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The difficult facelift

Article-The difficult facelift

Dr. Barton
New Orleans — The round face, the thin face and the sun-damaged face present varying challenges for the plastic surgeon, according to panelists at the American Society for Aesthetic Plastic Surgery's (ASAPS) Aesthetic Meeting 2005 here.

In a discussion of "The difficult facelift: Successful solutions for shaping the round face, sun-damaged skin and volume-depleted patient," surgeons offered advice to their colleagues on what techniques they employ to ensure optimal results.

"It's one thing to get a good result in a straightforward face," says James Stuzin, M.D., scientific program chairman of the meeting and moderator of the panel. "Certain types of faces are more challenging than others. We typically have less consistent results with round faces, those that are damaged by sun, and in some patients with thin faces and a significant degree of facial deflation," he tells Cosmetic Surgery Times.

Sun-damaged skin Dr. Stuzin says patients with sun-damaged skin often do not respond to vertical shifting.

"The wrinkles can be shifted in the wrong direction and produce an unnatural facial appearance," he says. Dr. Stuzin is clinical assistant professor in the department of plastic surgery at the University of Miami. "Additionally, sun-damaged skin does not hold the results of the facelift as well as normal skin. Plastic surgeons on the panel also emphasize that laser resurfacing is an important adjunct to improve wrinkles."

Fritz Barton Jr., M.D., a panelist and a clinical professor in the department of medicine and surgery at the University of Texas Southwestern Medical Center, says that extracting fat from a round face is difficult because of the way the fat is distributed.

Dr. Little
"Generally, if you have a round face, the fat is through all the layers," he says. "You can take some of the fat out of the areas along the jawline and cheeks. You can contour a neck fairly well, as well as the jowls. However, you can't take a round-faced person and make them a thinned-faced person."

Fat injections in a patient with a volume-depleted or thin face may not last regardless of how the fat is harvested or processed. When they survive, fat grafts can be helpful, but most people find them to be inconsistent in providing significant volume restoration, according to Dr. Barton.

Counseling important Surgeons should not forget the ABCs of plastic surgery, including counseling a patient to explain the limitations of plastic surgery, particularly with challenging cases.

"You have to inform people that they will have the basic face that they started out with," Dr. Barton says. "You have to spend time talking with the patient beforehand about the results."

Clinicians cannot predict how long-lasting the improvement from a facelift will be, notes Dr. Barton, a former president of the American Society for Aesthetic Surgery.

"How long it lasts depends on the thoroughness of the procedure and how quickly people continue to age," he says.

Fat grafting J. William Little, M.D., a panelist and a clinical professor of surgery at Georgetown University, says that the art of structural fat grafting can be mastered, and he disputes the notion that grafted fat does not survive.

"Some research has shown four-, six- and eight-year results with fat grafting," he says. "Many surgeons around the world use the technique."

Dr. Little says that thinner faces, generally, will age more rapidly than fuller, rounder faces. He adds that the challenge with the round face is to bring out the jawline.

"Thin patients will age with more harshness in the face than heavier-set patients," he says.

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