How is a facial wrinkle reduction (facelift) performed?

1.Frontal wrinkle removal surgery: The frontal hairline margin incision is suitable for those with higher forehead (more than 6~7cm), the incision design is 1~2mm along the frontal hairline or within the hairline, the stripping range is relatively reduced, the disadvantage is that the incision is easy to be revealed. The frontal hairline incision is suitable for those with low forehead (6cm or less), and is a coronal incision of 5-6cm within the frontal hairline, which can increase the forehead and conceal the incision, but the stripping area is relatively larger. The scalp is incised along the incision line in the direction of parallel hair to the sparse tissue under the capitellar tendon. Peeling area: downward to the orbital rim and nasal bone surface. Level of dissection: superficial surface of the periosteum, mainly blunt dissection. The scalp flap is turned downward to fully expose the nasal root between the eyebrows. The periosteum and tendon membrane are incised in the midline to reveal the frown muscles and interbrow descending muscles, and they are carefully severed. Care is taken to protect the supraorbital neurovascular bundle when cutting the lateral frown muscle, which is adjacent to the frown muscle stop. The capitellar tendon and the frontalis muscle are cut at the level of the superior orbital rim above the frontalis muscle, taking care to avoid the supraorbital neurovascular bundle. Half-tube drainage or negative pressure drainage is left in place, and the scalp flap is pulled backward to adjust the height of the brow and to note bilateral symmetry. The flap is first positioned and then lifted so that the flap is appropriately tightened and the incision is tension-free, the excess scalp is excised, and the incision is sutured. After surgery, local pressure dressing was applied. Half-tube drainage is removed the next day after surgery; negative pressure drainage is removed within 48 to 72 hours after surgery. The stitches were removed 7 days after surgery. 2.Temporal wrinkle removal surgery: Temporal hair margin incision is suitable for those with large distance between eyebrow tips and sideburns, after the incision is curved downward along the temporal hair margin or 1~2mm within the hair margin, the distance between eyebrow tips and sideburns becomes significantly smaller after surgery, and the incision is easily revealed. The incision within the temporal hairline is suitable for all types of patients, while the sideburns and the distance between the tips of the eyebrows is small can only choose this incision, which is a curved incision along the temporal hairline 4-7 cm convex to the back, the incision is hidden, but the sideburns narrow or disappear after surgery. The skin is incised along the incision line parallel to the hair root in the direction of the hair follicle. The peeling area is posterior to the line connecting the following points: 1.7 cm in front of the ear screen, 5.1 cm outside the level of the external canthus, 3.5 cm outside the level of the eyebrow tip, and 2.1 cm above the vertical line of the eyebrow tip, with the safety zone of the facial nerve behind the line. The peeling level was superficial to the superficial temporal fascia. For heavier crow’s feet, a fine peel is made on the superficial surface of the orbicularis oculi muscle to break the connection between the muscle fibers and the subdermis. Three to five radial outward pulling sutures can be made at the outer edge of the orbicularis oculi to stretch the orbicularis oculi and elevate the upper lid and outer canthus. Half-tube drainage or negative pressure drainage is left in the operative area. The canthus is first positioned and sutured, with one stitch fixed at the horizontal counterpart of the canthus, to determine the height of the canthus. The flap is then lifted so that the flap is appropriately loose and the incision is tension-free, the excess scalp is removed, and the incision is sutured. Postoperative local pressure dressing was applied. Half-tube drainage is removed the next day after surgery; negative pressure drainage is removed within 48 to 72 hours after surgery. The stitches were removed 7 days after surgery. 3.Buccal debridement: either pre- or post-ear screen incision can be used, but both need to pay attention to protect the ear screen cartilage from damage. The postauricular incision can be designed in the lower 2/3 of the cranial-ear sulcus, or slightly above the cranial-ear sulcus on the side of the eardrum. The skin is peeled forward to the nasolabial fold and downward to the mandibular rim, and the SMAS fascial flap can be peeled forward to the outer edge of the zygomaticus major muscle and downward to the inferior mandibular rim. The SMAS layer is incised along the anterior 0.5 cm of the preauricular skin incision and 0.5 cm below the inferior edge of the zygomatic arch to form a triangular flap. The parotid fascia is sharply dissected on the surface of the parotid fascia, i.e., within the safety zone, without cutting through the parotid fascia as much as possible to avoid postoperative complications of parotid fistula. The posterior-superior corner of the SMAS flap is fixed to the periosteum on the surface of the zygomatic arch root, and the lifted SMAS-rhomboid flap below the earlobe is pulled posteriorly upward and fixed to the triangular dense area posterior to the earlobe, or to the fascia or periosteum of the mastoid area. The redundant portion of the SMAS-latissimus cervicis flap is cut out. Half-tube drainage or negative pressure drainage is left in the operative area. The flap is first positioned and sutured, and the flap is lifted posteriorly and superiorly so that the flap is appropriately tightened and the incision is tension-free, fixed first, excess skin is excised, and the incision is sutured. After surgery, local pressure dressing was applied. Half-tube drainage was removed the next day after surgery; negative pressure drainage was removed within 48-72 hours after surgery. The stitches were removed 7 days after surgery.