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Rhytidectomy

OMFS SNUH

Introduction: Turning Back The Hands of Time  Rhytidoplasty

or Rhytidectomy  reduce sagging and wrinkling in the face and neck  Average Price of Rhytidectomy minor lifts : $4,500. - $7,000 major work, $5,500. - $15,500 OMFS SNUH

History  Hollander

in 1901 : first report of facelift preocedure  Bames and Bettman in 1927 : skinsubcutaneous flap  Skoog in 1974 : SMAS-platysma layer  Hamra in 1990 : composite rhytidectomy OMFS SNUH

Types of operation  Classic

operation : skin-flap op.

 SMAS-platysma  Composite

technique

flap of SMAS and skin

 Brow-forehead

lift OMFS SNUH

Classic operation  Indication

: young pt. with minimal ptosis of tissue, pt. with previous op. history  Procedure – Underming the skin and subcutaneous tissue – Rotation and advancement of skin flap – Excision of excess skin OMFS SNUH

Incision

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Undermining

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Traction of flap

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Excision of excess skin

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Trmming of flap

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Suture Foreward migration of ear lobe

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SMAS-platysma face-lift  Owsley

in 1977  SMAS : Superficial (or Sub-) muscular Aponeurotic System  Different direction of traction

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Incision on submental crease

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liposuction

Plication of platysma

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Dissection of temporal region

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SMAS incision and dissection

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SMAS-platysma rotation

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Redraping of the skin flap

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Composite Rhytidectomy  Aging

face : ptotic platysma, ptotic cheek fat pad, redundant orbicular oculi m.  Dissection plane : suborbicular, prezygomatic, subplatysma m.

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Dissection plane

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Brow-forehead lift  Indication

: brow ptosis, ptosis of lateral upper eyelid  Transverse forehead line, glabellar crease, transverse fold at nose, upper nasal and medial eyelid fullness

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Anatomy  Musculi

frontalis : eyebrow elevation, cause of transverse forehead line  Musculi corrugator : brow pulling, vertical glabellar crease  Musculi procerus : transverse wrinkle at the root of the nose

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Incision

Standard coronal incision

Ant. hairline incision OMFS SNUH

Disseciton

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Glabellar crease

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Redraping of flap

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Postoperative Care  Dressing

and drain  Upper body elevated at 30 degrees  Soft diet  Suture removal

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Complication  Hematoma  Pigmentation  Skin

slough  Infection  Hair loss  Nerve injury  Pain OMFS SNUH

Beauty is only skin-deep. OMFS SNUH