DISSECTING THE FACELIFT Claude Le Louarn
the same line to the muscle. This procedure allows for a strong physiological neck rejuvenation that counters the aging process. In order to achieve a jaw line improvement in this new concept, the rejuvenation surgical intervention has to be performed upward and posteriorly (upwards and towards the back of the ears), which is the standard in fact. I was very interested in the sub-smas dissection, as a means to achieving a more stable tension on skin and muscle, however experience and studies have demonstrated that the sub smas dissection was not more efficient or more stable than the smas placation. The submandibular gland is descending with time and can create a bulging below the mandibular line, visible after a necklift. The submandibular skin is tensed with the face lift and the gland volume is perfectly visible like a jowl descent. This submandibular gland ptosis is palpated before the surgery and the patient has 3 choices: - either nothing specific is performed: if the gland ptosis is moderate, the hyo neck lift with the platysma tension will minimize the gland visibility - either gland ptosis is more important and a surgical partial excision is decided, with a rare risk of paralysis of a the mandibular branch of the facial nerve: smiling can be changed on one side for some months. If a safer and simplier alternative is preferred, botox injection in the bulging part of the gland melt it. Injection has to be repeated every 6 months for 2 years to maintain the effect. What is the fastest and more efficient way to improve the marionette or bitterness fold (the lines that run from the corners of the lips downward towards the sides of the chin)? A technical point has to be added to stabilize this bitterness fold area (drooping corners of the mouth).The descent of the corner of the mouth is due to the increase in resting tone of the Depressor anguli oris muscle (the facial muscle running between chin and and the corner of the mouth, and associated with frowning). Skin at the preauricular level (in the area of the ear) can be tensed very high, but this would not give a long term improvement to the marionette fold (no longer than 3 months). If a more long lasting effect is desired, a direct action, the DAO, on the cause of the descent is necessary.
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