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Facial aging is associated with a predictable set of soft tissue changes that are treated by various forms of facelift surgery. In the U.S. concomitant bone procedures with a facelift are typically augmentative with chin, cheek and temporal implants being the most common. In Asian patients who already have strong facial skeletal features of the cheeks and jaw, which can become accentuated with facial aging due to soft atrophy, a reductive approach is needed for their bony features.

With the popularity of facial bone slimming in the young Asian population it is no surprise that ‘older’ (middle-aged) patients may well desire such improvements as well. Given that a well known potential problem with all facial bone reduction operations is a postoperative soft tissue sag, this effect would likely be more evident in older patients with less skin elasticity. This raises the question of whether management of any resultant soft tissue sag should be addressed secondarily or performed at the take of the cheek and jaw reductions.

In the March/April 2020 issue of the Journal of Craniofacial Surgery an article was published in the intersection of these two topics entitled ‘Simultaneous Surgery for Contouring the Prominent Zygoma and Mandibular Angles With Facelift in Middle-Aged Patients’. In this clinical series of fifty-five (55) patients, they all underwent facelift surgery with three different groups based on the type of facial bone reduction that was done. (A = jaw reduction, B= cheek reduction and C = both cheek and jaw reduction. The jaw reductions were performed intraorally with a curved angle osteotomy. Cheek reductions were performed by an intraoral anterior cheek osteotomy with the posterior arch osteotomy done through the facelift incision. The facelift was performed by the standard pre- and postauricular skin incisions. Patients were followed out to one year after the procedures.

Over a nine year period seventeen (17) patients had jaw reduction and a facelift, twenty-two (22) patients had cheek reduction and a facelift and sixteen (16) had both cheek and jaw bone reduction with a facelift. Complications were limited to three hematomas. No infections occurred. All patients were satisfied with their postop facial appearances.

Performing bone reduction and facelift surgery concurrently has never seemed to be an issue of operative or patient safety. From my perspective it is more of an issue of swelling and recovery and the patient’s tolerance for it. But from an aesthetic standpoint would the stretch of the soft tissues from the bone reductions be counterproductive to the soft tissue reduction and tightening of the facelift. This is less of an issue from cheekbone reduction as the swelling from that procedure is fairly modest. But jaw reduction causes a lot of swelling which would be right at the location of the greatest pull and tightening of the facelift. This would probably be a potential issue in how we perform facelift surgery int the U.S. in older patients were the soft tissue movements are usually significant. But in the Asian patient who is getting bone reduction as the primary procedure with the facelift being a ‘preventative’ procedure the issue of stretching out the facelift has less significance.

Dr. Barry Eppley

Indianapolis, Indiana

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