Cosmetic Surgery of the Asian Face

Temporal and periorbital area: All of these ligaments are divided during dissection, except the masseteric ligament to prevent Bichat's fat herniation. As with other face-lift procedures, the typical patient is in his or her fifties and presents nasolabial fold deepening, jowling, loss of mandibular line, submental lipodystrophy, and neck laxity. A more aggressive neck dissection and redraping is usually performed when platysmal band are present.

Brow ptosis and frontal rhytides are indications to perform a concomitant bicoronal forehead lift with corrugator resection. A slightly curved temporal incision is used and is extended superiorly to allow later repositioning of the lateral eyebrow. If a concomitant forehead lift is performed, the bilateral temporal incisions are joined superiorly to perform a formal bicoronal incision. Anterior to the ear, a retro-tragal incision is preferred. Inferiorly, the incision often ends a few millimeters behind the lobule tip.

If an extensive neck redraping is planned, the incision can be extended close to the concho-mastoid groove, on the mastoid skin and into the hair-bearing scalp. Skin incision and extent of subcutaneous dissection. The temporal incision is hidden behind the hairline. A retro-tragal incision is performed. The retro-auricular incision is extended superiorly as necessary. Superiorly, the dissection extends 1 cm above the zygomatic arch. Inferiorly, the dissection extends a few centimeters below the mandibular angle. In the temporal area, a subgaleal dissection is carried superior to the zygomatic arch.

The undermining is performed anteriorly to the lateral eyebrow. To mobilize the lateral eyebrow Fig. If forehead rhytides and brow ptosis are present, a formal bicoronal forehead lift is performed. The supraorbital ligamentous adhesion is released as well. Partial corrugator resection is performed. A monopolar cautery with a Colorado-type needle is used to score the undersurface of the frontalis.

One needs to identify by transparency from the undersurface of the frontalis the two supraorbital nerves. To facilitate the exposure for the following dissection, it is suggested to ligate and divide the superficial artery and vein. The SMAS is incised along the dotted line. The shaded area is the zone that is undermined. The superior dissection starts under the SMAS in the cheek area. It proceeds superiorly and anteriorly until the lateral border of the zygomaticus major is seen where the superior arrow is broken.

The dissection plane is then made just superficial to the zygomaticus major. The dissection continues anteriorly and inferiorly over both the zygomaticus major and minor. The nasolabial fold is released by blunt dissection with scissor tips. In the inferior dissection lower arrow , the dissection is carried along the mandibular border anteriorly until the mandibular ligament is released. The SMAS is incised below the zygomatic arch, 1. The dissection proceeds anteriorly, between the SMAS and the parotid fascia.

It stops at the masseteric ligaments, which are preserved. Releasing these cutaneous ligaments and dissecting further will likely cause Bichat's fat to herniate, complicate the procedure, and give too much definition to the zygomas. Inferiorly, the dissection extends anteriorly along the mandibular border, deep to the platysma. Once the mandibular cutaneous ligaments are visualized, they are released. Liposuction of the submental area can be performed at this time if required.

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Superiorly, the sub-SMAS dissection is continued until the lateral border of the zygomaticus major is seen, at its confluence with the orbicularis muscle fibers. At this point, the dissection plane changes to a more superficial plane, following the surface of the zygomaticus major. This plane change is necessary to prevent injury to the facial nerve branch to the zygomaticus major muscle, which enters the muscle belly from its undersurface. The dissection proceeds until the zygomaticus minor is seen. The tip of the scissors are used to bluntly free the nasolabial fold.

At this point, it is critical to adequately free the zygomatic ligament see Fig. An adequately released SMAS will move freely upon traction and provide a smooth cheek contour, without skin dimpling or irregular waving at the nasolabial fold. Pulling on the mobilized SMAS in a superolateral direction will allow smoothing of the nasolabial fold as well as reposition cheek soft-tissues. Fibrin glue is applied. Traction on the lower part of the SMAS is used to smoothen the mandibular border.

Excessive skin in the cheek area is resected. Note that skin resection is often very minimal compared with that in Caucasians. Fibrin glue is applied in the subcutaneous plane, and final skin closure is performed. Particular attention is paid to the tragal and lobule area. The tragal skin flap is thinned.

A deep suture is then used to re-create the pre-tragal sulcus.

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The retro-tragal incision is then closed normally. When closing the skin incisions around the earlobe, no tension should be placed on it to prevent the pixie ear deformity. In the temporal area, the scalp is pulled to reposition the lateral brow in the desired position. Excessive scalp is trimmed, and skin closure is performed with subcutaneous sutures and staples.

In both cases, note the improvement of nasolabial folds, restoration of cheek fullness, and the smoothing of the mandibular line, which restores the desired oval facial shape.

Asian female face lift. Combined face lift and forehead lift. A, B Preoperative; C, D postoperative. Note the improvement of the nasolabial folds. The mandibular line is smoothed without excessive definition. An attractive, youthful, oval facial shape is restored. Asian male face lift. Face lift and lower eyelid blepharoplasty.

Nasolabial folds are improved, cheek fullness is restored, and a smooth, youthful mandibular outline is obtained. Antibiotics are given at induction time, as well as for 3 days postoperatively. Sutures are removed at 5 days, and scalp staples are removed at 2 weeks. Cold packs are applied for 15 minutes every hour while awake during the first 48 hours.

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Warm packs are then applied three times daily for 2 weeks. Patients are instructed to refrain from performing activities that can increase blood pressure or increase blood flow to the face for 2 weeks. Social activities can be resumed at soonest at 1 week. The final result is obtained at 3 to 6 months postoperatively when most of the healing process has occurred. As with other face-lift techniques, possible complications can include wound dehiscence, skin necrosis, facial nerve palsy, and asymmetries.

Tragal deformation, lobule lengthening, and hypertrophic scars are also possible unfavorable outcomes. The rate of complications, however, is similar to that of other techniques, with the exception of hypertrophic scarring, which is believed to occur more often in the Asian population. The fibrin glue is used to reduce both the postoperative hematoma rate and the extent of swelling.

The Asian face lift requires an adaptation of current techniques to achieve the desired aesthetic outcome. Cultural differences and differences in anthropomorphologic features alter the patient's vision of beauty and youthfulness. Lam, MD, is the much anticipated update and expansion of the original monograph published by McCurdy in The new edition has pages divided into 14 chapters as well as 2 DVDs containing over 3 hours of video tutorial.

The first half of the book, written by McCurdy, is essentially an updated description of his personal philosophy and surgical techniques he has honed over 30 years in practice. Lam wrote the second half of the book, which is completely new and details alternative surgical and ancillary techniques not covered in McCurdy's section of the book.

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