LIFTING REVISION
Pulling up as much as possible
is not the answer to lifting.
#Doctor's SAY
Over many years, we use our facial expression muscles to make countless expressions, and many signs of aging appear on the face, from the forehead and eyebrows to the eyelids, cheeks, and a sagging jawline.
The most reliable way to improve sagging is facelift surgery.
Because a facelift involves operating on areas with many nerves and blood vessels, it is best to have it performed by a medical team with thorough knowledge of facial anatomy.
The face is divided into anterior and lateral regions along a vertical line drawn down from the outer edge of the eyebrow. Between them are retaining ligaments that firmly anchor the skin to the periosteum and fascia.
Retaining ligaments Anterior region Lateral region
These result from skin aging. UV light reduces collagen and elastic fibers and thins the dermis, causing elastosis and a loss of elasticity, which leads to fine lines.
Typical examples are forehead, glabellar (between-the-brows), and crow's feet wrinkles. The face has 17 pairs of expression muscles that create a variety of expressions. As these muscles contract repeatedly over many years, the skin over them folds, forming wrinkles.
Typical examples are nasolabial folds and jowls. Many retaining ligaments hold bone and soft tissue in place. As these ligaments weaken with aging, the skin and fat sag under the pull of gravity.
Surgical methods vary by area
Forehead Lift
01
People usually judge aging in the upper face by looking at the eyelids, under-eye area, and crow's feet. However, aging of the upper face actually begins in the forehead and brows. To improve drooping eyelids, it is advisable to first correct them with a forehead lift and then consider double eyelid surgery.
02
When lower eyelid sagging occurs together with cheek sagging, this procedure lifts the fat layer beneath the muscle around the cheekbone (SOOF), which also improves the nasolabial folds caused by cheek sagging. It can give the entire eye area a more youthful look.
03
With age, the area around the mouth and the jawline sag, forming jowls, and the cheeks droop, creating deep nasolabial folds. The face also becomes squarer and larger. This surgery corrects these sagging areas and restores the look of your younger years.
04
When fat accumulates under the chin or the neck muscles slacken, two vertical bands can form in the center of the neck, and horizontal lines can form from loose skin. Unlike other wrinkles, these cannot be concealed even with makeup and stand out more. They are often corrected together with a facelift.
WHY IT IS DIFFICULT
The nerves that create facial expressions are called facial nerves. Revision lifting involves dissecting a wide area through which these nerves run, and if the nerves are damaged, it can cause facial nerve paralysis such as the following.
Difficulty closing the eye after surgery
Asymmetry of the upper lip and an unnatural look when smiling
A lower lip that is twisted out of position, with food frequently spilling while eating
Lifting results can also vary depending on the extent of dissection. If the surgeon, worried about facial nerve damage, cannot perform extensive dissection, or does not dissect along the correct plane even when dissecting, a revision lift may not deliver a reliable effect, and another revision may be needed.
Revision lifting means understanding and correcting dynamic causes. If surgery is performed by judging only the visible symptoms in a static way, no improvement can be achieved.
Surgery on static structures that do not move, such as cheekbone, square jaw, and nose surgery.
Refers to areas where the fascia and retaining ligaments weaken with aging and, under the force of gravity, sag downward. Examples include nasolabial folds caused by cheek sagging, jawline sagging, neck wrinkles, and forehead wrinkles.
The face consists of five layers, from the skin to the periosteum.
Skin Subcutaneous fat Fascia (SMAS layer) Retaining ligaments Periosteum / deep fascia
Pulling only the skin surface damages the connection between the facial expression muscles and the skin, which easily leads to an unnatural or awkward look, and the results do not last long.
Flip through the three axes — dissection range, incision amount, and fixation method — to review each.
The face has many nerves and blood vessels, so accurate dissection all the way through is difficult, and even with endoscopic equipment, dissection is often limited to the area near the incision. By dissecting a wide range of the SMAS layer, a forehead lift can reach right up to just above the eyebrows, and a facelift can improve nasolabial folds, jowls, and neck sagging.
The wide SMAS dissection range delivers a reliable and long-lasting lifting effect.
For a facelift, the lifting range is determined by the areas you want to improve, and the extent of the incision may vary — along the hairline, around the earlobe, and behind the neck.
Because a forehead lift is performed inside the hairline, surgery is carried out through 5 minimal incisions.
In a forehead lift, if fixation uses a foreign material, symptoms such as palpable lumps, a foreign-body sensation, and nerve irritation may occur, and the short duration may make it hard to see long-lasting results.
Surgery is performed using a method of fixing to the periosteum of the forehead bone, which can maintain the lifting effect for longer.
The retaining ligaments anchored to the SMAS layer are cut so the SMAS layer can be lifted. The skin flap is then pulled upward, and the remaining retaining ligaments of the lifted skin flap are secured to the lifted SMAS area.
Skin layer Fat layer SMAS layer
Retaining ligaments anchored to the SMAS
Releasing the retaining ligaments from the SMAS
Lifting the SMAS layer
Lifting the skin flap
Securing the remaining retaining ligament portions of the lifted skin flap to the lifted SMAS area
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