J Cosmet Med.  2021 Dec;5(2):57-66. 10.25056/JCM.2021.5.2.57.

Difficulties of facelift in patients with scar after treatment of facial liposuction or thread lift sutures

• Wang ZJ
• Li G
• Guo S
• Fu D
• Shen B
• Bai C

• KMID: 2561115
• DOI: http://doi.org/10.25056/JCM.2021.5.2.57

Abstract

Objective
To explore the methods and safety of general abnormal anatomical layers and structure in rhytidectomy, which is also of clinical significance. In this group, 39 patients with static and dynamic deformities formed at different levels after liposuction and thread technique more than one time were treated with stable and active separation skills in high SMAS facelift operation. The results showed that the patients of this group could get the same effect of younger postoperative operation as “initial face” and solve dynamic adhesion deformity.
Methods
Magnetic resonance imaging and ultrasound were performed before operation, focusing on the abnormal changes of facial soft tissue. The results showed that the signal of the foreign body, the position and texture of scar, the relationship between scar and masseter fascia, buccal fat pad, and whether there was tissue defect or hyperplasia. In the operation, the normal separation was made in the second and fourth layers of the previously safe and easy to separate plane, instead of in the dense one or two layers of the scar. It is an alternative microsurgical separation technique. The key point is to separate the incomplete SMAS flap to achieve the expected good effect of rhytidectomy, release the scar adhesion and facial spasm. At the same time, the severed injury of facial nerve branches should be strictly prevented.
Results
74 cases of facelift were taken in recent eight months and 67 patients were treated with micro plastic surgery. Among them, 39 patients received more than one facial liposuction and more than one thread lift. In the scar formed by liposuction and thread technology, liposuction is especially serious; liposuction can still absorb the structural layer, and scar directly involves the SMAS and buccal fat pad envelope containing facial nerve branches, one of which directly causes the injury of the mandibular marginal branch. Most of the chronic granuloma scar formed after the degradation of the thread technology is in the facial space, which causes the scar atresia of the space. The flap and SMAS flap of 39 cases were separated, most of which were facial nerve branches in scar. All of them were difficult to separate and form the SMAS flap of superficial temporal fascia-Orbicularis oculi-platysma, and 89.6% of the excellent facelift effect was obtained. Facial nerve injury was found in 2 cases, 1 case was right mandible marginal branch traction injury, and the other side was left corner nerve injury. In the process of recovery.
Conclusion
For patients with facial liposuction and thread technique, doctors must be prepared for the difficult separation of scar adhesion and have a high risk of facial nerve branch disconnection. If we don’t pursue the rejuvenation effect, it will lead to the existence of surgical effect discount, bilateral asymmetry, and dynamic adhesion deformity.

Keyword

aspiration lipectomy; cicatrix; facial nerve; rhytidoplasty; scar; sutures