Face-Lifts and Their Long-Term Results

Abstract

Introduction:

The literature on face-lifting over its history varies from simple to complex. It can be difficult to determine which technique is best for each individual patient. We collected a series sufficiently large to show valid conclusions up to 6 years postoperatively.

Materials and Methods:

Between January 1987 and January 1997, 348 female and 26 male patients underwent face-lifting. Based on complexity of the procedure, the cases were stratified into 5 groups. Group A had limited skin undermining out to 5 cm, with submuscular aponeurotic system (SMAS) plication (21 patients). Group B had longer skin flaps with undermining out to 10 cm, with SMAS plication (27 patients). Group C had skin undermining out to 7–8 cm and sub-SMAS dissection to the anterior border of the parotid, with myofascial imbrication (136 patients). Group D had skin undermining and sub-SMAS dissection to the caudal limit of the melolabial groove and mandibular ligament and for 7–8 cm below the platysma, with myofascial imbrication (153 patients). Group E had composite lifts according to Hamra (37 patients). At 2 and 6 years' follow-up, patients were evaluated in a blinded fashion with direct observation by 2 nurses and with photographic comparisons made by 3 independent surgeons.

Results:

Two-year follow-up evaluations were performed for 189 patients. Six-year follow-up evaluations were performed for 128 patients. At 2 years, the degree of improvement tended to favor the more complex techniques, and at 6 years, it definitely favored the more complex techniques. Complications were: 10 hematomas, evenly distributed among the groups; 13 cases of temporary facial nerve weakness, with a higher percentage in groups D and E; 4 skin sloughs, 1 for group B and 3 for group D; and no infections.

Discussion:

While some patients can obtain satisfactory results with skin undermining and SMAS plication, the majority of our patients enjoyed longer-lasting results with more complex face-lifts, encompassing SMAS dissection and imbrication.