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Lift of cheek and neck: technical notes

Maurice Yves Mommaerts

European Face Centre, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
Address for correspondence: Prof. Maurice Yves Mommaerts, European Face Centre, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090
Brussels, Belgium. E-mail: maurice.mommaerts@uzbrussel.be

INTRODUCTION MINIMAL SEDATION

Because alternatives exist for the full facelift (rhytidectomy), For all patients, reduction of anxiety and mild hypnosis are
this procedure has become less popular overtime. In the achieved with the oral administration of 1 mg lorazepam,
past, forehead wrinkles were addressed with coronal [1,2] and along with the 100 mg of diclofenac, 1 g of paracetamol,
endoscopically assisted forehead lift procedures. Today, 2 g of penicillin and 32 mg of methylprednisolone given
[3]
botulinum toxin and hyaluronic acid fillers are used for this 1 h prior to the procedure. Lorazepam has a half‑life
purpose because they are more effective and result in less of 9‑16 h, which helps the patient to remain calm
[12]
downtime. Lateral brow sag can be corrected by using the and normotensive postoperatively. Because pain occurs
Fogli and Knize browlift techniques, Endotine browlift only with injection of the local anesthetic intravenously
[4]
[5]
[6]
®
or sub‑brow fat augmentation. The pretrichial incision solution along the skin incision line, midazolam is given
[7]
is occasionally chosen, typically in facial feminization 2 min prior to the administration of local anesthetic for
surgery, which includes supraorbital rim contouring and those patients who are anxious IV or agitated; oriented
scalp advancement. Although indications for facelift and calm patients may not require sedation. Midazolam
[8]
surgery remain, they are limited. A more recent approach is given by slow intravenous injection, starting with a
to restoring a youthful appearance to the midface involves test dose of 0.1 mg and slowly delivering a total dose of
volume augmentation, although this is questionable. Facial 2‑6 mg (depending on body weight) over 2 min. During
[9]
aging is thought to be primarily due to gravitational sagging this time the skin is marked for the incision and prepping
because of the loss of collagenous support [Figure 1]; and draping are performed. The half‑life of midazolam is
however, fillers provide more predictable results than lifting 2‑6 h. The goal is to achieve a co‑operative, oriented
[13]
in this area. Furthermore, hyaluronic acid fillers are more and calm state (level 2 on the Ramsey Scale of Sedation).
[14]
predictable than micro fat grafting and are safer to use The patient should still be able to respond normally to
[10]
around the eyes. The lifting of tissues is more useful in verbal stimuli (i.e. minimal sedation on the American
[11]
the lower face (caudal extension of nasolabial folds and Society of Anesthesiologists scale of sedation); however, if
grooves, labiomental folds and grooves and jowls disrupting moderate or conscious sedation is reached (i.e. purposeful
the jaw line) and neck (platysmal bands, skin excess). Hence, response to verbal/tactile stimulation), this state will not
“cheek and neck lift” or “buccocervical lift” may be more last longer than 20 min.
appropriate terms for this type of procedure.
This article describes important features of facelift surgery INFILTRATION ANESTHESIA USING THE
as performed by the author. All patients involved in this WHITACRE SPINAL NEEDLE
article agreed to have their facial pictures published and
signed the consent form. The proper sequence of steps is The aim is to numb the area and provide a bloodless
explained in the last section. surgical field, defined by the marked dissection area,
including the skin and superficial muscular aponeurotic
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How to cite this article: Mommaerts MY. Lift of cheek and neck:
DOI: technical notes. Plast Aesthet Res 2015;2:301-8.
10.4103/2347-9264.169502
Received: 30-05-2015; Accepted: 08-09-2015

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