Your Villa Magazine Foothill Cities April-June 2021

Gregory J. Vipond, M.D., F.R.C.S.C. VIP Facial Artistry (909) 608-7770 info@drvipond.com www.drvipond.com 1601 Monte Vista Avenue Suite 200, Claremont, CA 91711 Facial Artistry Gregory J. Vipond MD, Inc. New patients mention ‘ YOUR VILLA ’ and receive $50 OFF your first treatment! *Cannot be combined with others offers. Expires 5/31/2021 For this month’s editorial, I thought I would talk a little bit about facial rejuvenation and some of the techniques used. Recently I had a patient come into the office to discuss treatment of her neck and jowls. She had already seen several plastic surgeons and done extensive internet research. She had several questions regarding non-invasive options and well as different surgical techniques that are very common among my patient consultations. So, I thought it would be a good idea to share them and my answers with you. Q: What is a corset platysmaplasty? A: A corset platysmaplasty is a technique that is used to tighten the front edges of the platysma muscle. This is the muscle that gives us that “turkey neck” underneath our chins. There are a number of different techniques used to rejuvenate the front of the neck, ranging from liposuction only, liposuction with tightening of the muscle directly underneath the chin and then making a wedge cut in the muscle at the Adam’s apple, completely cutting through the muscle at the Adam’s apple, and corset platysmaplasty. For years, I would suture the muscle edges together from the Adam’s apple to the chin and then make a wedge cut right below the Adam’s apple to break up the banding. The rationale for this technique is that the wedge cut breaks up the banding of the muscle but does not limit how much the muscle can then be lifted during the necklift portion of the procedure. While this technique can look good right after surgery while the platysma muscle is weakened, as the body recovers from the surgery, the muscle strength improves. With muscle-cutting procedures, there is a risk of an unnatural muscle shape afterwards as well as the fact that the muscle bands come back. With the corset platysmaplasty, the edges of the platysma muscle are sutured together all the way down the neck to below the Adam’s apple. This helps to eliminate the gap between the edges of the muscle and create a smooth neck underneath the chin. While this is more technically demanding than other techniques, the long-term results are much better and that is why I use this technique to treat “turkey necks”. Q: What is the Deep Plane Lift? A: The Deep Plane Lift or Technique describes a surgical approach to lift the droopy muscles of the face. Just as with the first question, there are a number of different methods that can be used to lift of the up the jowl and facial tissues to rejuvenate and improve the sagging appearance of the face. Many surgeons use a form of SMAS (Superficial Musculo Aponeurotic System) plication or imbrication, which involves stretching the saggy tissue up to a more youthful position. This is the technique that I was trained in and used for almost 10 years. While it definitely helps with the jowl and neckline, it does have some limitations. There are several retaining ligament systems of the face that connect the bones with the skin. They act as anchor points and fight against any lifting done during surgery. They are especially strong at the edge of the cheek and make it very difficult to lift the midface and improve the nasolabial folds. These ligaments also continue to pull after a SMAS surgery and can decrease the longevity of the surgical improvement. The Deep Plane Lift involves dissecting underneath the SMAS muscle layer and releasing it from the anchor points. This is a very delicate maneuver that is much more advanced than the typical SMAS techniques but it allows the muscles of the face to be lifted up without the anchors pulling them back. I find that I can lift the droopy jowls and fat much better and the results should last longer than the SMAS techniques I used to use. More importantly, the Deep Plane Lift can help lift the cheek/midface and soften the nasolabial folds much better than any other techniques. The reason that not every surgeon uses this approach is that it is more technical, takes a little more time and usually requires much more experience than SMAS approaches. However, having used both the Deep Plane and SMAS techniques, I feel that the benefits far outweigh any potential disadvantages. Q: Is there a risk of facial nerve injury? A: With any facelifting technique, there is always a risk of injury to the facial nerve, even if it is incredibly small. Critics of the deep plane technique often say that there is a higher risk of injury than with the SMAS techniques. While the Deep Plane dissection is anatomically closer to the facial nerve, if the surgeon is experienced, knows the facial anatomy, and is meticulous when operating, the risk is actually pretty low. In a recent study performed by Dr. Andrew Jacono of New York City, he found that the rate of facial nerve injury was actually higher with the SMAS techniques than with the Deep Plane Approach. While nothing is impossible in surgery, a carefully performed Deep Plane Lift has an extremely low rate of problems with the facial nerve. Q: Do you use drains after surgery? A: The use of drains is another controversial subject when it comes to facial rejuvenation. During my training, I worked with surgeons that used them and with those that didn’t. During my facial plastic fellowship, there was a study that was conducted that evaluated if surgical drains actually decreased the rate of hematomas or blood collections after surgery. The study found that there was no difference if the drains were used or not. Drains have a number of disadvantages including pain, the possibility of scarring, pain when they are taken out, and they are often distressing to patients because they can fill up with bloody fluid. Since the only reason to use surgical drains is to decrease hematomas after surgery, and they really have not proven to do that, I do not use them in my patients. Q: Do you use perform fat grafting when you do a facelift? A: This is also a very controversial subject in facial rejuvenation. Plastic surgeons often have the reputation of used car salesman where procedures are added on to the initial treatment plan, just like rust proof coating and sporting options. The reality is that facial aging involves different parts of the face: the skin, drooping muscles and ligaments, bone loss, and facial fat volume loss. Surgery will lift drooping muscles and fat compartments and reposition volume, but it cannot create new volume. Fat grafting is a fantastic technique that can help with long term volume restoration and it may sound logical to do this at the same time as a facelifting procedure. However, I do not perform fat grafting with facelifts for several reasons. Many surgeons will do fat grafting at the beginning of the procedure and then perform a limited muscle lift to avoid disturbing the fat grafts. I don’t want to injure new fat grafts but I also want to lift up the facial muscles the best that I can. I also don’t want to do fat grafting at the end of the surgery when the face is swollen because it is very difficult to determine the correct amount of fat to inject when there is swelling. Lastly, I feel that facial rejuvenation is very personal and don’t ever want to feel like I am trying to sell something to a patient. The vast majority of my patients are very happy with just the facelifting procedure and do not want to add volume. The choice of what to do should be entirely up to the patient, although the plastic surgeon does need to discuss the benefits and disadvantages of any discussed treatment. My preference is to wait until the swelling from the facelift has diminished enough so that I can determine with my patients if fat grafting would be beneficial and so that I can accurately assess the optimal areas and amounts of fat to inject. The decision to undergo facial rejuvenation can be very exciting but also stressful. It is essential that each patient feel comfortable in their choice of facial plastic surgeon and in their treatment plan in order to have a smooth recovery and the best results possible. COSMETIC CORNER