Face-lift

API standards for balanced and unbalanced seals are good guidelines too low a pressure for a balanced seal may encourage face lift-off. 

Barnes HO (1927) Truth and fallacies of face peeling and face lifting. Med J Record 126 86-87... 

Litton C (1962) Chemical face lifting. Plast Reconstr Surg 29 371... 

William Cullen and Joseph Black successively built on Boerhaave s accomplishments to effect a more thoroughgoing face-lift for chemistry in Scotland Arthur Donovan, Philosophical Chemistry in the Scottish Enlightenment (Edinburgh University Press, 1975) Jan Golinski, Science as Public Culture (Cambridge University Press, 1992). 

Equation [2.5.40] may be considered a face-lift of van der Waals equations [2.5.28 and 36[. Obviously, molecular models are needed to use this equation to predict surface tensions. Hence, this approach remains rather academic and [2.5.40] is cm alternative to [2.4.5 and 7] ... 

DMAE has been used for several years as a topical application to produce a face-lift effect. Even if there is no doubt that it produces a tightening effect on the face, there is no definitive evidence regarding its mode of action. We will see below what type of skin structures respond to DMAE and why it would be difficult to explain this action by an improvement in tension of the striated muscle mass of the face. 

Sagging skin only responds to a phenol peel and only if the skin is relatively thin. Peels are not indicated for sagging in thick skins or for nasolabial folds. Chemical peels cannot compete with surgical face-lifts they cannot stretch the skin as well as the latter do. 

Along with laser and abrasion treatment, a full-face phenol peel is certainly one of the best options for treating facial scars. It is not completely effective, however, and it is often necessary to use chemabrasion - that is, a combination of a phenol peel followed (immediately or the next day) by abrasion with a diamond fraise or sandpaper. See Chapter 30 for more information on the treatment of acne scars and phenol peel face lifts. 

A patient 8 years after a full-face phenol peel the quality of the skin has remained much improved, but the wrinkles and sagging did not really benefit from the peel. A face-lift would be indicated for this patient. 

There is not much point asking this question, as a full-face peel is no substitute for a full face-lift, and vice versa (Figures 29.7 and 29.8). The indications are different peels and... 

When the damage is localized, the doctor alone can advise his or her patient on which treatment or combination of techniques to use. A face-lift cannot treat wrinkles on the upper lip, but laser treatment, dermabrasion or Lip Eyelid formula can get rid of them. These treatments should be carried out on the same day as the sur-... 

If surgical blepharoplasty is not combined with a facelift, Lip Eyelid formula can be applied on the eyelids at the same time as the face-lift. 

The patient in Figure 29.9 is a typical case where the facial photoaging would benefit far more from a full-face phenol peel than from a neck- and face-lift. Nevertheless, phenol, with difficulty, tightens and rejuvenates the neck, which will only benefit from surgery followed by a peel to the papillary dermis or several peels to the Grenz zone (with ETCA) to improve the quality and the color of the skin after the surgical face-lift. 

When the wrinkles are on the eyelids and around the mouth, the problem is therefore easily solved. In the case of sagging and wrinkled skin, it is clear that the best results can be achieved with a combination of treatments that should be carried out at different times (see below). The large majority of patients are in this situation, and the degree of facial ptosis will be the deciding factor in whether to suggest a face-lift or a phenol peel. 

A face-lift gives better results for facial ptosis (Figure... 

Phenol peel combined with a surgical face-lift... 

We have seen above that there is no problem with performing a localized phenol peel at the same time as a surgical face-lift if the two treatments are aimed at different areas. When both treatments are indicated for the whole face, the face-lift should be done first, followed by a rest period of around 6 months before the deep peel (Figure... 

The peel will have the additional advantage of softening the scars from the face-lift at the same time as... 

With a phenol peel, a demarcation line is left under the jaw that is partially hidden by shadow. A face-lift after a phenol peel could raise this demarcation line to the cheeks any face-lift should therefore be done before a phenol peel. More importantly still, using a phenol peel (or even a deep TCA peek ) at the same time of operation on an area that has just been treated with a surgical lift can potentially cause extensive facial necrosis. The general principle is not to undermine the skin s inner vitality with surgery at the same time as injuring the outer layers of the skin with a peel. In other words a face-lift should not be done on the same day as a full-face deep phenol peel. 

Another study on animals came to the conclusion that raising a skin flap causes changes in the tissue of the reticular dermis and the underlying tissue, which makes it more sensitive to any subsequent injury. The risk of compromising the viability of a raised skin flap is therefore too high to opt for a simultaneous face-lift and deep peel. 

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