Enhanced Facelift Rhytidectomy with SMAS - Weinstein Plastic Surgery Center

Enhanced Facelift Rhytidectomy with SMAS


Larry Weinstein, MD FACS, Chief Plastic Surgery, Chester Surgery Center, USA

A retrospective review of 218 patients had rhytidectomy with SMAS . Average age 55 over 18 years range of 43 to 83. From 1992 to 2004 average age was 49, In 2017, average age 62. 60 % of patients are done under local with conscious sedation, 40 % under general anesthesia. Patients take Valium 10mg, Emend a long acting antinausea medication and an antibiotic orally with a sip of water 1 hour prior to procedure. 0.5% lidocaine with epi injected to incision lines and fatty areas. 10 minutes elapses while a TCA peel, filler and/or Botox are administered. Skin painted betadine, the hair and ears are soaked with Betadine. Hair is slicked back with Bacitracin ointment . The angle of the head rest is raised to an acute angle to flex the neck as much as possible. Orbicularis oris muscle fascia is grasped with a forceps and a 3-0 ethibond is placed as a suspension suture to the anterior SMAS. Platysma muscle is suspended to the mastoid fascia with a 3-0 Ethibond suture. A 2-0 PDO Quill is placed over the 3-0 Ethibonds and SMAS to bury the Ethibond suture. Any irregularities are trimmed . 3-0 Monocryl subcuticular. Bacitracin is applied to the wounds, gauze and Kerlex Barton’s dressing. Results: There was no postoperative nausea or vomiting. Tylenol postoperatively PRN. Patients had Tylenol PM at night and 5mg Valium for anxiety or tightness. Two small hematomas evacuated with a syringe during a postoperative visit. A seroma over the parotid gland required syringe aspirations till resolved. 3 pixie ears were noted with long term follow up. All patients with conscious sedation reported an excellent operative experience on a post-procedure questionnaire. Conclusion: Emend may help prevent postoperative nausea and vomiting. The 2-0 PDO quill may help SMAS elevation and prevent exposure of permanent Ethibond suture. Elevating the head rest can help elevate the SMAS and skin under no tension intraoperatively .


LARRY P. WEINSTEIN, M.D., FACS Diplomat American Board Plastic Surgery , Fellow American College Surgeons , SUNY(Brooklyn) Plastic Surgery Clinical Instructor. Attending Plastic Surgeon Morristown Medical Center. Third Prize 1988, Plastic Surgery Educational Foundation Scholarship Contest September 1989, ACS/Volunteer Leadership Award, March 1993, Award Northwest NJ Regional Woman’s Center Centenary College. Alfred Cohen Research Award BVAMC,. In May 2005, American Chinese Medical Association NJ “Plastic Surgery & Facial Rejuvenation”, The ASERF In Chul Song Award-Philanthropic Efforts and Humanitarian, 2012, Madison HS wall of Distinction NYC City Council Citation April 27, 2014, MtFJC Honoree March 10, Plastic Surgery missions India 25 times since 1993.

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