The Anatomic Implications Of Utilizing Cannula Lipodissection And Avoiding Platysmaplasty In The Tumescent Facelift: A Clinical And Cadaveric Study
Michael N. Mirzabeigi, MD, Ran Y. Stark, MD, Catherine S. Chang, MD, Martin Carney, BS, Jason Weissler, MD, Louis P. Bucky, MD.
University of Pennsylvania, Philadelphia, PA, USA.
PURPOSE: The tumescent facelift utilizes Saldanha's concept of cannula lipodissection, as opposed to wide undermining, to recruit soft tissue while preserving perforating neurovascular branches. The information herein is a clinical and cadaveric study examining the senior author’s technique for tumescent lipodissection in rhytidectomy.
METHODS: From 2005-2016, 1,000 consecutive patients underwent rhytidectomy by the senior author (LPB). In addition to implementing cannula lipodissection, the senior author avoids routine anterior platysmaplasty as it was observed to limit jowl excursion of the lower face. In an attempt to validate the abovementioned approach (developed from clinical observation), a cadaveric study was performed on five fresh tissue cadavers. Post-auricular skin excursion was measured following lipodissection (cannula only) and then measured again after traditional wide undermining. Next, SMAS flap and jowl excursion were measured with and without anterior platysmaplasty. A force gauge was utilized to ensure that equivalent force was applied during all comparisons of skin and SMAS excursion.
RESULTS: Cannula lipodissection resulted in a mean skin excursion of 41.9mm. There was no significant difference in skin excursion compared to wide undermining (41.9 versus 42.1mm; p=0.785). Jowl position, in reference to the mandibular border, was significantly lower following anterior plastysmaplasty (18.3 versus -3.4mm; p=0.005). Anterior platsymaplasty; however, did not adversely affect the excursion at the tip of the high lateral SMAS flap (39.3 versus 37.9mm; p=0.644)
CONCLUSION: Cannula lipodissection results in equivalent skin recruitment in comparison to wide undermining. Routine anterior platysmaplasty may compromise results by inhibiting jowl excursion.
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