This technique provides a minimally invasive procedure with no visible incision. For the younger patient who is not yet ready for a facelift and whose primary concerns are the nasolabial folds, this option is effective.
The procedure is perhaps most suitable for the patient with prominent nasolabial folds who has elected rhythidectomy to address lower-face aging as well, not only because SMAS resuspension is being performed and there is the ability to excise excess skin but also because flap elevation can be more conservative when the nasolabial fold is certain to be addressed. Combining the percutaneous cheek lift with an endoscopic ferehead lift also has advantages, as the temporal incision has already been created. Short-term results show efficacy. Downtime, when only the percutaneous lift is performed, is relatively short.
Postoperative fullness and firmness are seen initially after resuspension of the malar pads. Patients are counseled beforehand about this necessary look and are given reassurance that resolution with follow.
Bruising in the area of the sentinel vein common , so adequate bipolar cautery under direct vision is important. Attention to detail, from adequate scrubbing and sterile technique to meticulous dissection atop the temporalis fascia circumvents the most common potential problems of infection and temporary weakness of the frontal branch of the facial nerve. Edema and mild skin wrinkling in the in thje lateral canthal area can be seen for 3 to 4 weeks, with spontaneous resolution thereafter. Re-exploration of the temporal incision site with manipulation of the suspension sutures is possible in the rare instance of asymmetry or overcorrection.
Choosing appropiate patients is important, with the best candidates for the separate isolated procedure being those with prominent folds who have filling agents without great success or those whose overall facial-skin laxity is judged as minimal to moderate. Combinig this procedure with a rhydectomy and/or endoscopic forehead lift offers great benefit, as less bunching occurs toward the lateral orbital commissure secondary to the overalll added benefit of skin redraping and excision that these procedures allow.
We have found Kellers1 percutaneous elevation of the malar fat pad to be relatively simple, with proven efficacy and patient satisfaction. Because of technical points that are difficult to explain in writing, it is suggested that direct physician observation of this procedure be performed prior to its incorporation into practice.
Russell W. H. Kridel, MD, is certified by the Arnerican Board of Facial Plastic and Reconstructive Surgery, the American Board of Otolaryngoly (Head and Neck Surgery), and the American Board of Cosmetrc Surgery. Kridel has been in private practice in Houston since 1981, and he can be reached at 713-5265665. Paul E. Kelly, MD, is certified by the American Board of Otolaryngology and the American Board of Facial Plastic Surgery. He is also a member of the American Medical Association and the Texas Medical Association. Kelly's practice is in Houston and he can be reached at 713-526-5665.
References
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