Fig. 18 - 22. ( 1,2,3,4,51 Correction of outstanding ears: Cartilage Island PreseNation technique and Cartilage Island Excision technique. (61 The free edges of the cartilage are approximated by 4/0 PDS mattress sutures. (71 Immediate postoperative results.
Fig. 18 - 23. Upper and lower transconjunctival blepharoplasty. (8) Preoperative photos showing the eyebags and sagging. (9, 1 0, 11, 12) Upper blepharoplasty: the central longitudinal fat pad and medial round fat pad. (13, 14, 15) Lower transconjunctival blepharoplasty showing the central fat pad and inferior oblique muscle.
Fig. 18-24. (16, 17) The fat pads w hich have been excised following upper and lower blepharoplasty. (18, 19, 20,21,22,23) Facelifting: the planned skin incision is marked. The anterior, inferior and posterior limits of the dissection are noted. (23) Local anaesthesia: Xylocaine I %, 1 :200,000 Adrenaline is infiltrated using spinal needle.
Fig. 18 - 25. (24) Lower facelifting: Dissection and undermining of skin is carried out, forward, downward, backward in all direction up to the noted dissection limits. The dissection is carried out by a straight blunt scissors just deeper than the hair follicles between the skin and platisma. (25,26,27,28) SMAS management: The SMAS plane is entered with a blunt scissors superficial to the parotid capsule. The SMAS flap is elevated, then advanced and rotated superiorly. The excessive overlapped tissue is trimmed and then edge to edge suture repair is completed with 2/0 Ethibond. (29,301 Suspension rhytidectomy: SMAS plication in addition to the above SMAS management is recommended. The author adds six to eight sutures 2/0 Ethibond which is positioned anteroposteriorly from the anterior limit of the dissection at the junction between the skin and platisma then posteriorly JUSt one cm anterior to the skin incision. (31 J Skin flap redistribution and closure: Closure is achieved w ith subcutaneous 4/0 Dexon. Hemovac is used.
Fig. 18 - 26. (32,33) First day postoperative, no haematoma and no bruises. Patient ready to go home. (34) Filler injection: Facial markings: The patient should have a mirror or be asked to mark any areas of concern. (35) The fat obtained by 60cc syringe connected to liposuction cannula obtaining about 50cc of haNested fat. (36) The fillers syringe is placed in vertical position for ten minutes until separation is complete, the fat moves up and the fluid down. (37,38) The pure fat is transferred to Sec syringe which is then connected to the injector syringe