Abstract
Patients with thick skin typically present with a redundant, baggy, lax skin envelope
together with prominent nasolabial folds, jowls, and a heavy neck. Durable and natural-appearing
rejuvenation is not possible unless the deformities are addressed adequately and harmoniously
in these patients. Traditional superficial musculoaponeurotic system techniques do
not include surgical release of the zygomatic cutaneous ligaments and repositioning
of descendent malar fat pad, and may lead to an unbalanced, unnatural appearance and
the lateral sweep phenomenon. Additional attempts to improve unopposed nasolabial
folds such as fat grafting to malar region are more likely to result with a “stuffed”
look, far from a natural and rejuvenated appearance, and must therefore be avoided.
The facelift techniques including true release of the anchoring ligaments of the midface
and allowing adequate repositioning of saggy tissues are ideal for these patients
to obtain harmonious, natural result. Despite the extensive dissections, maximal release,
and maximal lateral pull, additional maneuvers, e.g., platysmaplasty, subplatysmal
fat removal, or partial resection of submandibular glands may be required for satisfying
result in patients with heavy neck. In this article, the authors outline the relevant
anatomy of the facial retaining ligaments and their implications to surgical management
of patients with heavy skin are discussed.
Keywords
facelift - neck lift - nasolabial fold - thick skin - heavy neck
