The past 3 decades have seen a fascinating shift in cervicofacial rhytidectomy philosophies and techniques. The quest for more natural-appearing and longer-lasting facial rejuvenation has led to increasingly complex and deep dissections. Many surgeons achieve superb results with the so-called deep plane or composite approaches. However, the more recent past has witnessed a shift in patient preferences for procedures with shorter recovery periods and less surgical morbidity. Drs Tonnard and Verpaele recently published their modifications to Dr Saylan's "S-lift" technique. This video serves to complement the authors' article of the same title (Tonnard P, Verpaele A, Monstrey S, et al. Minimal access cranial suspension lift: a modified S-lift. Plast Reconstr Surg. 2002;109:2074). The name of their technique, minimal access cranial suspension lift (MACS), eloquently summarizes their face-lift approach. The authors advocate a short-scar approach. Their skin flap incision extends from the temporal hairline to a point anterior and inferior to the ear, hence the "minimal access" portion of the technique. If a standing cutaneous cone resection is required, the incision is extended just behind the ear to allow for a traction-free positioning of the ear lobule. A limited skin flap is then created. The use of permanent monofilament sutures through the superficial musculoaponeurotic system and anchored to the deep temporal fascia provides lift in an upward direction; thus, the "cranial suspension" portion of the name. The authors rightly stress the importance of maintaining a pure vertical vector in the lift. In selected cases, a suspending suture from the malar fat pad to the deep temporal fascia serves to address midface descent. The authors' have achieved nice results with their described technique. They describe the excision of lower eyelid skin as an adjuvant to the malar elevation. In essence, they are performing a miniature lower eyelid blepharoplasty to address redundant skin that can ensue from malar elevation. Although the authors have not found any problems with this maneuver, our typical approach would be to do this on a selective rather than routine basis. Another useful addition to their technique is to place imbricating sutures at the zygomatic arch to achieve additional cheek-lift. Our minor variations aside, the authors describe a safe and effective technique that appears to give effective and reproducible results. The authors' original article is well written, and given the inherently visual nature of surgery, the addition of this video is welcomed. The video shows the entire procedure from preoperative skin marking to final suturing of the skin flap and provides several good preoperative and postoperative pictures to assess outcomes. The commentary is succinct and addresses nearly all questions that arose in our minds as we watched the video. The addition of animation supplements the live surgery and helps to stress key concepts. We find no material shortcomings in the video. The authors' technique is well within the bounds of a dermatologic surgeons' practice. While the video is performed with the patient under general anesthesia to minimize disruption during filming, this is the exception and not the rule. Typically, this procedure is performed in an outpatient ambulatory surgery setting with the patient under local anesthesia with minimal conscious sedation. Recovery time is minimal, on the order of 1 to 2 weeks. Any dermatologic surgeon currently performing or considering adding face-lifting to their practice would find this work a meaningful addition to their library. Utility Index: Important Production Quality: Excellent Primary Readership: Dermatologic surgeons Value for Money: Good buy Article Submissions The Archives of Dermatology reviews books, journals, CD-ROMs, Web-based products, and other information sources of interest to dermatologists. We welcome the submission of review copies, which should be sent to the Book and New Media Reviews Section, Archives of Dermatology, Loyola University Chicago, Division of Dermatology, 2160 S First Ave, Bldg 112, Room 341, Maywood, IL 60153. Questions regarding the review process may be directed to the section editor at firstname.lastname@example.org.
Archives of Dermatology – American Medical Association
Published: Feb 1, 2004