Based on a thorough understanding of facial structure around the superficial musculoaponeurotic system (SMAS), some types of sub-SMAS techniques have emerged to allow more harmonious rejuvenation procedures in the lower face and midface. These techniques are the Hamra composite facelift, the Stuzin extended SMAS technique, the Barton high SMAS technique, and the Ramirez subperiosteal facelift, each of which involves a specific dissection plane and is informed by distinct rationales with reasonable support. Each patient presents a unique facial structure and undergoes an individual rate of aging. The facial structures of East Asian faces, in particular, differ from those of Western faces. While emphasizing that the theory of structural mid-cheek anatomy is an essential part of facial rejuvenation, we would like to discuss the advantages and disadvantages of various sub-SMAS facelift techniques and to propose the most suitable techniques for a variety of individual faces.
Aging ; Asian Continental Ancestry Group ; Facial Muscles ; Humans ; Rejuvenation ; Rhytidoplasty* ; Superficial Musculoaponeurotic System

Submandibular gland ptosis is a common impediment to obtaining superior surgical aesthetic results in neck lift surgery. Techniques for suspending the submandibular gland have been proposed, but these procedures have the drawbacks of disturbing the floor of the mouth mucosa and periosteum. We present an approach of submandibular gland suspension for the treatment of gland ptosis by employing a platysma and hyoid bone fascia cradle. Our technique was performed on cadaveric models. The platysma muscle and hyoid bone cradle for submandibular gland ptosis was created on the left side of the neck in two cadavers. A submental incision with sharp dissection was performed to raise a supraplatysmal flap. A subplatysmal plane was developed until the submandibular gland was identified. Sutures were used to pexy the platysma to the hyoid bone periosteum and deep cervical fascia, tightening the overlying muscle and in turn elevating the submandibular gland. Submandibular gland ptosis must be corrected in order to achieve exemplary aesthetic results. Our approach of creating a cradle with the platysma and hyoid bone avoids the potential complications of previously described sling procedures, while still maintaining the integrity of the gland and surrounding tissues.
Cadaver ; Fascia ; Hyoid Bone* ; Mouth Mucosa ; Neck ; Periosteum ; Rhytidoplasty ; Submandibular Gland* ; Superficial Musculoaponeurotic System* ; Sutures

Submandibular gland ptosis is a common impediment to obtaining superior surgical aesthetic results in neck lift surgery. Techniques for suspending the submandibular gland have been proposed, but these procedures have the drawbacks of disturbing the floor of the mouth mucosa and periosteum. We present an approach of submandibular gland suspension for the treatment of gland ptosis by employing a platysma and hyoid bone fascia cradle. Our technique was performed on cadaveric models. The platysma muscle and hyoid bone cradle for submandibular gland ptosis was created on the left side of the neck in two cadavers. A submental incision with sharp dissection was performed to raise a supraplatysmal flap. A subplatysmal plane was developed until the submandibular gland was identified. Sutures were used to pexy the platysma to the hyoid bone periosteum and deep cervical fascia, tightening the overlying muscle and in turn elevating the submandibular gland. Submandibular gland ptosis must be corrected in order to achieve exemplary aesthetic results. Our approach of creating a cradle with the platysma and hyoid bone avoids the potential complications of previously described sling procedures, while still maintaining the integrity of the gland and surrounding tissues.
Cadaver ; Fascia ; Hyoid Bone* ; Mouth Mucosa ; Neck ; Periosteum ; Rhytidoplasty ; Submandibular Gland* ; Superficial Musculoaponeurotic System* ; Sutures

BACKGROUND: Most depth of anesthesia (DOA) monitors rely on the temporal characteristics of a single-channel electroencephalogram (EEG) and cannot provide spatial or connectivity information. Phase lag entropy (PLE) reflects DOA by calculating diverse connectivity from temporal patterns of phase relationships. The aim of this study was to compare the performance of PLE and bispectral index (BIS) monitors for assessing DOA during anesthesia induction, nerve integrity monitoring (NIM), and anesthesia emergence. METHODS: Thirty-five patients undergoing elective thyroid surgery with recurrent laryngeal nerve NIM received propofol and remifentanil via target-controlled infusion. After applying PLE and BIS monitors, propofol infusion was initiated at a calculated effect site concentration (Ce) of 2 µg/mL and then increased in 1-µg/mL Ce increments. After propofol Ce reached 5 μg/mL, a remifentanil infusion was begun, and anesthesia induction was considered complete. During NIM, PLE and BIS values were compared at a specific time points from platysma muscle exposure to subcutaneous tissue closure. PLE and BIS values were recorded continuously from preanesthetic state to full recovery of orientation; bias and limits of agreement between monitors were calculated. RESULTS: PLE and BIS values decreased progressively with increasing propofol Ce during anesthetic induction and increased by stages during emergence. The prediction probabilities of PLE and BIS for detecting propofol Ce changes were 0.750 and 0.756, respectively, during induction and 0.749 and 0.746, respectively, during emergence. No aberrant PLE or BIS values occurred during NIM. Correlation coefficients for BIS and PLE were 0.98 and 0.92 during induction and emergence, respectively. PLE values were significantly higher than BIS values at full recovery of orientation. Estimated bias between monitors was −4.16 ± 8.7, and 95% limits of agreement were −21.21 to 12.89. CONCLUSION: PLE is a reasonable alternative to BIS for evaluating consciousness and DOA during general anesthesia and during NIM. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003490
Anesthesia ; Anesthesia, General ; Bias (Epidemiology) ; Consciousness ; Consciousness Monitors ; Electroencephalography ; Entropy ; Humans ; Information Services ; Propofol ; Recurrent Laryngeal Nerve ; Subcutaneous Tissue ; Superficial Musculoaponeurotic System ; Thyroid Gland

OBJECTIVETo explore the surgical strategy for postburn cervical scar contracture.

METHODSSixty-five patients with scar contracture as a result of burn injury in the neck were hospitalized from July 2013 to July 2014. Release of cervical scar contracture was conducted according to different demands of the 3 anatomic subunits of neck, i.e. lower lip vermilion border-supramaxillary region, submaxillary region, and anterior region of neck. After release of contracture, platysma was released. For some cases with chin retrusion, genioplasty with horizontal osteotomy was performed. The coverage of wound followed the principle of similarity, i.e. the skin tissue covering the wound in the neck should be similar to the characters of skin around the wound in terms of color, texture, and thickness. Based on this principle, except for the preschool children in whom skin grafting was performed, the wounds of the other patients were covered by local skin flaps, adjacent skin flaps, or free skin flaps.

RESULTSAll patients underwent release of scar and platysma, while 9 patients underwent genioplasty with horizontal osteotomy. Wounds were covered with local skin flaps in 32 patients, with adjacent skin flaps in 7 patients, with free skin flaps in 11 patients, and with skin grafts in 15 patients. All skin grafts and flaps survived. Good range of motion was achieved in the neck of all patients, with the cervicomental angle after reconstruction ranging from 90 to 120°. All patients were followed up for 6 to 24 months. Six patients who had undergone skin grafting were found to have some degrees of skin contracture, while none of the patients who had undergone flap coverage showed any signs of contracture recurrence.

CONCLUSIONSRestoration of the cervicomental angle is critical in the treatment of postburn cervical scar contracture, and the release of scar contracture should conform to the subunit principle. The coverage of wound should be based on the principle of similarity, with repair by skin flaps as the first choice, and skin grafting as the second choice. Satisfactory effect of repair would be achieved by following the above surgical principles.

Burns ; complications ; surgery ; Child ; Child, Preschool ; Cicatrix ; etiology ; surgery ; Contracture ; etiology ; surgery ; Free Tissue Flaps ; Humans ; Neck ; surgery ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; methods ; Skin ; Skin Transplantation ; Superficial Musculoaponeurotic System ; Surgical Flaps ; Treatment Outcome