HIGH-TECH FACELIFT

Recent technological advances in our specialty have made us reappraise the way we approach facial rejuvenation. Some of these technological interfaces have made it possible, in the author's exerpience, to impro ve results and to tackle difficult aesthetic problems. The purpose of this paper is to report how we combine these technological advances in an effort to improve the aesthetic outcomes. These technological adva nces are: laser skin resurfacing, endoscopy, newer fat grafting proced ures, and new alloplastic materials for bone augmentation. Other techn ological advances are consultations via the Internet, computer imaging for simulation of possible outcomes, etc. Endoscopy is routinely used in our facial rejuvenative procedures, almost always for the forehead , often for the midface and less often for the neck. Fat grafting proc edures using newly adapted concepts are used for the brow, glabella, t ear trough deformity, cheeks, lips, chin, nasolabial folds, marionette lines, and other areas of soft tissue depressions apparent before or after the lifting procedures. This has allowed us to restore the tridi mensional volume and treat the soft tissue atrophy. Patients with sign ificant skeletal soft tissue disproportion due to aging, loss of denti tion, prior trauma or congenital defects may receive one or more of th e following implants: glabella, cheek, piriformis, angle of the mandib le, mandibular body glove type of implant, prejawl implant, chin overl ay or a glove type of implant. Our preference is for a porous polyethy lene material because of its tissue ingrowth inductiveness. Individual s who have damaged skin due to solar exposure, aging, smoking, etc., m ay receive Ultrapulse CO2 laser resurfacing at the same operative sett ing (more often) or in a delayed fashion. The Versapulse laser is also needed for the treatment of some skin changes secondary to aging such as telangiectasias (Variable Pulse Green) and brown spots (Q-Switch 5 32). The high-tech facelift has allowed us to treat the severely damag ed skin, fat atrophy, bone atrophy in many patients, at the same time that the lifting procedure is performed. This provides a more comprehe nsive approach to facial rejuvenation. The combination of different te chniques and technologies maximizes the effectiveness and minimizes th e potential side effects of each one. Scars in the forehead and scalp are avoided. Incision and fat removal in the lower eyelid are often un necessary. It provides a more precise vertical lifting with correction of the tear trough deformity and gives a tridimensional restoration o f the facial volume. The facial disharmony is treated at every level s tarting from the facial skeletal support to the most external envelope (skin). Over 200 patients have been treated this way with a minimal r ate of complications. The high-tech facial rejuvenation has allowed us to improve the surgical results of our patients compared with previou s isolated techniques. The combination of each one of the techniques r equire a precise understanding of the limits and benefits of each. Cas e examples of the different combinations will be shown.