Facelift and endoscopic forehead lift: a step by step approach

Surgical ClinicsS101Facelift and Endoscopic Forehead Lift:A Step by Step ApproachJohn Griffin, DMD, Columbus, MSP.J. Schaner, DMD, Marietta, GA

Interest in facial rejuvenation has greatly increased inrecent years. Some of this interest stems from advancesin technology and improved surgical technique. Theseadvances are making it possible for the facial cosmeticsurgeon to reliably produce excellent results with fewerrisks of complications. This translates into satisfied pa-tients and greater patient acceptance of proposed treat-ment plans.

The natural aging process, heredity, exposure to thesun, and other factors cause the skin to wrinkle and sag.Folds of the skin become more prominent around themouth, chin, jaw line, and neck.

The laser-assisted endoscopic forehead lift provides analternative to traditional brow lifting techniques. With-out question, the periorbital area is one of the mostexpressive areas of the face, and there are many tech-niques available which affect the position of the eye-brows. The brow lift technique using the endoscope andthe CO2 laser is proving to be readily accepted by pa-tients and provides consistently excellent results withfewer complications than other methods. Before thistechnique is added to the armamentarium of the cos-metic surgeon, it is important to understand the indica-tions for the procedure to insure a good outcome.

In the last decade there have been many advance-ments in the technique of the facelift operation. Thesehave resulted from a better understanding of the anat-omy of the face and the neck and how the process ofaging affects these tissues and alters their position.

Currently, the long flap rhytidectomy is the most pop-ular procedure. This includes wide detachment of skinover the face, neck, mastoid, and frontotemporal re-gions. The superficial musculoaponeurotic system(SMAS) is then suspended in a superior and posteriordirection.

The contour of the neck is very important in facialrejuvenation. A well-contoured mandibular border is oneof the key signs of a youthful appearance. Liposuction ofthe submental and submandibular areas to remove fat isperformed along with resection or plication of theplatysmal muscle. A sling suture from the midlineplatysma muscle to the contralateral mastoid fascia isused to achieve the youthful appearing neck.

Oral and maxillofacial surgeons should become famil-iar with the various rhytidectomy techniques along witha good understanding of the anatomy. Preoperative andpostoperative care is also crucial to obtaining excellentresults.

References

Griffin J, Frey B, Max D, et al: Laser-assisted endoscopic forehead lift.J Oral Maxillofac Surg 56:1040, 1998

Epker B: Esthetic Maxillofacial Surgery. Philadelphia, PA, Lea andFebiger, 1994

Rees DT, LaTrenta SG: Aesthetic Plastic Surgery. Philadelphia, PA,Saunders, 1994

Tardy ME, Regan T Jr, Brown JR: Facial Aesthetic Surgery. St Louis,MO, Mosby, 1995

Giamppapa CV, Di Bernardo EB: Neck recontouring with suturesuspension and liposuction: An alternative for the early rhytidectomycandidate. Aesth Plast Surg 19:217, 1999

S102Practical Approach to the Diagnosis andTreatment of TemporomandibularDisordersM. Franklin Dolwick, DMD, PhD, Gainesville, FL

The diagnosis and management of common temporo-mandibular disorders continue to present a challenge toclinicians. The differential diagnosis of common muscleand temporomandibular joint disorders is a mandatory re-quirement for successful treatment. During this presenta-tion, diagnostic criteria for the common muscle and tem-poromandibular joint disorders will be reviewed and dis-cussed. A simple nonsurgical treatment approach formyofascial pain and temporomandibular joint internal de-rangement, which results in a high rate of success, will bepresented. The relationship of bruxism to internal derange-ment will be discussed emphasizing the role of increasedjoint loading as an etiological factor for osteoarthritis anddisc displacement. Arthrocentesis for the treatment of tem-poromandibular joint internal derangement will be dis-cussed in detail.

For those small numbers of patients who do not respondto conservative treatment, surgical alternatives will be re-viewed. The benefits and limitations of each of the surgicalprocedures are readily determined on an individual-casebasis. The goal is to determine the most appropriate tech-nique that will yield the highest probability of success withthe lowest morbidity. Arthroscopic lavage and lysis, arthro-plasty (disc preservation, eminectomy and discectomy),and condylotomy will be discussed. The discussion willinclude indications, techniques, outcomes, and complica-tions associated with each procedure.

References

Dolwick MF, Dimitroulis G: Is there a role for temporomandibularjoint surgery? Br J Oral Maxillofac Surg 32:307, 1994

Dimitroulis G, Dolwick MF, Martinez A: Temporomandibular jointarthrocentesis and lavage for the treatment of closed lock: A follow-upstudy. Br J Oral Maxillofac Surg 33:23, 1995

Nitzan DW: The process of luberication impairment and its involve-ment in temporomandibular joint disk displacement. A theoreticalconcept. J Oral Maxillofac Surg 59:26, 2001

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