, for example, if surgery is performed on a patient suffering from any systemic chronic disease. Several sessions of physiotherapy, antibiotics and antiallergic drugs are prescribed.

Tightening effect with photos before and after surgery

A midface lift usually shows its visible and lasting effect after swelling and bruising have subsided. Do not worry if such phenomena and feelings of discomfort occur in the first days. Here are some photos before and after a midface lift:

Youth is so beautiful, but, unfortunately, fleeting. But any woman after forty wants to maintain her beauty, to be desirable and irresistible. To do this, it is important not only to have a fit and slender silhouette, but also to take care of the skin of your face. With age, as well as due to bad habits and a dynamic rhythm of life, there is an increasing destruction of the amount of elastin and collagen fibers, which are responsible for the elasticity and smoothness of the dermis.

We observe the earliest signs of aging on the skin of the face: changes in the contour and oval, also the lines of the forehead area, above the eyebrows, around the mouth become permanent, a nasolacrimal groove appears and “crow’s feet” appear around the eyes.

The main reason for such changes is the separation of fat bags. It is precisely because of the large weight of adipose tissue that we note weak fixation of the oval of the face, various recesses and overhangs in the facial areas.

Year after year, the face takes on a heavy and senile outline. But we can get out of this crisis. Modern aesthetic cosmetology provides us with the opportunity to stop the process of inevitable aging.

Endoscopic facelift is the most popular, safe and effective technique among the methods of correction, tightening and lifting. The famous endoscopic facelift, as it is also called, does not require a long rehabilitation period. It is much less traumatic and associated with low risks of complications than, for example, a classic lift. In addition, he is not inferior to her in terms of performance.

The effect of this type of rejuvenation lasts for 7-10 years. In this case, we are talking about the restoration of several zones in the complex. This period can be increased if you actively take care of the condition of your skin and systematically undergo cosmetic facial care programs.

Abroad, this type of operation is also common and is known as “seamless facelift”. What is this method of rejuvenation?

An endoscopic facelift is a surgical facelift in which incisions are made in the hair growth area of the head, behind the ears, or in the mouth area. They are hidden and small in size. The doctor makes incisions smaller than 1-2 cm, which in most cases do not require surgical stitches. 3-4 incisions are made in the forehead and temple areas. Special staples secure the incisions, which are removed by the surgeon in about 10-15 days. Therefore, the patient does not have any visible traces or scars from the intervention.

Invisible stitches heal quickly, and swelling and bruising during rehabilitation are minimal. That’s why the procedure was called “seamless” lifting. The effect of the procedure is visible much faster and you can enjoy your new look.

Patients return to their normal rhythm of life earlier than after traditional plastic surgery, which requires a long hospital stay and recovery. As for the average time, rehabilitation for endoscopic lifting lasts no more than one week.

Video: how to look 10 years younger using the procedure:

Let's list how endoscopic lifting differs from other types of facelift:

minimal trauma to skin tissue;
safety;
shorter duration of operation;
fast rehabilitation period;
symbiosis of skin lifting and volume restoration;
natural tightening effect;
duration of the result (up to 10 years).

Endoscopic facelift is performed in medical centers and clinics by professional and qualified surgeons. It is impossible not to appreciate the use of expensive medical equipment when performing endoscopic lifting, which further helps to protect the patient from possible risks.

Using endoscopic equipment, the doctor controls the entire process and progress of the operation. The procedure is performed using a special device – an endoscope. The endoscopic stand is equipped with optics, the necessary instruments, and an advanced micro-camera, so the image is displayed on the monitor. The surgeon makes the cut as accurately as possible, avoiding damage to blood vessels and nerve endings.

Before surgery, the patient will have to undergo a preliminary consultation with the surgeon. Endoscopic lifting should be performed between the ages of 35 and 50, when the skin still retains sufficient elasticity. But often ladies both younger and older than their required age turn to doctors.

Of course, you can go for a consultation, and each situation is individual: for some, age-related changes occur earlier, for others later than the average period. But only a competent specialist can determine the indications necessary for you and recommend treatment.

Basically, doctors prescribe endoscopic face lifting to people with thin and normal skin, with a short and flat forehead, without severe wrinkles, medium-type wrinkles, and with not very large excesses and sagging skin on the face.

In case of severe ptosis of soft tissues and large excess skin, the procedure is not performed. For older patients, it is better to resort to a standard surgical facelift in the future in combination with laser and injection techniques (fillers, Botox, Dysport).

gravitational ptosis of the facial oval;
“heavy”, tired face;
sagging facial skin;
folds, furrows and wrinkles in the forehead area;
drooping, change in shape and position of eyebrows;
crow's feet, bags under the eyes, wrinkles around the eyes,
nasolacrimal groove;
sagging, sagging tissues in the area of the cheekbones and cheeks;
, perioral wrinkles;
sagging of the upper eyelids, in the temple area;
nasolabial folds;
double or layered chin;
creating a beautiful convexity of the forehead and projection of the cheekbones;
facial asymmetry;
facial beauty, if desired, change facial features (eyebrow height, for example).

Endoscopic lifting is a surgical operation, and naturally has a number of contraindications. These include:

The shape and height of the forehead also become some limitations to the operation, in particular to the use of an endoscope. It is easy for the surgeon to work with patients who have a low and flat forehead. A convex and high forehead makes it difficult for a doctor to work with a hard, straight endoscope and limits the accessibility of the equipment.

The first type of lift is endoscopic forehead rejuvenation, eyebrow correction or brow-lift. An endoscopic forehead lift is performed in the hair area of the head. Make from 2 to 6 small incisions 1-2 cm long.

This method allows you to get rid of transverse and vertical wrinkles in the forehead area, bags under the eyes, crow’s feet, and correct the shape and position of the eyebrows. In some cases, the method is quite effective in raising the outer canthus, without even having to resort to blepharoplasty. Miniscrews are installed on the frontal bone to fix the tissues, which are removed 10 days after surgery. At first, the patient wears a compression bandage for about 4 days, and final recovery occurs 9-14 days after the procedure.

The next type of lift is cheek-lift light or lower eyelid rejuvenation combined with limited rejuvenation of the middle zone. With the help of special and very small Endotin plates, simultaneous lifting of the cheek-zygomatic area and blepharoplasty of the eyelids occurs. The plates are very small and do not cause any inconvenience.

As a result of this method, “bags” under the eyes and “sinks under the eyes”, folds in the cheek area and furrows are corrected. You will spend one day in the hospital, and rehabilitation will last from 10 to 14 days.

3D mask lift or endoscopic midface and forehead lift is a volumetric remodeling of the midface and forehead rejuvenation. With this endoscopic rejuvenation, up to 5 small incisions are made on the scalp and 2 incisions in the oral cavity under the upper lip.

The purpose of this operation is not only rejuvenation, but also facial beauty, that is, creating the desired convexity of the forehead, as well as the projection of the cheekbones, correcting the correct position and shape of the eyebrows, corners of the mouth and eyes.

Endoscopic midface lift has received the most positive reviews since it leads to a significant and pronounced effect: it lifts the midface and produces deep skin lifting. During rehabilitation in the first few days, it is necessary to maintain proper and gentle oral hygiene.

Photo: Before and after endoscopic midface lift.

Endoscopic rejuvenation of the lower area of the face and neck or neck lift is a neck lift, during which a beautiful transition line to the neck and a tightened chin contour are created. During the operation, the so-called “youth angle” is formed. This procedure is effective when the skin on the neck becomes sagging with age and folds and sagging appear.

The technology is also effective in cases where we have a double chin, or if overhanging is a feature from birth that is not related to age, but, for example, to a genetic trait and nationality. Neck lifting is a very popular procedure among patients and has many satisfied reviews, since it is the neck that experiences the symptoms of aging in the first years.

Photo: Before and after endoscopic rejuvenation of the lower face.

Preparation for surgery begins with choosing a clinic. Be sure to read reviews about surgeons on the websites of medical centers and choose a competent specialist. The success and effectiveness of the procedure mainly depends on the work of the doctor.

Once you have decided, schedule a consultation with a specialist. During the consultation, the surgeon determines the indications and scope of work. The doctor selects the location of the incisions, performs 3D modeling, and informs the patient about preparation for the procedure and care during the rehabilitation period.

It is important for you, as a patient, to inform us in advance about your state of health, past illnesses, allergies, including to any types of anesthesia, and existing ailments. Next, the doctor prescribes a full medical examination, during which the patient does an ECG and donates blood for laboratory tests to determine the blood type and Rh factor.

Video: three weeks after the procedure

For several days, the patient continues to experience pain, swelling, bruising, decreased sensitivity, and may be bothered by slight bleeding.

The risks of an endoscopic lift are minimal, but it is important to monitor your well-being after surgery, and if such symptoms may worsen, contact your doctor immediately. If you follow all the doctor’s recommendations, after 1.5 weeks you will be able to restore your normal, everyday lifestyle, pleasant compliments and reviews are guaranteed.

The final price of the operation is calculated during consultation with the surgeon, based on the indications and the average amount of work. However, the average prices for the endoscopic lifting procedure are presented in this table:

The higher cost of the operation also depends on expensive endoscopic equipment. Of course, the average prices for endoscopic lifting are quite high, but the result and effect of this rejuvenation method is truly visible and long-lasting.

Endoscopy has made it possible to work with the human face as carefully as possible, like artists who draw the ideal human profile in their paintings. And the excellent results from the “endoscopic lifting” procedure are guaranteed by reviews from patients who have already received a boost of youth for several years to come. Surprise everyone with your timeless beauty!

Video: a detailed story from the surgeon about the procedure

Minimally invasive operations are practiced in all branches of medicine, including plastic surgery. For such interventions, minimal incisions are made on the skin (up to 3 cm), which do not require sutures. They are invisible, heal quickly and painlessly without complications, providing excellent and long-lasting aesthetic results.

Endoscopic frontotemporal lifting

The described form of the procedure is a minimally invasive plastic surgery of the upper third of the face. Endoscopic forehead and eyebrow lift provides:

elimination of longitudinal wrinkles;
smoothing the skin;
removal of transverse folds on the bridge of the nose;
raising the eyebrow arches;
excision of excess tissue.

The effect of gravitational forces on the skin manifests itself in the form of noticeable age-related changes - ptosis (drooping) of soft tissues. Endoscopic forehead lift helps return them to their previous position. Additionally, the operation involves correcting the localization or removing muscles that are hypertonic and provoke the formation of horizontal wrinkles.

An endoscopic forehead lift is performed through 3-5 small incisions (1-2 cm) in the scalp. The procedure is performed under anesthesia, preferably general anesthesia. The duration of the manipulation is about 1-2 hours. Due to minimal trauma, endoscopic facelift has a number of advantages compared to classical plastic surgery:

minor blood loss;
risk reduction ;
short rehabilitation period;
maintaining normal sensitivity of the scalp;
almost invisible visually and thin scars.

This type of lifting is performed simultaneously with correction of the frontal area. A separate endoscopic brow lift is not done, because this would require cutting the skin above the eyes, causing the formation of noticeable scars. When the soft tissues on the forehead are shifted upward and the new position is fixed, the entire upper third of the face is smoothed out. Endoscopic eyebrow lifting helps make the look more open and friendly, and eliminates the “gloomy mask”. The effect after surgery will appear within 4-6 months and will last for several years.

The manipulation in question is recommended for people under the age of 40-45, when age-related changes are already pronounced but easily reversible. Temporal endoscopic lifting is a tightening of the skin around the eyes through 2 small (up to 15 mm) incisions in the scalp. With the help of the operation, sagging of the upper and lower eyelids is eliminated, facial folds are smoothed, and the position of the eyebrows is corrected.

The presented area is exposed to gravitational forces earlier than others. As a result of endoscopic facelift you can achieve:

smoothing;
raising the upper part of the cheeks;
removal of ptosis of the skin under the eyes;
oval normalization;
eliminating "" under the lower eyelids;
restoring the elasticity of the dermis.

Endoscopic midface lifting is often prescribed in conjunction with forehead and eyebrow lifting. This surgical procedure is suitable for patients with shallow but pronounced wrinkles and a tendency to swelling. It is effective up to the age of 50, especially with good tissue fullness and speed of tissue regeneration. The incisions are made in the most inconspicuous places, so they heal quickly and are almost invisible to others.

The described manipulation is aimed at removing ptosis of the cheeks, filling them, and eliminating nasolabial folds. Endoscopic lifting is performed under general anesthesia with preliminary marking of the areas in which punctures will be made. Preferred areas are the scalp, just below the temples, and inside the mouth, around the upper lip. The incisions are microscopic and are not sutured, so endoscopic midface lift does not require long-term recovery. The first results of the operation are visible immediately after discharge, but a pronounced effect appears after six months.

This type of plastic surgery is designed to correct the shape of the eyes, eliminate “bags” and tear grooves. This endoscopic face lift can be performed even under local anesthesia. The procedure is minimally invasive and is characterized by low trauma to soft tissues and skin with almost no blood loss. The endoscopic facelift in question is carried out through micro-incisions along the line of the lower eyelid, in the crease area.

Compared to classic blepharoplasty and other variations of surgical interventions in the eye area, this operation has many advantages:

the duration of the manipulation is about 70 minutes;
minimal risks of subsequent complications;
the fabrics do not shift to the periphery (temples), which ensures the most natural appearance;
long-term result, up to 8 years;
The “round eye” effect is eliminated and its original cut is restored.

At the age of 35-50 years, gravitational changes on the cheeks, neck and chin become visible:

drooping of the corners of the lips and fat pad of the cheekbones;
unclear contours of the lower jaw;
shaved;
nasolabial wrinkles;
double chin;
looseness, sagging skin.

Professional endoscopic lifting will help get rid of all the listed defects in a single session. To perform the operation, longer incisions will be required, up to 3 cm. They are also made in inconspicuous places, guaranteeing excellent aesthetic results. Often the procedure is combined with other surgical procedures - liposuction, platysmoplasty and correction of the décolleté area.

This area is considered the most problematic, especially among women who have thin skin that is more susceptible to age-related changes. In such cases, experts recommend endoscopy. This technique involves not only tightening and redistributing tissue, but also excision of unnecessary structures and their reliable fixation in new locations.

The described endoscopic facelift is performed through incisions at 3 points:

behind the ears;
at the edge of hair growth on the upper part of the neck;
under the chin.

The work requires a highly qualified plastic surgeon and a thorough knowledge of human anatomy, because during the lifting process it is necessary to exclude influence on nerve clusters. The presented operation is accompanied by sutures with absorbable threads and involves a longer recovery period under the supervision of doctors.

Rehabilitation after endoscopic face lift

Similar to any surgical intervention, the manipulation in question is accompanied by swelling, the occurrence of extensive hematomas and unpleasant, sometimes painful, sensations. A facelift using the endoscopic method is low-traumatic, so the listed symptoms disappear quickly, especially when the recovery is organized correctly and in accordance with the doctor’s recommendations.

Immediately after the operation, a pressure fixing bandage is put on the treated areas; it should be worn for at least 3-5 days. After 7-10 days, the stitches are removed, if they were applied. Swelling, pain and hematomas disappear on their own after 1-2 weeks. On days 13-15, the patient can safely return to his work activity and standard routine.

Rehabilitation after an endoscopic facelift involves observing the following rules:

Sleep on a high pillow for about 3 weeks.
Avoid strenuous physical activity.
Limit or eliminate smoking, alcohol intake, medications, and dietary supplements.
Apply cold compresses or ice to swelling and bruising.
Do not go to the solarium or sunbathe on the beach.
Avoid intimate contact for 3-4 weeks.
Do not visit saunas, baths and steam rooms, do not take hot baths.
Use special medicinal cosmetics.
Go to physiotherapeutic procedures - lymphatic drainage with microcurrents, hardware massage and others (optional).
Do not apply cosmetic masks, scrubs, or peeling compounds.

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History and indications for surgery

It has now been established that the eyelids, eyebrows and forehead should be considered as a whole and a treatment plan should be drawn up taking into account the entire range of cosmetic problems. The basis for performing operations in this group are:
1) pronounced facial wrinkles on the forehead and bridge of the nose;
2) ptosis of the eyebrows with well-defined “crow’s feet” and a decrease in the distance between the eyebrows and the upper eyelids;
3) more pronounced age-related changes in the upper part of the face (compared to the lower).

Most often, indications for isolated forehead skin tightening occur at a relatively young age in patients whose individual characteristic is the development of tissue sagging processes starting from the upper third of the face. At the age of 40-45 years and later, as a rule, there are reasons for lifting facial tissue at all levels.

Shifting the eyebrow upward and tensioning the skin at the temples leads to straightening of the tissues of the upper eyelid, smoothing out wrinkles and improving the contours of the palpebral fissure. Understanding this became the basis for performing a conventional frontotemporal lift. However, its results were not entirely satisfactory, both in terms of the scale of changes made by the surgeon and in terms of the duration of their maintenance.

A significant improvement in the results of rejuvenating operations on the upper half of the face occurred with the beginning of the use of the subperiosteal technique proposed by P. Tessicr in 1979.

This intervention involved lifting the soft tissue-periosteal complex of tissues of the periorbital, zygomatic and maxillary areas of the face upward by subperiosteal detachment of tissues in these areas with a raspator and fixing them in the reposition position with permanent sutures.

However, a significant improvement in the position of the tissues was not always achieved due to the rigidity of the periosteum displaced upward.

In 1991, R. De La Plaza proposed performing a one-stage tissue lift of the forehead, temporal region and middle third of the face with their division between the PIPJ and the periosteum. This highly effective operation is called a supraperiosteal lift of the upper two-thirds of the face, or a frontotemporal periorbital PMJ lift.

Forehead skin lift (classic version)

This intervention in an isolated version is advisable primarily in younger patients with age-related changes mainly in the upper part of the face. With more severe tissue ptosis, preference may be given to more extensive interventions.

Operation technique. Coronary access is planned at a distance of approximately 5-7 cm behind the hairline. It is never a straight line connecting the temporal areas (Fig. 35.4.1, a, b).

Rice. 35.4.1. Options for coronary access planning for forehead lift.
A. b - typical access; c, d — location of the central part of the access along the hairline.

In patients with a very short haircut, the incision is made in the form of a zigzag line with a dissection of the skin in the transverse direction of hair growth (Fig. 35.4.2, a). In the postoperative period, the hair shafts pierce the scar line, thereby achieving its maximum camouflage (Fig. 35.4.2, b).

Rice. 35.4.2. The plane of skin dissection within the scalp (explanation in the text).

If the forehead height is significant, the central section of the skin incision is shifted to the front hairline (Fig. 35.4.1, c, d). In this case, the following surgical techniques can be used to hide the postoperative scar as much as possible:
1) the skin incision runs along the front hairline, follows its curves and has the shape of an irregular broken line;
2) the wound in this area is closed in layers with the following types of sutures:
a) deep skin-unloading sutures on the aponeurosis - PDS No. 3/0 (nodal or continuous);
b) intermediate intradermal matching sutures with vicryl No. 4/0 (interrupted or continuous);
c) micro-matching continuous blanket suture on the skin with ethylene No. 6/0, which is removed no later than the 5th day.

The skin incision is made with the intersection of the tendon extension of the skull (galea aponeurotica), and in the temporal regions - to the deep temporal fascia. The coronary flap is formed at the level of the layer of loose tissue separating the periosteum from the tissue being lifted.

Detachment is performed with a scalpel to the level of the brow ridges. Next, in the area of the bridge of the nose, the bridge of the nose and the supraorbital neurovascular bundles, the tissues are precision separated with scissors to identify the nerves and muscles that corrugate the eyebrows. The latter in most cases are subject to resection (see Fig. 35.3.26).

It should be taken into account that the removal of a large area of muscle can lead to the formation of a visible contour tissue defect. This is why muscles should only be removed at their origin at the bone. Resection of the proud muscles is performed even less frequently. It is removed (coagulated) at the level of the bridge of the nose over a short distance.

Excessive muscle resection also leads to the formation of skin depressions that are difficult to correct cosmetically.

As is known, the presence of deep horizontal wrinkles in the central part of the forehead is due to the work of the frontal muscles, the removal of which during this operation allows one to obtain a good cosmetic effect. However, not all patients are satisfied with reducing active facial expression of the forehead. It is this circumstance that in many cases stops the surgeon from wanting to get a smooth and “clean” forehead. If the need for this procedure is beyond doubt, then resection of the frontal muscles is performed as follows.

On the inner surface of the coronary flap, one central and two lateral areas of muscle excision are marked so that the anterior excision zone does not reach the upper edge of the orbit by 1.5 cm, and in the lateral areas of the forehead there remain two intact vertical strips of tissue containing supraorbital vascular vessels. nerve bundles. As a rule, the height of the resected areas does not exceed 3 cm. Muscle removal is performed with a scalpel or electric knife down to the subcutaneous fatty tissue (see Fig. 35.3.26).

As an alternative to direct muscle resection, a method of intersecting their fibers at several levels can be used. However, this option does not allow you to completely straighten the folds and wrinkles in the forehead area. In addition, the contractility of some muscle areas is maintained, which can lead to asymmetrical wrinkling of the forehead.

After the final stop of bleeding, the wound is washed with antiseptic solutions and the coronary flap is placed in its bed. Then, using a marking clamp, determine the length of the excised tissue area on three tension lines, which run strictly along the midline of the forehead and outward to both sides of it at a distance of 5-7 cm. Tension along the central line ensures straightening of the forehead skin above the bridge of the nose and lifting the internal sections eyebrows, and tensioning the lateral sections of the flap eliminates ptosis of the outer eyebrows. The coronary flap is fixed at the designated points with strong sutures with mandatory suturing of the aponeurotic layer (Fig. 35.4.3). Then the skin is excised between the fixation sutures and, without tension (!), the edges of the wound are fixed with tantalum sutures using a stapler.

Rice. 35.4.3. Scheme of applying the main fixing sutures to the coronary flap when lifting the forehead skin.

Drainage is carried out using active or passive systems. At the end of the operation, a pressure bandage is applied to the entire surface of the forehead. The staples are removed after 8-10 days, and the fixation sutures are removed 3 weeks after the operation. When deep sutures are applied to the aponeurosis, this period can be reduced to 2 weeks.

Supraperiosteal tissue lift of the upper two thirds of the face

Supraperiosteal tissue lifting of the upper two-thirds of the face involves tightening the skin of the forehead, eyebrows, as well as the temporal and zygomatic areas. The content of the operation is justified by the following theoretical principles:

1) tissue separation with the subperiosteal technique is accompanied by significant trauma to the periosteum and can lead to the development of bone tissue atrophy;

2) the periosteum is inelastic and, when tensioned, moves a relatively small distance; The PMFC is less firmly fixed to the periosteum than the periosteum to the bone;

3) with subperiosteal tissue tightening, the points of fixation of the zygomatic muscles shift upward along with the periosteum; with prolonged tissue tension, this can lead to fibrosis of muscle fibers and a decrease in their contractility, which can negatively affect the expressiveness of facial expressions of the middle part of the face as a whole;

4) as a rule, the resulting displacement of the periosteum in the vertical direction is not enough to straighten the tissues in the periorbital region; improved results can be achieved by making releasing incisions on the periosteum with partial periosteal lifting of the tissue, which significantly increases the invasiveness of the intervention;

5) with the subperiosteal technique, the inevitable displacement of the muscle fixation points requires tissue immobilization for at least 2-3 weeks to consolidate the tightening effect, which is practically impossible to ensure, therefore, muscle contraction in the immediate postoperative period can lead not only to the loss of correction, but also to the convergence of the attachment points muscles compared to their original state;

6) age-related downward displacement of the soft tissue complex under the influence of gravity occurs over the bone structures, therefore, the reverse upward displacement of tissue above the periosteum successfully eliminates deep folds of the forehead, effectively raises the eyebrows, the orbicularis oculi muscle with the eyelids, eliminates musculocutaneous ptosis in the outer part of the orbit and straightens crow's foot wrinkles.

Currently, supraperiosteal lift of the upper two-thirds of the face is considered the most effective anti-aging surgery, often performed in combination with blepharoplasty. Its advantages include not only the effectiveness of eliminating ptosis of the eyebrows and forehead skin, but also the possibility of tightening the tissues of the middle part of the face. In this case, the lifting effect is transferred to a certain extent to the cheek area.

Surgical technique. This option for correcting age-related facial changes involves:
1) lifting of eyebrows and forehead skin;
2) elimination of blepharochalasis (excessive overhang of skin under the eyebrow above the upper eyelid);
3) reducing the severity of the skin lines of the glabella, including through excision of the muscles that corrugate the eyebrows and the proud muscles;
4) reduction of transverse wrinkles of the forehead, including through resection (intersection) of the frontal muscle;
5) the effect of a limited lifting of the upper and middle parts of the cheek;
6) external kaitopexy;
7) reducing the severity of the infraorbital groove;
8) slight lifting of the tip of the nose by moving the skin of the back of the nose upward.

The operation begins with a coronary approach with tissue detachment above the periosteum in the central part of the incision and above the deep temporal fascia in the lateral parts of the scalp and forehead (Fig. 35.4.4, a).

Approximately 1-2 cm outward and downward from the line of attachment of the temporal muscle, the surgeon divides the tissue just above the superficial layer of deep fascia, which covers the interaponeurotic fat pad of the temporal region (Fig. 35.4.4, b). The tissues are separated as carefully as possible to the level of the anterior two-thirds of the arch of the temporomygomatic arch, followed by anterior and downward transition to the entire surface of the body of the zygomatic bone.

Rice. 35.4.4. Scheme and level of tissue detachment in the frontotemporal-zygomatic region during supraperiosteal lifting of the upper two thirds of the face.
1 - deep temporal fascia; 2—superficial temporal fascia; 3 - temporal fatty body; 4 - frontal branch of the facial nerve; 5 - zygomatic arch.

If the level of tissue separation is violated, it is possible, on the one hand, damage to the frontal branch of the facial nerve passing in the superficial temporal fascia, and on the other, traumatization of the adipose tissue located under the superficial plate of the deep temporal fascia. Note that penetration of the surgeon's instruments under the superficial layer of the deep fascia and subsequent tissue detachment in the caudal direction is a safer option for this stage of the operation (in relation to the frontal branch of the facial nerve).

However, the inevitable trauma to fatty tissue with subsequent scarring of tissue is accompanied by a decrease in their volume and in some cases can lead to the appearance of a noticeable depression above the temporomygomatic arch.

If, simultaneously with this intervention, a skin tightening of the face and neck is performed, then two levels of tissue separation are formed in the temporal zone: suprafascial and subfascial. Between them is the so-called intermediate fascial layer (mesotemporalis), which contains the frontal branch of the facial nerve (Fig. 35.4.5).

Rice. 35.4.5. Anatomy of the intermediate fascial layer of the temporal region.
1—frontal branch of the facial nerve and superficial temporal artery; 2 - intermediate fascial layer; 3 - deep temporal fascia; 4-PMFS.

Tissue separation in the deep layer of the wound in the temporal region is carried out to the upper edge of the orbit and the arch of the temporal bone. However, it should not be extended below the posterior third of the zygomatic temporoarch arch to avoid direct damage to the frontal branch of the facial nerve. Next, the tissues are peeled off supraperiostally towards the middle part of the face into the periorbital and zygomatic zones (Fig. 35.4.6).

Rice. 35.4.6. The boundaries of tissue detachment (dotted line) during supraperiosteal lifting of the upper two thirds of the face.

At 1 cm from the outer corner of the orbit there are perforating vessels passing from the temporal muscle to the PIPJ. They are identified and coagulated. Even more caudally and outwardly, the temporomygomatic neurovascular bundle is found, which should be preserved if possible, since its intersection leads to a deterioration in the sensitivity of the skin in the temporomygomatic region.

Subsequently, tissue detachment can be continued to the maxillary region in the direction of the cheek. This relatively safe separation of tissues is carried out above the surface of the upper jaw, above the area of attachment of the zygomatic muscles and further in the thickness of the fatty body of the cheek. Taking into account the location of the infraorbital foramen and the exit zone of the infraorbital nerve, the tissues are separated in a blunt manner below the point of its projection.

An important and mandatory component of the operation is the intersection of strong fibrous bridges in the area of the upper outer part of the orbit, running from the PIPJ to the periosteum (Fig. 35.4.7). Only after this the eyebrow becomes mobile and easily moves upward.

Rice. 35.4.7. Diagram of the intersection of ligaments at the upper outer edge of the orbit.
The arrows indicate the zone of detachment of the superior orbital fixation point of the PIPJ.

If there is an excessively overhanging external bony edge of the orbit, it can be resected using a cutter. To do this, the periosteum above the protruding upper outer portion of the orbit is lifted with a bone rasp and, after subperiosteal treatment, the bones are placed back.

By dividing the tissue to the upper edge of the orbit, the surgeon is able to penetrate through the fascial septum that separates the orbital cavity from the orbicularis oculi muscle. The septum is incised directly adjacent to the bony edge, causing intraorbital fatty tissue to protrude into the wound. Excess of the latter can be easily removed, with the exception of the area located at the level of the supraorbital neurovascular bundle. Therefore, the internal fat pocket of the upper eyelid is most often opened during upper blepharoplasty.

During the operation, the corrugator and procerus muscles are identified and removed. If necessary, the tissues are separated above the bridge of the nose and the bridge of the nose, which makes it possible to eliminate skin drooping in this area and thereby improve the position of the tip of the nose.

According to indications, an increase in the volume of tissue in the zygomatic region can be performed using a silicone implant. In this case, the caudal border of the tissue separation in the zygomatic region should correspond to the dimensions of the implant pocket.

After forming the flap and washing the wound with an antiseptic solution, the space above the zygomatic bone is drained using an active drainage system and the tissue is fixed in the lifting position. In this case, the line of tissue tension in the middle and upper parts of the face should run predominantly in the vertical direction. The movement of the temporal part of the flap in the cranial direction can be significant and is usually 2-3 cm.

It is believed that excessive tension on the flap may cause dysfunction of the frontal branch of the facial nerve. Note that the tension of the flap also leads to a displacement of the outer canthus, which, if necessary, makes it possible to give the palpebral fissure a more slanted appearance. In the postoperative period, these phenomena decrease due to partial loss of correction.

Fixation sutures are applied with non-absorbable suture material (mersilene No. 2/0) in the projection of the anterior hairline of the temporal region (between the inner surface of the coronary flap and the deep temporal fascia).

As a rule, 3-4 strong sutures on each side are sufficient to completely straighten the tissues in the zygomatic and maxillary areas.

At the final stage of the operation, the excess coronary flap is excised so that the skin suture on the scalp is made without tension. Tantalum staples are applied to the wound using a stapler. Due to the transfer of tension to deep structures, a thin, unnoticeable scar is formed on the skin, which does not hypertrophy or stretch during maturation.

The final stage of the operation has significant differences in patients with a relatively high forehead (on average more than 5.5 cm), when the central part of the access is located along the anterior hairline.

results

With careful technique, this operation is safe and significantly more effective than a conventional forehead skin lift. In fact, this intervention is a frontotemporal lift and has a fairly significant effect on the tissues of the middle part of the face, tightening them in the cranial direction. On the other hand, over time, under the influence of gravity and the work of the facial muscles, a partial loss of the achieved correction always occurs.

That is why the final result of the operation is assessed after 6 months, when the scars become more mature (Fig. 35.4.8). Among the typical complications, it is necessary to treat the sometimes occurring unilateral paresis of the frontal branch of the facial nerve. As a rule, this condition resolves within 10-50 days from the date of surgery without further treatment.

Rice. 35.4.8. Photographs of a 42-year-old patient before (a-c) and 6 months (d-c) after supraperiosteal lift of the upper two-thirds of the face and quadrilateral blepharoplasty.

IN AND. Arkhangelsky, V.F. Kirillov

Maintaining a young, attractive and beautiful face is one of the strongest desires of any woman. There is a wide range of methods to combat age-related changes.

lifting the upper part of the face: lifting the forehead and eyebrow line (an incision during the operation is made in the scalp);
midface lift: cheeks, folds around the mouth, nasolabial folds are tightened (incisions are made above the upper lip and in the temporal area);
lower face lift or lower third face lift (incision is made above the chin).

A facelift can be performed using plastic surgery and also non-surgical techniques.

There are several types of surgical operations:

classic circular lift;
endoscopic lifting;
smas-lifting;
scarless lifting.

A classic lift (or circular lift) is performed through an incision along the hairline, around the ear, and under the chin in natural folds, that is, the incision is made along the circumference of the face. Due to the location of the incisions, the scars after surgery will not be noticeable.

The muscular frame is not affected during this operation. The procedure is aimed at excision of excess skin.

The effect lasts for a long time. This surgical lifting restores a beautiful and clear oval of the face. Classic circular lifting can be combined with eyelid rejuvenation surgery - blepharoplasty.

An endoscopic facelift is a minimally invasive plastic surgery aimed at rejuvenating the face and correcting the oval.

A significant advantage of endoscopic lifting is that it does not require large incisions or extensive tissue excision.

Surgical procedures are performed using special endoscopic equipment. An endoscope with a camera is inserted into the incisions and slowly moved to the place where manipulations need to be performed. Surgical instruments are also introduced. The surgeon can monitor the progress of the operation on the monitor.

During endoscopic lifting, the skin is tightened, excess fat is removed, and the muscles are fixed in a new position.

How much does it cost to tighten skin using the endoscopic method? A mid-face lift using endoscopic lifting costs from 14,000 rubles, an upper face lift costs the same, and a full face lift costs 150,000.

SMAS stands for Superficial Musculoaponeurotic System. The SMAS system is an inextricable fibromuscular layer that connects muscles to the dermis and is located under the skin and subcutaneous fat.

The operation allows for an effective tightening and restoration of facial features and contours lost with age without the effect of over-tightening the skin, as well as restoring a clear oval shape. After the operation, the patient remains and is observed in a hospital for several days.

How much does SMAS lifting cost? The average price of the procedure is from 120,000 rubles.

During a scarless lift, an incision is made in the temporal region and in front of the ear, which does not go behind the ears as in a classic lift. It is recommended for people aged 30 to 40 who need to slightly tighten their skin and slightly correct their oval shape. This lifting is a minimally invasive type of SMAS lifting.

Small-scar plastic surgery is very effective and requires much less recovery time. It leaves a short and barely noticeable scar.

Many reviews from patients who have undergone surgery note high efficiency and a pronounced facelift after surgery.

Non-surgical lifting methods include:

Face lift with threads.
Facelift at home.
Hardware cosmetology (lifting using special cosmetology devices).

You can choose which non-surgical method is best to tighten the skin by analyzing numerous patient reviews and recommendations from a cosmetologist.

You can effectively and safely lift and tighten your oval shape without surgery using thread lifting. It does not require long-term rehabilitation, the likelihood of complications is unlikely, and a facelift with threads has a minimal number of contraindications.

The essence of the procedure is as follows: the cosmetologist inserts a thread under the skin into a microscopic puncture using a needle. The threads have micro-notches that help fix them in the required position and, thus, tighten the skin and smooth out wrinkles.

You can do a face lift quickly and easily at home. Lifting at home includes: massage, masks, creams, various folk remedies, gymnastics and exercises.

Massage in general has a beneficial effect on the skin and has a lifting effect, helping to make the oval of the face clearer.

In order for massage, exercises and folk remedies to bring the desired effect, you should definitely give up smoking and alcoholic beverages, because they cause enormous harm to the body and nullify all efforts to rejuvenate. It is also necessary to eat right, get enough sleep, and avoid stress.

A very important nuance is the amount of time spent on rejuvenation at home - the more, the more effective the effect will be.

Lifting creams usually contain collagen, alpha-lipoic acid (a natural antioxidant for human cells), kinetin, vitamins, and oils. Products with such substances smooth out wrinkles, tighten and rejuvenate the skin, making it more elastic. When choosing cosmetics, you should also pay attention to the amount of natural ingredients: the more there are in a cream or mask, the better.

If you make a tightening mask before applying the lifting cream, you can achieve greater results. The mask should be done two or three times a week, and the cream should be applied every day.

In addition to store-bought masks, you can make homemade ones using only natural ingredients. Time-tested folk recipes for anti-aging products will be very beneficial for the skin in general. Effective masks at home can be made from honey, clay (can be purchased at a pharmacy), potatoes, egg yolk, oatmeal, cabbage juice, aloe juice and other natural remedies. You can add cosmetic oils to the prepared mask: olive, almond, grape seed oil, sesame, peach, sea buckthorn, avocado oil, jojoba and others.

Exercises and gymnastics for the face will help achieve significant rejuvenation if done every day.

Rejuvenation and tightening of the oval at home is the most convenient and cost-effective option that anyone can afford.

Hardware cosmetology is very popular due to its effectiveness, painlessness, complete safety and long-lasting effect. Lifting with cosmetology devices includes the following procedures: ultrasonic lifting, microcurrent lifting, fractional photothermolysis (laser lifting).

Ultrasonic tightening is performed using a special device that creates focused ultrasound radiation.

High-frequency sound waves generated by the device affect the deep layers of the skin, namely SMAS. The waves compress and shorten collagen fibers, provoking the process of neocollagenesis (the formation of the skin's own collagen) and the formation of new elastin fibers. The process of neocollagenesis can continue for three or four months.

The procedure lasts from thirty to sixty minutes. The result is noticeable immediately after the first session. For ultrasonic lifting, local anesthesia with anesthetic creams is used.