Surgical Anatomy of the Face
Mr. Dev ROY, UK
Saturday, 08:30

The SMAS is a fibromuscular layer investing the muscles of the facial expression and extends from the neck, to the scalp with its distinct differences in each region. In the scalp, the SMAS is represented by the fibrous galea aponeurotica, which envelops the frontalis and occipitalis muscles. In the temporal region, it is continuous with the temporoparietal fascia. At the level of zygomatic arch the SMAS is discontinuous, since the fascial layers are adherent to the periosteum. During dissection, a bridge of tissue should be left attached to the zygomatic arch to prevent damage to the frontal branch of the facial nerve. Below the zygoma, the SMAS is thick over the parotid and is continuous with the platysma in the neck. Anteriorly it envelops the zygomaticus major muscle and it becomes a thin meshwork over the anterior cheek, nose and lips. There are fibrous septae connecting from the dermis to the SMAS, so traction on the SMAS, helps to reposition the skin superolaterally. However, the SMAS has strong attachments to the nasolabial groove, which causes deepening of the nasolabial groove when traction is applied to the SMAS.

S-Lift and Adjuvant Techniques; minimally invasive procedures for Facial Rejuvenation
Dr. Ziya SAYLAN, Germany
Saturday, 09:00

Patients are requesting surgical interventions at earlier ages than ever before. They are interested in maintaining a fresh, youthful appearance but reject the traditional facelift and more invasive procedures designed principally for "restorative" facial rejuvenation in older patients. This course will emphasize minimally invasive techniques developed and utilized successfully by the authors over the past seven years. The proper combination of less invasive procedures in such patients can provide results equal to more traditional techniques often with less scaring, short recovery time and more natural results. Part of the aging process is gravity but much of aging is atrophy. This course will discuss minimally invasive techniques for both "filling" and "lifting" the aging face to
achieve superior, less operated looking results.

S-Lift with SMASectomy
Dr. Steven HOPPING, USA
Saturday, 09:30

The short scar facelift or S-lift is becoming an increasingly important adjuvant for facial rejuvenation. The short scar approach is useful in younger patients, patients with previous facelifts, patients desiring a "natural" result, patients who desire to wear their hair "pulled back" and want to avoid a post auricular scar. The S-Lift technique as described by Ziya Saylan included a short scar incision with SMAS tightening utilizing the O and U purse string sutures. SMASectomy is a technique for lifting the jowl and midface that was originally described by Dan Baker. It can be easily combined with the
S-Lift to enhance midface and jowl lifting. By combining the two techniques, superior results particularly in the midface and jowl areas can be achieved. The indications, technique, and clinical results are discussed.

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Scarless Serdev suture method in Brow and face lifts
Dr. Nikolay SERDEV, Bulgaria
Saturday, 10:00

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The s.c. "Serdev Suture" lifting methods are scarless and uncomplicated in the postop period. The main idea is to use a curved elastic needle and a semi-elastic thread to fix higher flabby fibrotic structures such as: temporal fascia, facial SMAS (galea, zygomatic SMAS extension, checks SMAS, platysma), subdermal skin layer to stable structures as temporal fascia, coli fascia, mastoid periosteum.

The most important idea in the upper face is to lift the lateral face temporally (including lateral brow, lateral cantus of the eyes and mouth). In art and theatre, the faces called the "mask of tragedy" and the "mask of comedy" are well known and used to express age and status. The concept of the scarless lift suture methods is to turn the "mask of tragedy" into a "mask of comedy", i.e. to lift up "the subcutaneous facial mask" - the SMAS. Since soft tissue and skin are attached to the SMAS, the lifting of the SMAS in temporal direction reflects in lifting of the face and its most important elements in the same direction.

Structuring and positioning different face elements could be used not only in face ptosis of elderly individuals. Aesthetically wrong face angles could enhance a sad look also in young patients. Fixing the SMAS in a higher position aims repositioning of other structures as well. Changing the position of the SMAS could restore the aesthetic angles, shape and proportions as a basis for beautification and rejuvenation, to give a happy, youthful appearance and a smiling expression not only to the elderly. With young patients the aim of the "temporal SMAS lift" should be beautification, based on face aesthetics.

Serdev suture is using simple steps: The needle is introduced through the skin in the selected direction; a puncture or a zig-zag sewing is done through the SMAS and brought out at the exit point using a second skin perforation. The thread is introduced in the hole of the needle tip and the one end of the thread is pulled out with the needle. Using same skin perforations, same direction but another way through the fibrotic tissue or SMAS, the needle pulls out the other end of the thread and provides a circle fixing stable structures. The suture is done under elastic pressure. Thus, the whole SMAS of the face is pulled up in temporo-occipital direction. The galea, presenting the temporal SMAS is pulled up and fixed higher to the temporal fascia, the buccal fat pad - to the temporal fascia, the cheek SMAS and the platysma - to the periosteum of the mastoid retroauriculary, the subdermal tissue of the eyebrow - higher to the frontal muscle anterior and posterior fascias, the chin soft tissue is fixed in a circular suture Usually no dressings are necessary. Photographs before and after of the face, profile and ? are necessary to approve the aesthetic result.

Sequels are very rare. Edema and bruising occur in less than2 %; haematomas and infections have been not observed. Less than 1% aesthetic disappointment is due to subjective unsatisfactory effect of lifting angles.

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A 3D, volumetric brow-upper eyelid rejuvenation using a new 4.0 MHz Micro Mono RF Forceps
Dr. Constantin STAN, Romania
Saturday, 10:30

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Objective: To review and appreciate our results and the surgical technique benefits in aesthetic surgery of the upper eyelid-brow interface region, doing mobile tissue incision and dissection with RF 4.0MHz and a special surgical tool called Micro Mono RF Forceps.

Methods: The 4.0MHz radio wave surgical technology is discussed in a multimedia presentation with a review of histological studies and a comparison with the cold scalpel, 0.6 MHz classical electro surgery unit and other RF Low frequency devices (1.7 MHz - Italian machine).

Based on our experience and clinical observation during the last 10 years, using the scalpel and classical electrosurgery unit for the performance of upper and lower blepharoplasties and our 7 years experience using high radiofrequency we have noticed clear differences and advantages of the radio surgery technique: less bleeding with simultaneous hemostasis, pressure less incision, minimal safety precautions needed compared with lasers, less post surgical pain and faster healing.
An important element of RF technologies is the active electrode. A special innovative device designed as a modification of the small bipolar forceps is called Micro Mono RF Forceps for cutting, dissection and simultaneously prospective hemostasis which gives more precision in adjustable depth of the cut and less collateral tissue damage, increased control and tactile sensitivity in mobile tissue of very thin skin of the upper eyelid. The ability to cut like a monopolar tip electrode and coagulate in the same time, like a bipolar forceps, without reducing the frequency from 4.0 MHz to 1.7 MHz and increasing the lateral heat, gives to this new device the great ability to be used practically in all skin, muscular and fat flaps dissections and preparations.
Having two forceps in both hands (left hand with Adson-Brown forceps and the right, dominant hand, the Micro Mono RF Forceps), the surgical technique became more precise, more accurate with a better control of the different soft tissue encountered in the operating field. With the added safety of low wattage, there is no collateral thermal damage and direct visualization is greatly improved.

Results: 4.0MHz RF surgery with Micro Mono RF Forceps produces cutting and coagulation in the same time without no extensive thermal injury and shorter delay healing process and minimal scar tissue with superior cosmetic result.

Conclusions: 4.0MHz radio wave surgery is a useful adjunct for multiple applications in cosmetic facial surgery. More than standard electro surgery and low RF 1.7MHz, this technology have shown low levels of thermal damage which produces less bleeding, less pain and faster healing.

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ABC in Face Lifting
Mr. Anthony ERIAN, UK
Saturday, 11:30

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Facial Rejuvenation has been attempted by many surgeons and I for one have tried many different types of face lifts (sub-periostal - SMAS, skins lift, brow lifts etc). Yet two questions have never been solved in my practice (over 20 years) - which is the best technique, has it really benefited any patients, how longs will this procedure lasts.

I went back to the drawing board and started on the motto "Less Is More" by performing combination surgery around the face in areas that facelifts fail to address and have achieved excellent aesthetic results five areas of weakness.

1. Marionette lines, very common in middle aged women - due to loss of fat and shrinkage of gums by undermining and cutting the mandibular ligament and filling the area with Dermalive seen to rejuvenate the area.
2. Lips, using the rotating evasion technique in lip enhancement has been a great success. You must determine whether you need volume or outline.
3. Deep Frown Lines, are difficult to eradicate, a combination of Botox and filler and avulsion of middle end of corrugator and procerus - gives an excellent result.
4. Low Eye Brow - can be elevated through upper bleph incision and reverse lift and fixation into scalp.
5. Skin - Exoderm is my choice. Exoderm which is a modification of the phenol peel gives excellent consistent results and is very safe. By applying these techniques in 10 years my patients look amazing.

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Face Lift - Bypass
Dr. Ziya SAYLAN, Germany
Saturday, 12:00

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This Video/DVD presentation will emphasize the Minimal Incision Face-lift and the use of the purse string plication of the SMAS combined with the treatment of the aging neck with posterior neck lift technique, ePTFE neck sling and serial platyma notching for banding will be presented. Techniques of profileplasy including cervical liposculpture, buccal fat extraction, and chin augmentation for rejuvenation of the neck and the lower third of the face will be discussed.

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"Contour" Lift
Dr. Steven HOPPING, USA
Sunday, 10:30

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The traditional SMAS facelift is a two dimensional lifting procedure that has limited effectiveness in some patients. The Contour lift is a three dimensional facelift that provides volumetric enhancement to the key facial prominences of the malar region and chin-jowl thereby providing a longer lasting and more dramatic result. The three dimensions of the Contour lift are:
1. Mass volume enhancement of the cheeks and chin prominences with alloplastic implants
2. Vertical soft tissue movement and positioning of the SMAS
3. Posterior-vertical vector advancement of the skin envelope
The rational and techniques of the Contour lift are discussed. Clinical results confirm the advantages of three dimensional facelifting.

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Minimal Incision / Maximum Improvement in Facial Procedures
Dr. Steven HOPPING, USA
Sunday, 11:00

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Increasingly, patients are requesting less aggressive, minimally invasive, minimal scars and minimal recovery procedures. There are many such procedures available that can be utilized by the cosmetic surgeon to achieve such desired results. The face is divided into three regions- upper, middle, and lower face. Minimal and limited incision techniques for each region are reviewed. Examples and technical pearls are provided.

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Facial Fillers and their complications
Dr. Ziya SAYLAN, Germany
Sunday, 11:30

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The development of facial filler material designed for permanent implantation offers obvious benefits to patients and physicians with respect to both convenience and cost. However, I believe that a prudent approach to their use is called for, because my own clinical experience and reports in the literature indicate the possibility of long-term complications following injection of these materials such as granulomas and secondary infections.

In addition, the long-term aesthetic consequences of using permanent or long-lasting facial filling material merit careful consideration. Facial contours change over time; in particular, the soft tissues can shrink as the patient grows older. Permanent fillers that provide satisfactory results at first might become more visible or create an unnatural appearance as aging progresses. Precisely because, these products are so long-lasting, such untoward consequences would be difficult or impossible to correct without surgical intervention.

A long lasting or permanent facial implant is a permanent risk for patients. In my presentation I will try to emphasize few complications or untoward events that have occurred following the injection or inappropriate application of "Acryl Facial Fillers" used in Europe. The question is "Do we need long lasting or permanent results?"

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Why and how to do 3D facial rejuvenation in the central oval of the face ("SMILE"3D LIFT)
Dr. Constantin STAN, Romania
Sunday, 12:00

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Objective: To review the unique properties of the early aging process in the central oval of the face and the natural way to get a 3D, volumetric face rejuvenation using a deep, subperiosteal dissection with different vertical suspension of the ptatic tissue customizing different surgical ideas for these called "scar less face lift".
Methods: More and more, in my surgical experience for face rejuvenation, standard periphery face lifts techniques are indicated only for the jaw line and the necks. A three-dimensional manipulations of the soft tissue of an aged face done by deep subperiosteal dissection under direct/endoscope visualization with two or three vertical suspension sutures threads anchored to the temporal fascia proper provide an anterior projection of the cheek and elevate in a "SMILE" effect, the corner of the month.
The visualized fat pads (Bichat's fat pad, the three lower orbital fat pad, and the super lateral eye fat pad) are released and advanced over the orbital rim or over the zygomatic bone and fixed to provide a more volumetric cheek augmentation and infraorbital V deformity improvement. Fat grafting by microinjection is used to tread facial minor problems for a better and rejuvenated aspect.
Results: The volumetric enhancement of the central oval of the face made by suspension and imbrications sutures of the inframalar periosteum and SOOF, the vascularized fat pad manipulation and the micro fat grafting injection, all included in different, customized surgical menus, represent today in my surgical practice, the modern approach for a natural, fuller faces who is welcome even from the patients who did not have fuller faces, particularly during their youth.
Conclusion: The combination of these new, modern techniques meet most of the objectives for a natural, ideal, scar less, central oval rejuvenation, most appealing even for the early aged patients, done safely and with short recovery time and less complications.