Surgical lifting of the lower third of the face. Endoscopic lifting of the upper and middle third of the face Endoscopic lifting of the upper third of the face The effect lasts

A mid-face lift is an operation, the main focus of which is the correction of age-related changes in the patient's skin.

Its localization is on the upper part of the cheeks, cheekbones and nasolabial region.

Age-related changes in the face

Advantages and disadvantages

The benefits of a mid-face lift are:
The ability to rejuvenate the face and get rid of sagging skin in a very short time.
After the procedure, the patient does not have noticeable scars or scars.
The surgeon can create the effect of natural rejuvenation (after the operation, it will not be noticeable that the patient has undergone a surgical lift).
The ability to use local anesthesia for those patients who cannot be given general anesthesia.
Quite a long-term effect of the procedure (5-7 years). This is longer than all other results from conventional cosmetic non-surgical rejuvenation techniques.

Like any rejuvenation technique, facelift has its drawbacks.

These are:

The presence of a large number of contraindications to the procedure.
The risk of developing unwanted side effects.
Risk of infection.
There is a high risk of injury and achieving the wrong result from the operation, especially when it is performed by an inexperienced specialist.
The high cost of the procedure.
The need for the transfer of harmful anesthesia.
The need for a long recovery period.
The patient must follow a number of preoperative and postoperative rules.

Indications and contraindications

Indications for a mid-face lift are:

Bumps under the eyes.
Noticeable nasolabial folds.
Age-related drooping of the corners of the eyes.
Sagging and loss of elasticity of the skin of the cheeks.
Retraction of the skin of the cheeks.
Pronounced bags under the eyes.
The presence of excessively pronounced fatty deposits in the patient's cheeks.
The presence of deep wrinkles in the area of the cheeks and nose.

In some cases, this rejuvenation technique can be dangerous for the patient's health.

Direct contraindications to facelift are:

The age of the patient is under twenty years old (in general, cosmetologists do not recommend such a procedure for people under thirty years old, since before this age they simply do not have such pronounced wrinkles and other signs of skin aging).
Hypertension (high blood pressure).
Acute viral, respiratory or bacterial diseases.
Violation of blood clotting.
Diabetes.
The age of the patient is over sixty-five years (during such a period, the body's forces are very weakened, so it is undesirable to additionally overload them with anesthesia, surgery and stress).
Various thyroid diseases and disruptions in the hormonal background.
Oncological pathologies.
Acute or chronic renal or hepatic failure.
Hepatitis.
Syphilis.
active tuberculosis.
Blood diseases (HIV infection).
The period after a recent stroke or heart attack.
Period after recent surgery.
Various diseases of the cardiovascular system (arrhythmia, tachycardia, etc.).
Diseases of the gastrointestinal tract, which are in the exacerbation phase.
Tendency to scarring.
The presence of purulent rashes on the skin at the site of the procedure.
Various disorders in the patient's nervous system (depression, neurosis).
The presence of an inflammatory process in the body.
Epilepsy.
Taking antibiotics and other drugs.
The period of pregnancy and breastfeeding.
Increased intraocular pressure of the patient.
Vasculitis.

Surgical midface lift

The middle zone of the face is conditionally limited to the area from the eyebrow line to the nose. It is in this area that the muscles most often experience stress, which is why mimic wrinkles appear earlier than on other parts of the face.

Preparation

The patient should consult a doctor two weeks before the procedure.

After the initial examination, the specialist will determine the degree of neglect of each specific case and begin preparations for the procedure.

Ten days before the operation, the patient needs to do the following examinations:

general clinical blood and urine tests;
blood test for sugar level;
blood clotting test;
test for hepatitis and HIV infection;
pregnancy test (for women);
Ultrasound of the abdominal cavity;
lung radiography.

A week before the operation, you need to stop taking alcoholic beverages and medicines. It is also advisable not to be nervous, eat a balanced diet and stop smoking in order to increase immunity.

On the day of the procedure, you can not eat or drink anything (if the operation will be performed under general anesthesia). With you from home, you need to prepare essential items for a stay in the hospital for 1-2 days.

Anesthesia

Traditionally, a mid-face lift is done under general anesthesia.

This means that during the operation the patient falls asleep and does not feel any pain. He regains consciousness when the procedure has already been completed. Usually a person wakes up already in the ward.

Sometimes the patient is given local anesthesia. At the same time, he will not feel pain, but he will be conscious all the time.

Such anesthesia is carried out in the case when a person has contraindications to the introduction of general anesthesia.

Methods and technique

The duration of the operation averages 1.5 hours.

The most commonly used surgical techniques are:

Check lifting.
FAME.
Endotins.

The traditional facelift technique is as follows:

The patient is given anesthesia.
Doctors carefully treat the skin of the face with antiseptic solutions.
The doctor makes small incisions above the auricle that will not be visible.
Through them, the lifting of the desired part of the face is performed.
After the skin is separated, the specialist will redistribute the subcutaneous fat and remove its excess.
At the end of the procedure, the sutures are carefully sutured and re-treated with antimicrobial solutions. This will pull the skin up and distribute it in the new position.
A bandage is applied and the patient is brought back to consciousness.

Check lifting

The check-lift is a modern mid-face lift technique.

It is carried out under general anesthesia in this way:

The surgeon makes a small incision under the eyelashes along the lower eyelid area.
Next, the tissues are moved and further fixed in a new position.

Using this technique, you can eliminate bags under the eyes and wrinkles in the eye area.

The advantage of this method is considered low-impact. The downside is the complexity and long recovery period.

FAME

The FAME technique involves making an incision in the cheekbones.

Thus, the surgeon can stretch the skin of the cheeks and completely rid the patient of wrinkles in this part of the face.

As practice shows, the FAME technique is well tolerated by patients and shows excellent results.

Endotins

Facelift with endotines involves the establishment of special fixators in the form of plates - endotines - in the patient's tissue.

They are used with plastic surgery to hold as well as tighten sagging tissues.

These plates are very thin. Usually they have a thickness of no more than two millimeters. Each such endotin has special teeth that are at an angle to the board.

Thanks to these teeth, the surgeon can evenly stretch the tissues.

In addition, there is a special indentation on the tips of the plates. Neem plate is attached to the bone of the skull.

The technique for performing a facelift depends on the total volume of the operation.

The procedure for establishing endotins is the same. Only the places for the incisions made on the face can differ.

For example, for a midface lift, endotines are placed by making an incision over the oral mucosa. Sometimes these implants can be inserted through an incision under the lower eyelid.

After the incision is made, the surgeon places the plate, secures the soft tissue with the dentate portion of the endotines, and fixes the plate to the bone by making an incision behind the ear.

It is important to know that you do not need to use screws and other fixators to fix the endotin.

Moreover, this technique does not leave behind scars and scars. There is also a low risk of edema and hematoma.

Risks and Complications

After a mid-face lift, the patient is at risk for the following complications:

Postoperative bleeding

Observed on the first day after surgery.

This condition can also be accompanied by swelling and severe pain. When it occurs, the patient requires repeated cleaning of the wounds and suturing. Such a complication arises due to a person’s high blood pressure, damage to blood vessels, or the patient taking medications that disrupt blood clotting.

Necrosis or death of the skin in the suture area

It can happen with excessive trauma to the layers of the epidermis. In this case, most likely, the patient will have to remove such areas of the skin surgically - that is, to do a second operation.

Fortunately, with the right facelift technique, the risk of necrosis is minimal.

Infection is possible when performing an operation in insufficiently sterile conditions, or when bandaging with non-compliance with asepsis rules.

Signs of this complication may include:

increase in body temperature;
chills;
the appearance of purulent discharge from the skin;
fever and other signs of intoxication of the body.

Loss of sensation in the skin

It can happen when the surgeon damages the nerve endings of the face.

In this case, this condition usually goes away on its own after a few weeks after the operation, but in more severe cases, skin sensitivity may not resume.

Violation of natural facial expressions

Can happen when muscles are damaged.

Formation of ugly and noticeable scars

It happens when the operation is performed by an inexperienced surgeon.

General deformation of facial contours

It happens due to excessive skin tension.

This is a common complication of classic facelift surgery.

Unfortunately, this shortcoming can be corrected only by performing a second surgical intervention.

Eversion of the eyelid

It happens with improperly planned plastic surgery of the middle part of the face.

An operation called will help solve this problem.

Eyelid eversion

In addition to these complications, it is possible hematoma development(in the first few days after surgery), as well as the appearance excessive pigmentation on the skin in the form of ugly spots and hemorrhages.

Rehabilitation

After a facelift, you need to know about such recommendations for rehabilitation:

There will be a bandage on the face for the first few days. It cannot be removed on its own. This should be done by a doctor during dressings.
In the first two weeks, it is advisable not to sleep on your stomach, so as not to accidentally damage your face and stitches.
Dressings should be done daily under sterile conditions.
It is not advisable to go home immediately after the procedure. It is better to stay in the hospital for several days, so that if edema, hematoma, or other complications occur, the doctor can notice and eliminate them in time.
For pain, you can take analgesics and antipyretics, but only after a doctor's prescription.
With swelling, you can apply cold compresses, but not longer than five minutes.
Usually the stitches are removed on the 5th-6th day. In their place will be pink scars. To make them heal faster, they can be lubricated with special regenerating creams and ointments.

Lift without surgery

Fortunately, face rejuvenation is possible not only through surgical intervention.

To date, there are less traumatic methods for eliminating wrinkles - injections, exercises and various cosmetic procedures.

Injections

Anti-wrinkle injections mean the introduction of special drugs with a rejuvenating effect. Botox injections are considered the most effective.

After getting into the layers of the skin, Botox partially paralyzes the nerve fibers of the skin, due to which it relaxes and smoothes.

The duration of the effect of this procedure is about 5-8 months.

After that, the drug is absorbed, and the skin again acquires the ability to contract and form wrinkles.

Botox Results

Exercises

Anti-wrinkle exercises are useful and painless.

This technique involves the implementation of a number of specially selected facial exercises, with which you can restore the skin to its former elasticity and smoothness.

Moreover, anti-wrinkle exercises can also be used as a prevention of skin aging. They will be useful even for young people.

The most effective facelift exercises are:

Exercise to strengthen the upper eyelids

put your fingers under the eyebrows and start lifting them up, while slightly pressing;
hold your fingers like this for ten seconds;
while still holding your fingers, you need to try to lower your eyebrows down;
You can repeat this exercise five times a day.

Exercise for the skin in the area under the eyes

apply a rich moisturizer to the skin near the eyes;
with quick patting movements, begin to massage the skin under the eyes and in the corners of the eyes;
then you need to slightly pull the skin to the side;
in this position, you need to open and close your eyes.

Cheek tightening exercise

take a breath and at the same time puff out your cheeks as much as possible;
hold your breath and press your hands on your cheeks, while resisting pressure;
release air slowly
repeat the exercise ten times with a break of half a minute, and it will improve the tone of the skin of the cheeks.

To improve the clarity of the oval of the face

It is useful to pronounce vowels, while stretching the lips. Each letter (a, o, y) must be pronounced, using the muscles of the cheeks and lips fifteen times.

Threads

Thread lifting is a non-surgical facelift technique, with which you can quickly and not very painfully rejuvenate the skin and get rid of wrinkles.

This method of rejuvenation will be effective when a person does not want to perform an open operation, but there is no longer any result from the use of conventional face creams.

Thread lifting is a low-traumatic procedure.

Its technique is as follows:

First, microscopic punctures are made on the patient's skin.
Threads are inserted through these punctures (usually four threads are enough for a facelift).
These threads are attached in the area of the temples. They stretch the muscles in the nasolabial and infraorbital zones.
After stretching, the threads hold the skin, and become a kind of frame for it, preventing the muscles from sagging.

The recovery period after such a procedure usually takes no longer than three to five days.

The final result from will be noticeable only after three weeks, when the skin "gets used" to the new position.

At home

Rejuvenation at home includes the following:

Making homemade gelatin masks

dissolve 2 tbsp. l. gelatin and heat it;
when the gelatin begins to thicken, add one raw egg yolk to it;
apply on the face in layers with a cosmetic silicone brush;
when the first layer of gelatin dries, you need to apply the second and third layers;
after that, leave the mask for fifteen minutes (at this time it is advisable to stay in a supine position and minimize facial movement);
remove the mask very carefully so as not to damage the skin. It is best to soak the gelatin with warm water, rather than peel off the dry film from the face;
after the procedure, you can apply a fat cream to the skin.

starch mask

dissolve starch (2 cl. l.) in water and boil a little until the starch becomes thicker;
add cream (2 tsp) and the same amount of olive oil to it;
apply a thick layer on the face and leave the mask for twenty minutes;
wash off with warm water;
repeat the procedure 2-3 times a week.

Masks from such components are considered the most effective.

By applying them on the face for three weeks in a row, you can significantly improve the complexion, rid it of minor defects and wrinkles.

Facial peeling with oatmeal

To do this, grind the fanned flakes (2 tablespoons) and mix them with cream (1 tablespoon). After a thorough massage application, you can effectively cleanse the skin.

Prices

Mid face lift has the following pricing policy in different clinics:

Moreover, the cost of this procedure may vary depending on the complexity of the operation and the qualifications of the surgeon.

Photos before and after

How long does the result last?

On average, the effect of a surgical facelift lasts from six to eight years.

With the injection method of rejuvenation or the elimination of wrinkles at home, the duration of the result will be much less.

This is the only way to achieve sustainable results.

A mid-face lift has many nuances of its implementation, so before agreeing to it, you should think carefully and weigh all the pros and cons.

Actually, the signs of aging are considered not so much the appearance, since the latter are formed for various reasons, but the formation of folds and omission of tissues. The latter, ceteris paribus, appears with weakening of the muscles of the face, loss of elasticity and a noticeable decrease in skin elasticity.

It is these symptoms that are signs of aging and it is they that are designed to be removed.

What is Endoscopic Midface Lift?

The face ages unevenly: first, the middle part changes, then, oddly enough, later than everyone else. Under the middle zone is meant the part of the face between the horizontal lines passing at the level of the eyebrows and nostrils. Moreover, the nasolabial folds are included in the middle part, since their presence depends on the state of the muscles located here.

Signs of "fatal" changes are:

tear trough- a sharp, well-marked border between the cheek and the lower eyelid;
high lower eyelid- the distance between the ciliary margin and the lacrimal sulcus. At the same time, the lower edge of the eye does not touch the iris, that is, the eyelid is not pulled up;
zygomatic pouch- a relief formation below the lacrimal sulcus and slightly to the side. Formed by overhanging skin rather than zygomatic bone;
nasolabial fold- appears when the skin of the cheek hangs on the side of the nose.

It is worth noting that the upper part of the area around the eyes refers to the upper part of the face, and the lower part to the middle. The eyes seem to focus on themselves the early signs of aging, and therefore the rejuvenation of this zone dramatically reduces the visible age.

The middle part of the face ages earlier than others, and therefore it is corrected at the age of 40, and even at 35. Various methods are used for this, however, endoscopic in this case is most suitable. The fact is that the method belongs to minimally invasive surgery, that is, minimal surgical intervention is assumed. In practice, this means the presence of incisions of a minimum size - up to 2 cm, and the operation without excision of the skin. The surgeon peels off loose skin, repositions muscle tissue, removes excess fat if necessary, and redistributes the skin.

The operation carried out in this way is accompanied by a minimal loss of blood, since the exfoliation of the skin occurs in a layer depleted in capillaries. And this, in turn, causes a minimum of bruising and, as well as the fastest possible recovery.

Depending on the scale of the changes, the timing of the operation may be different. With a circular eye lift, it will take 1.5–2 hours, and local anesthesia can be dispensed with. With a total change in the middle part of the face, 2-3 hours are needed and under general anesthesia.

What is an endoscopic midface lift, the video below will tell:

Features of the procedure

Endoscopic lifting differs from or other possible options not only in the technique itself, but also in the method of lifting. Obviously, sagging of the skin is possible due to its excess, which means that a facelift involves the removal of this “extra” part. In fact, this can be dispensed with, but the technique of the operation also changes.

In normal cases, incisions are made near the ears, where the excess skin is excised. With an endoscopic facelift, the incision is made under the eyelashes of the lower eyelid, as is done with conventional blepharoplasty, that is, the skin on the middle part of the face is pulled vertically. At the same time, folds remain on the sides of the orbit, which cannot be excised, since scars will be noticeable here. This deficiency is corrected either with the help of a temporal lift, or left to the mercy of time.

The fact is that the initial result - 2-3 days after the operation, is not preserved. There is a so-called "shrinkage". On the one hand, the result of hypercorrection disappears in 2 months, when there is a feeling of tightened skin, on the other hand, the fold on the side of the orbit is also redistributed.

A mid-zone lift is easily combined with blepharoplasty. More precisely, the lower eyelid lift is performed automatically, as it is part of the operation. But the top change is optional. As a rule, patients combine circumferential blepharoplasty with a mid-zone lift, as this provides the maximum result.

It is worth noting another feature of the procedure. An endoscopic vertical lift requires a highly skilled surgeon, while a lateral lift with an incision near the ear can be performed by any plastic surgeon.

Photos before and after

Indications

The most noticeable and appear before all. Accordingly, such an operation is indicated for relatively young women and men - at the age of 35-40 years. It is used to correct the following age signs:

decreased muscle tone of the cheeks and skin, omission of tissues;
relief formations associated with sagging skin - and on the cheekbones;
nasolabial folds of varying severity;
omission of the corner of the eye, corner of the lips;
deformation of the lower eyelid, which appeared as a result of incorrectly performed plastic surgery - eversion, retraction, omission;
deep lacrimal grooves.

Wrinkles by themselves are not an indication for surgery. Surgical intervention is required when it comes to tissue displacement.

Contraindications

Contraindications for minimally invasive surgery methods are quite standard. This fully applies to the facelift.

Contraindications are:

- usually for those cases when the intervention is required to be carried out under general anesthesia;
- any manipulations with the skin in this condition do not give a result, and the healing of even small incisions is very difficult;
mental disorders;
or ;
acute infectious diseases or inflammation - the operation is possible after healing;
serious facial injury;
poor blood clotting;
thyroid disease;
pregnancy and lactation.

The operation is not performed with strong age-related changes and. As a rule, it is observed in 50-60 years. In this case, it is impossible to do without excision of excess skin tissue.

How the operation goes, the specialist will tell in this video:

How is it carried out

Endoscopic mid-face lift is performed using 2 main technologies. Any of them involves cuts of minimal size, but their placement and number differ. The preparatory and recovery stages are the same.

Before and after the

Preparation

Although a facelift is a minimally invasive method, you should prepare for it thoroughly enough.

First of all, the doctor determines the method and scale of the operation and the fundamental possibility of its implementation. That is, for example, the absence of diabetes in history.
Then the patient is required to pass certain tests to assess the general condition:
- - obligatory stage;
- blood test -, for sugar, for clotting,;
2-3 weeks before surgery, the patient should and. These factors too strongly affect the condition of the tissues.
In addition, it is recommended not to follow strict diets either during preparation or later, as weight loss negatively affects the result of a facelift.
On the day of the operation, the patient must take all prescribed drugs - antiviral and anti-inflammatory, in order to minimize possible consequences.

Operation

A distinctive feature of endoscopic intervention is the ability to observe the surgical field. With this procedure, silicone tubes are inserted into the incisions made, along which the instruments and the endoscope move - the lighting system and the camera. Thus, the surgeon during all actions receives a two-dimensional image, which, in fact, allows you to get by with a small incision, or even a puncture of the skin.

To correct the middle zone of the face, there are 2 main methods.

Check lifting

Check-lifting is a vertical skin tightening performed under general anesthesia. The operation lasts from 40 to 90 minutes. Usually combined with lower eyelid surgery. The use of endoscopic equipment makes it possible to prevent complications common for such operations, such as the “round eye” effect, eyelid sub eversion, and others.

The incision is made along the edge of the lower eyelid in a natural fold, so that its traces are invisible. Then the muscle fibers are tightened and strengthened in order to reduce the distance between the edge of the eyelid and the tear trough and displace the buccal muscles.
The skin is peeled off and then redistributed accordingly.
Muscles and skin are fixed in the desired position with special thin plates - endotines, 3.5 to 4.5 mm long. The staples are made from a biocompatible material that can be absorbed naturally. The specific design - with tweezers, allows you to evenly distribute the load.

Endotins disappear within a year, there is no need to remove them. During this time, a new connective tissue has time to form, which fixes the muscles and skin in the desired position.

Before and after

Bilateral lifting

Another way is a bilateral midsection lift. In this case, there are more cuts and they are located differently. The area from the temples to the middle of the cheeks is leveled by stretching the skin through incisions in the scalp. They are located above the ear. Nasolabial folds and wrinkles around the mouth are removed through incisions in the oral mucosa. This method is more traumatic. The operation is performed only under general anesthesia and takes longer.

A one-time lift from both sides through one incision is not possible. Nerve nodes are located in the middle third of the cheeks, if they are damaged, a long-term numbness of this part occurs, asymmetry of facial expressions from different sides of the face is possible. Therefore, the lift is carried out in 2 stages and through different incisions.

Scars on the temples are hidden by hair. The seams on the oral mucosa heal very quickly and easily due to the regenerative properties of this tissue.

Rehabilitation

Within 2 weeks after the lift, hematomas, edema, or even seromas persist - the accumulation of lymphatic fluid around the suture. These symptoms are normal and go away on their own. Completely all evidence of the operation disappear after 3-4 weeks.

On the first day, the patient is on bed rest. Wearing a compression bandage is mandatory. If severe discomfort is observed, pain medications are used to suppress them.
Usually the dressing is worn for 4-5 days if there are no complications.
The stitches are removed after 7-10 days. This is a completely painless procedure.
In the first month after a facelift, it is important not to provoke. During this time, physical activity is prohibited, including a swimming pool, and even an active sex life.
During this time, physical activity is prohibited, including the pool and even active sex life.
You can not visit saunas and baths. Wash your hair with warm water, and dry your hair only with cool air.

You should refrain from smoking and drinking strong drinks. One of the main causes of slow, poor stitch healing is smoking.

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History and indications for surgery

It is now 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 complex of cosmetic problems. The basis for performing operations of this group are:
1) pronounced mimic wrinkles on the forehead and in the region of the 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 upper eyelids;
3) more pronounced age-related changes in the upper part of the face (compared to the lower one).

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

The upward shift of the eyebrow and the tension of the skin at the temples lead to the expansion of the tissues of the upper eyelid, the smoothing of wrinkles and the improvement of the contours of the palpebral fissure. Understanding this became the basis for performing a conventional fronto-temporal lift. However, its results were not entirely satisfactory both in terms of the extent of the changes introduced by the surgeon and the timing of their preservation.

A serious improvement in the results of rejuvenating operations on the upper half of the face occurred with the start of using 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 regions of the face upward by subperiosteal detachment of tissues in these areas with a raspator with their fixation 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 to perform a simultaneous lifting of the tissues of the forehead, temporal region and middle third of the face with their separation between the PMFS and the periosteum. This highly effective operation is called the supraperiosteal lift of the upper two-thirds of the face, or frontotemporal periorbital PMFS lift.

Forehead skin lift (classic)

This intervention in an isolated version is advisable primarily in younger patients with age-related changes mainly in the upper face. With more pronounced 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 regions (Fig. 35.4.1, a, b).

Rice. 35.4.1. Options for planning coronary access for a 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 skin incision in the transverse direction of hair growth (Fig. 35.4.2, a). In the postoperative period, hair rods pierce the scar line, which achieves its maximum masking (Fig. 35.4.2, b).

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

With a significant forehead height, the central section of the skin incision is shifted to the anterior hairline (Fig. 35.4.1, c, d). In this case, the use of the following surgical techniques allows you to hide the postoperative scar as much as possible:
1) the skin incision passes along the anterior hairline, repeats 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 suture:
a) deep skin-unloading sutures on the aponeurosis - PDS No. 3/0 (nodal or continuous);
b) Intermediate intradermal juxtaposition sutures with No. 4/0 vicryl (interrupted or continuous);
c) microadjustment continuous blanket suture on the skin with ethylon No. 6/0, which is removed no later than the 5th day.

The skin incision is performed with the intersection of the tendon sprain of the skull (galea aponeurotica), and in the temporal areas - to the deep temporal fascia. The coronary flap is formed at the level of the layer of loose fiber separating the periosteum from the lifted tissues.

Detachment is performed with a scalpel to the level of the superciliary arches. Further, in the region of the bridge of the nose, the back of the nose and the supraorbital neurovascular bundles, the tissues are precisely separated with scissors with the identification of nerves and muscles that wrinkle the eyebrows. The latter in most cases are subject to resection (see Fig. 35.3.26).

At the same time, it should be taken into account that the removal of a large area of muscles can lead to the formation of a visible contour tissue defect. That is why the muscles should be removed only at the place of their beginning at the bone. Resection of the proud muscles is performed even less often. It is removed (coagulated) at the level of the bridge of the nose over a short distance.

Excessive resection of the muscle also leads to the formation of a skin depression that is difficult to cosmetically correct.

As you know, 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 to obtain a good cosmetic effect. However, a decrease in the active facial expressions of the forehead does not suit all patients. 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 the resection of the frontal muscles is performed as follows.

On the inner surface of the coronary flap, one central and two lateral sections of the muscle excision are marked in such a way that the excision zone does not reach the upper edge of the orbit by 1.5 cm anteriorly, and in the lateral zones of the forehead there are two intact vertical strips of tissues 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 to the subcutaneous fat (see Fig. 35.3.26).

As an alternative to direct muscle resection, the method of cutting 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. In addition, the contractility of some areas of the muscles is preserved, which can lead to an 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 clip, the length of the excised tissue section is determined on three tension lines that run strictly along the midline of the forehead and outward on both sides of it at a distance of 5–7 cm. eyebrows, and the tension of the lateral sections of the flap - the elimination of ptosis of the outer sections of the eyebrows. The coronary flap is fixed at the indicated points with strong sutures with obligatory stitching of the aponeurotic layer (Fig. 35.4.3). Then the skin is excised between the fixation sutures and without tension (!) the wound edges are fixed with tantalum sutures using a stapler.

Rice. 35.4.3. Scheme of applying the main fixing sutures to the coronary flap during forehead skin tightening.

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

Supraperiosteal lifting of the tissues of the upper two-thirds of the face

Supraperiosteal lifting of the tissues of the upper two-thirds of the face consists in tightening the skin of the forehead, eyebrows, as well as the temporal and zygomatic regions. The content of the operation is substantiated by the following theoretical provisions:

1) separation of tissues during subperiosteal technique is accompanied by a significant injury to the periosteum and can lead to the development of bone tissue atrophy;

2) the periosteum is inelastic and, under tension, shifts over a relatively small distance; PMFS 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 are shifted 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 adversely 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; improvement of the result can be achieved by applying laxative incisions on the periosteum with partial periosteal tissue elevation, which significantly increases the invasiveness of the intervention;

5) with the subperiosteal technique, the inevitable displacement of the points of muscle fixation requires immobilization of tissues for at least 2-3 weeks to consolidate the effect of tightening, 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 points of attachment muscles compared to their original state;

6) age-related downward displacement of the soft tissue complex under the action of gravity occurs above the bone structures, therefore, the reverse displacement of tissues upward above the periosteum successfully eliminates deep forehead folds, effectively raises the eyebrows, the circular muscle of the eye with eyelids, eliminates musculoskeletal ptosis in the outer part of the orbit and straightens crow's feet wrinkles.

Currently, the supraperiosteal lift of the upper two-thirds of the face is considered the most effective rejuvenating operation, 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. At the same time, the lifting effect is transferred to a certain extent to the cheek area.

Surgical technique. This option for correcting age-related changes in the face involves:
1) lifting of the eyebrows and forehead skin;
2) elimination of blepharochalasis (excessive overhanging of the skin under the eyebrow over the upper eyelid);
3) a decrease in the severity of the skin lines of the glabella, including due to the excision of the muscles that wrinkle the eyebrows and the muscles of the proud;
4) reduction of transverse wrinkles of the forehead, including by resection (crossing) of the frontalis muscle;
5) the effect of a limited lifting of the upper and middle parts of the cheek;
6) external catopexy;
7) decrease in the severity of the infraorbital furrow;
8) slight lifting of the tip of the nose due to the displacement of the skin of the back of the nose upwards.

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

Approximately 1-2 cm outside and down from the line of attachment of the temporal muscle, the surgeon separates the tissues immediately above the superficial sheet of the deep fascia, which covers the interaponeurotic fat body 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 temporo-zygomatic arch, followed by an 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 fronto-temporal-zygomatic region during supraperiosteal lifting of the upper two thirds of the face.
1 - deep temporal fascia; 2 - superficial temporal fascia; 3 - temporal fat body; 4 - frontal branch of the facial nerve; 5 - zygomatic arch.

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

However, the inevitable traumatization of adipose tissue with subsequent scarring of tissues is accompanied by a decrease in their volume and, in some cases, can lead to the appearance of a noticeable depression above the temporo-zygomatic arch.

If, simultaneously with this intervention, a face and neck skin tightening 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 interstitial 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.

Separation of tissues in the deep layer of the wound of 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 arch of the temporomygomatic arch to avoid direct damage to the frontal branch of the facial nerve. Next, the tissues are exfoliated supraperiosteally in the direction of the middle part of the face in the periorbital and zygomatic zones (Fig. 35.4.6).

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

At 1 cm from the outer angle of the orbit, there are perforating vessels passing from the temporalis muscle to the PMFS. They are identified and coagulated. Even more caudally and outwards, the temporo-zygomatic 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 temporo-zygomatic region.

Subsequently, tissue detachment can be continued to the maxillary region in the direction of the cheek. This relatively safe separation of tissues is performed above the surface of the upper jaw, above the zone 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 zone of exit of the infraorbital nerve, the tissues are separated in a blunt way below the point of its projection.

An important and mandatory component of the operation is the intersection of strong fibrous bridges in the region of the upper outer part of the orbit, going from the PMFS to the periosteum (Fig. 35.4.7). Only after that the eyebrow becomes mobile and easily shifts upwards.

Rice. 35.4.7. Scheme of intersection of ligaments at the upper outer edge of the orbit.
The arrows indicate the area of detachment of the upper orbital fixation point of the PMFS.

If there is an excessively overhanging outer bony edge of the orbit, it can be resected using a cutter. To do this, the periosteum over the protruding upper outer part of the orbit is lifted with a bone raspator and, after subperiosteal processing, the bones are laid back.

When the tissues are separated to the upper edge of the orbit, the surgeon gets the opportunity to penetrate through the fascial septum that separates the cavity of the orbit from the circular muscle of the eye. The septum is cut directly near the bone edge, as a result of which intraorbital adipose tissue protrudes into the wound. The 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 inner fat pocket of the upper eyelid is most often opened during upper blepharoplasty.

During the operation, the muscles that wrinkle the eyebrows and the proud muscle are identified and removed. If necessary, the tissues are separated over the bridge of the nose and the back of the nose, which makes it possible to eliminate the drooping of the skin in this area and thereby improve the position of the tip of the nose.

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

After the formation of 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 tissues are fixed in the tightening position. In this case, the line of tissue tension in the middle and upper parts of the face should run mainly 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 of the flap can cause dysfunction of the frontal branch of the facial nerve. Note that the tension of the flap also leads to 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 are reduced due to the 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 enough to completely straighten the tissues in the zygomatic and maxillary regions.

At the final stage of the operation, the excess of the 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, inconspicuous 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 (more than 5.5 cm on average), when the central part of the access is placed along the anterior hairline.

results

With a carefully developed technique, this operation is safe and much more effective than a conventional forehead lift. In fact, this intervention is a fronto-temporal lift and has a rather significant effect on the tissues of the middle part of the face, pulling them in the cranial direction. On the other hand, over time, under the influence of gravity and the work of mimic muscles, a partial loss of the achieved correction always occurs.

That is why the final result of the operation is evaluated after 6 months, when the scars become more mature (Figure 35.4.8). Among the typical complications, it is necessary to take revenge on occasional unilateral paresis of the frontal branch of the facial nerve. As a rule, this condition disappears within 10-50 days from the moment of surgery without additional treatment.

Rice. 35.4.8. Photos of a 42-year-old patient before (a-c) and 6 ms (d-s) after supraperiosteal lifting of the upper two-thirds of the face and quadrilateral blepharoplasty.

IN AND. Arkhangelsky, V.F. Kirillov

Keeping a young, attractive and beautiful face is one of the strongest desires of any woman. There is a wide range of methods for dealing with age-related changes.

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

A facelift can be performed with the help of plastic surgery and also non-surgical techniques.

There are several types of surgeries:

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

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

The muscular skeleton during such an operation is not affected. The procedure is aimed at excising excess skin.

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

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 and strong tissue excision.

Surgical manipulations are performed using special endoscopic techniques. An endoscope with a camera is inserted into the incisions and slowly moves to the place where manipulations are to be performed. Surgical instruments are also introduced. The surgeon can follow 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 endoscopic skin tightening cost? Lifting the middle zone of the face with the help of endoscopic lifting has a cost of 14,000 rubles, a lift of the upper zone costs the same, the cost of a lift of the entire face is 150,000.

SMAS stands for "superficial musculoaponeurotic system". The SMAS system is an inseparable fibromuscular layer that connects the muscles to the dermis and is located under the skin and subcutaneous fat.

The operation allows to carry out an effective facelift and restore the features and contours of the face lost with age without the effect of constricted skin, as well as restore a clear oval. After the operation, the patient stays and is observed in the hospital for several days.

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

During the scarless facelift surgery, 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 facelift. It is recommended for people between the ages of 30 and 40 who need to slightly tighten the skin and slightly correct the oval. This facelift is a minimally invasive type of SMAS facelift.

Small-scar plastic surgery is very effective and at the same time it takes much less time for rehabilitation after it. After it, a short and inconspicuous scar remains.

In many reviews of patients who have undergone surgery, high efficiency and a pronounced facelift after surgery are noted.

Non-surgical facelift methods include:

Thread facelift.
Facelift at home.
Hardware cosmetology (lifting with the help of special cosmetology devices).

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

It is possible to effectively and safely make a lift and tighten the oval without surgical intervention using a thread lift. It does not require long-term rehabilitation, the likelihood of complications is unlikely, and a facelift with threads has a minimum number of contraindications.

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

You can make a facelift 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, helps to make the face oval clearer.

In order for massage, exercises and folk remedies to bring the desired effect, you should definitely give up smoking, alcoholic beverages, because they cause tremendous harm to the body and negate all efforts to rejuvenate. It is also necessary to eat right, get enough sleep, 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 wrinkles, tighten and rejuvenate the skin, make it more elastic. When choosing cosmetics, you should also pay attention to the amount of natural ingredients: the more of them in a cream or mask, the better.

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

In addition to purchased masks, you can cook homemade using only natural ingredients. Folk recipes for anti-aging products, time-tested, will be very useful for the skin in general. Effective masks at home can be made from honey, clay (available at the 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 to achieve significant rejuvenation if done every day.

Rejuvenation and tightening of the oval at home is the most convenient and financially inexpensive option that anyone can afford.

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

Ultrasonic lifting is performed using a special apparatus that creates focused ultrasonic radiation.

The high-frequency sound waves generated by the device affect the deep layers of the skin, namely the SMAS. Waves compress and contract collagen fibers, provoke the process of neocollagenesis (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.

The essence of any surgical rejuvenation is reduced to relief shifts in muscle and skin tissue, the opposite of age-related changes. Endoscopic facelift is one of the safest methods of this type of surgery.

What is an endoscopic facelift

Rejuvenation surgery involves exfoliation of the skin, dissection and movement of muscle tissue, removal of fatty deposits, if necessary, fixation of muscle fibers, tension and fixation of the skin. In this case, excision of excess skin and connective tissue is carried out.

Endoscopic lifting belongs to the category of minimally invasive methods. Its fundamental difference from traditional plastic surgery is the absence of excision. And the skin, and muscles, and connective tissue are redistributed in such a way as to take their "rightful" place and thus level out age-related changes. Only adipose tissue is subject to removal, since it is definitely superfluous.

To hold the muscles and skin in a new place, special sutures or endotines are used - staples and tapes with "tweezers". The latter fix the tissues for a sufficiently long period, so that by the time they disappear, the newly formed connective tissue has fixed the skin and muscles. Endotins dissolve on their own and do not need to be removed.

This approach provides many benefits:

the minimum number of incisions and their very small size - within 1.5–2 cm;
high accuracy of the operation: the use of an endoscope allows you to receive an image and constantly evaluate the state of the surgical field;
minimal intervention guarantees a minimum of consequences and complications;
the rehabilitation period after a facelift is much lower;
the operation can be carried out locally - in certain areas, or in a complex.

The only drawback of the intervention is that a highly qualified surgeon is required. In addition, there are restrictions on age, and not only on the condition of the patient.

What is an endoscopic facelift, the video below will tell:

The essence of the procedure

Its name is endoscopic, the correction received due to the method. In a conventional operation, it is required to completely exfoliate the skin, literally removing it from the operated area, which implies large incisions and significant blood loss.

Endoscopic technology allows you to act differently. Small incisions are made in the required places - up to a maximum of 2 cm. Silicone tubes are inserted into the incisions. The lighting and recording system - the endoscope, and the instruments themselves move along them. As a result, the doctor does not need to exfoliate the skin, since he receives an image using an endoscope. Accordingly, there is no need to increase the cuts.

The small size of the incisions allows modification of the techniques used. To correct the middle zone of the face, a vertical lift is possible, when the skin of the cheeks is lifted to the lower ciliary edge and at the same time the nerve nodes located in the middle part of the cheek are not affected at all. The effectiveness of the vertical lift is higher, the minimum amount of skin needs to be redistributed, but it cannot be done in the usual way.

Endoscopic technique allows you to combine intervention in different areas, and with multi-vector stretching. Although many plastic surgeons believe that an integrated approach justifies itself to the greatest extent.

Professor A. M. Borovikov, one of the most famous practicing surgeons, claims that patients after local rejuvenation return literally a year later, as they find that, compared to the rejuvenated part of the face, the rest of the areas do not look aesthetically pleasing. After a comprehensive rejuvenation for 10 years of practice of this procedure, no one has yet applied for a second restoration.

The operation lasts from 40 minutes to 6 hours, depending on the extent of the intervention. Local anesthesia is possible only for partial correction or for blepharoplasty. All other types of facelifts are performed under general anesthesia, which is a limitation for people with diseases of the cardiovascular system.

The result of rejuvenation lasts on average 5–7 years: this is due to individual characteristics and general health. A complex operation, as already mentioned, provides a more stable result.

Photos before and after facelift

Venues

The division of the face into zones is associated with the mechanisms of aging and understanding of the subject of plastic surgery.

The face is divided into lateral and central - the medial part, along a conditional vertical line running along the nose. According to this division, it is immediately clear why a vertical lift, if possible, will give more tangible results. The signs of aging are concentrated mainly in the medial part, and the lateral skin tightening is effective only in relation to the lower part of the face and the lateral region. Although, of course, it still reduces relief changes.

The face is divided into 3, or rather, 4 zones. Conditional lines run horizontally at the level of the eyebrows and nostrils.

- neck, jaw line, chin, corners of the mouth. Nasolabial folds are no longer included in this zone, as they appear when the skin of the cheeks is lowered and, in fact, corrections are not available in this case. Signs of aging here are a double chin, jowls, lowered corners of the mouth, and wrinkles from the corner of the mouth to the chin. In the lower zone, excess fat most often accumulates, so the correction has to be combined with liposuction. The mechanism of correction of the lower third of the face is as follows: an incision is made around the ear and the soft tissues of the cheeks are redistributed. At the same time, the cheeks are removed, the folds around the mouth take on an inclined position and are smoothed out. For a facelift, do not make incisions under the chin. A lower facelift does not affect the condition of the middle zone in any way.

- the space between the horizontal lines at the level of the nostrils and eyebrows. Includes nasolabial folds and lower eyelids, although the latter are often distinguished into a separate 4th zone. The middle zone ages the fastest, the signs are the zygomatic sac, the relief between the lacrimal sulcus and the ciliary margin, and, of course, the most obvious sign of aging is the nasolabial folds formed by overhanging tissues. Mid-zone correction provides the most pronounced effect of rejuvenation, especially when combined with a lower eyelid lift. The operation takes from 1.5 hours, if it concerns only the circular muscle of the face, and up to 3 hours, if a check-lift is performed.
- The technique is as follows: incisions are made along the lower ciliary edge in a natural crease. Muscles are cut through them and moved to their original position, fixed with endotines, then the skin is pulled. The resulting folds in the corners of the eye are removed by a lift in the temporal region. The complexity of the procedure lies in the fact that it is necessary to work here with facial muscles. If they are incorrectly shifted, synchronous work is disrupted, and this is fraught with asymmetry and disturbances in facial expressions from different sides of the face.
- Another option is also possible: in this case, a lateral lift is combined - incisions are made near the ear, and a lift through incisions on the oral mucosa. The technique is safe, since the nerve nodes in the center of the cheeks are not affected.
- forehead and eyebrows. Signs of aging are here: drooping eyebrows, drooping upper eyelids, horizontal sweetness and wrinkles on the forehead. The drooping of the eyebrows and eyes may not be related to age and is quite amenable to correction. The essence of the operation: incisions are made along the border of hair growth in order to hide the roller that appears when the skin is pulled, and the sutures themselves, of course. In this case, the omission disappears, wrinkles are leveled, but the height of the forehead increases. If this is a problem, a variety of techniques are used: oblique slope, sawtooth pattern, and so on. An upper facelift is often combined with other types of correction. The fact is that exfoliation of the skin on the forehead opens up many opportunities for rejuvenation of the eyes, and the middle zone of the face, and even the lower one - it’s a sin not to use it. You can remove wrinkles at the temples, change the shape of the nose - a hump, fill the cheekbones. Moreover, in this case, the need for lateral incisions for lateral skin tightening disappears. True, the result of such an operation is initially fixed not with sutures or endotines, but with titanium screws, which are removed after 20 days.

4 zone - eye socket. Its upper part belongs to the upper third, the lower one to the middle. However, often the operation is performed only here, since the eye socket focuses the most obvious signs of aging: wrinkles and folds in the corners, drooping of the upper eyelid, sub-eversion and drooping of the lower, increasing the distance between the ciliary edge and the lacrimal groove. Often, patients who are not ready for radical rejuvenation perform eye socket correction as a compromise between the desire to get a younger face and the fear of a facelift. There are no physiological or anatomical justifications for isolating the eye socket into a separate zone. On the contrary, the surgeon works with two different zones during the operation, which, of course, is disadvantageous. However, blepharoplasty as a separate procedure is in great demand, which has to be taken into account.

Complex rejuvenation involves working on the entire face at once. This decision should be considered the most rational. The minimum number of incisions is made, since a maximum of actions are carried out through them. In relatively mild cases, the entire correction is performed through incisions on the forehead and in the crease of the lower eyelid. In addition, the result lasts longer.

Clearly and with useful diagrams, this video describes how the operation is performed:

At what age can you do

To correct cosmetic flaws - a drooping eyelid or eyebrow, there are practically no age restrictions. But for anti-aging procedures, age matters.

Endoscopic technique does not involve excision of muscles and skin. The calculation is that relatively elastic tissues take root on their own in a “new” place, and connective tissue is formed quickly enough to secure this position. Alas, in old age this is impossible.

Skin with too low elasticity simply cannot hold on and sags again. The same can be said about the muscle fibers: the better they are in condition, the greater the chances for the success of the operation. Accordingly, any endoscopic procedures after 60 years are meaningless.

Rejuvenation of the middle part of the face of this kind can be resorted to as early as 30-35 years. Age between 35 and 50 is optimal.
Correction of the lower part of the face, as a rule, is performed later - from 45 to 60 years. However, in combination with liposuction, it is also done earlier, if the double chin and cheekbones are due to excess adipose tissue.
The age limit for rejuvenation of the upper face is 60 years.
Blepharoplasty is performed between the ages of 35 and 60.

Photo of the patient