Most patients prefer non-invasive techniques as first line treatment. However, a well-performed classical face lift rhytidectomy continues to provide significant and lasting results compared to its nonsurgical alternatives.
Between these two ends, ribbon lower face lift provides a novel choice. This Ribbon lower face lift is indicated in patients with mild to moderate lower face component descent. It is ideal for patients with isolated jowl and early loss of their jawline. However, the technique is not ideal for patients with severe facial skin laxity.
The advantages of this method include shorter operative times, quicker recovery, and less patient morbidity. In a patient, with proper liposculpture, this procedure can produce a satisfied patient. Satisfaction is high even after repeated procedures with a usual interval of around 3–6 years.
The mainstream treatment for lower face rejuvenation is SMAS. For patients who would rather not have a preauricular scar or who prefer a faster recovery, Ribbon lower face lift is a good alternative. The results rely on mechanical fixation, tissue dissection and tissue reposition. Considering the reliable strength of the ribbon and the dissected plane adherence, this procedure should not be confused with thread lifts.
Ribbon was designed for minimally invasive jowl and neck lift and is a bioabsorbable fixation device. It features tines with tips that are 2.5 mm above the platform. The multipoint fixation tines are fashioned on a uniquely flexible platform. The multiple tines distribute the tension and avoid the “cheese-cutting” phenomenon. This platform can curve along the lower face contour, which results in smooth and close contact with the face.
The device was designed with a protective cover to facilitate a smooth insertion process; thus, its application is straightforward. A 2 cm-length incision is made along the postauricular groove. The skin flap is raised in a very thick fashion. A thick flap avoids future palpable stich nodes. The exposed fascial structure beneath the skin flap is prepared for later Ribbon fixation. During the raising of the flap, a few postauricular nerve branches might be encountered. Efforts to save them by blunt dissection is suggested.
Further anterior dissection is kept at a certain depth so that the sub SMAS plan may be accessed. Located two centimetres anterior to the ear lobe, the sub SMAS plan is virtually synonymous to the pre masseter space. At this stage, blunt dissection proceeds without resistance, and the space will expand and is created within a few seconds because it is a naturally existing space with only loose areolar tissues in between.
In inexperienced hands, initial mis dissection deep into the parotid glands is possible, but once returning to a more superficial and non-resistant plane, it causes no sequelae. The pre masseter space dissection will be stopped upon resistance, and the pocket will have been well created by that time. Within this space, gentle dissection takes place naturally, and there is no nerve injury risk throughout the procedure. After the sub SMAS premasseter space is prepared and the tunnel beneath the ear lobe is widened enough, one subcutaneous bite by 2-O Prolene suture is made a centimetre in front of the anterior earlobe sulcus. This skin-anchoring suture is prepared to the skin suspension.
Then, guiding by the preoperative markings, two Ribbon devices with its protective cover are inserted to the very distal end of the created pocket. Proper length of the device’s fixation section is adjusted before the device application. For average female faces, leaving seven pairs of tines is common, which means the platform holding 10 pairs of tines is cut and discarded. The length of the remaining tines fit the mobile portion of the SMAS flap. Extended contact and fixation with tines cause zero mobility of SMAS.
The surgeon inserts two of the devices, one by one and arranges it in a parallel fashion. The first one is placed along the mandibular rim and is about 1 cm above the rim. The second one is inserted about 1.5–2 cm above the first one. The tines are placed facing upward to hold the SMAS flap. They are engaged by the digital pressure to the inferior Surface of SMAS tissue after removal of the protected covers. After tissue engagement with the tines, the distal leash is pulled, and each device is fixed in the mastoid fasciae by 3-O Prolene in the lower face under certain tension.
The platform of the ribbon was designed with a series of holes, each stitch goes through each hole. Four fixations are required for each device by the surgeon. The two devices are overlapped and fixed because of limited space. Before the fixation, trials of pulling are performed to confirm the tissue engagement. Significant contour irregularities by the surgeon should be avoided because they will require lengthy recovery. To readjust the device, withdrawing the devices is not difficult either by retrograde to resheath or by using the dissector to free each tine from engagement. At the time the device’s leash is attached with proper tension, to achieve better skin tightening, the pre-set subcutaneous anchored suture is fixed in the mastoid fasciae. A dimple in front of the ear lobe is unavoidable after this subcutaneous suspension fixation. This dimple, covered easily by hair, will disappear in approximately 4 weeks.
The Traditional Method When the Ribbon was launched on the market, the company suggested for the surgeons to place one piece on each side under the subcutaneous plane (not under the SMAS plane) with tines facing downward. Without SMAS dissection, the pulling of the device caused limited mobility. Also, there is no tissue reposition and adherence after healing.
Advantages of the new Technique In contrast to the traditional method, by accessing the premasseter space, is that the Ribbon is placed well within the sub SMAS pocket. The lower SMAS flap, the key structure, is anchored by a multiple-point fixator after it has been mobilized. No other minimally invasive facial rejuvenation technique includes these key procedures, which are crucial to these noteworthy results. The Adjunct Procedures, the jowl deformity and perioral mound are amenable to fine contouring with lip sculpturing during the Ribbon lower face lift. The Jowl lip sculpturing is approached from the submental region with 2 mm cannula. The perioral mound is approached on site with 1.2 mm cannula.
Avoid too aggressive lipo sculpting over the mandibular rim because it might cause injury to the marginal branch of facial nerve. Injection of Marionette lines with hyaluronic acid or fat grafting also improve the result. With the implementation of the sub SMAS technique, there is no nerve injury, nor extrusion. The device remains undetectable through palpation.
Those suffering from pain may require an approximate two-day recovery. A few patients may experience ear numbness for months. Temporary visible contour irregularity in the early period of recovery may also be a result of this procedure.
To prevent the skin irregularity, avoid aggressive jowl liposuction, do not place the Ribbon device too anterior and to avoid the minor complication of numbness around the ear, preservation of the lobular branch of the great auricle nerve is possible by partial blunt dissection just posterior to the ear lobe after the post auricle incision.
Some surgeons also apply the ribbon device in forehead lifts or various SMAS procedures.
The traditional SMAS procedure is the most powerful technique for lower face lifting. For those surgeons wishing to avoid such complex operations, the Ribbon lower face lifting technique is the best choice when compared to other procedures.
This minimally invasive procedure avoids preauricular scars and has a reasonable satisfaction rate. As a practical issue, the greatest barrier to doctor application will be the cost of the devices, which is currently substantial.
What is Face Lift Surgery?
A face lift surgery in India, also known as rhytidectomy, is a surgical procedure that aims to improve the visible signs of aging in the face and neck. The process involves lifting and tightening the skin and the underlying muscles and tissues to create a smoother and firmer appearance.
Types of Face Lift Surgery
There are several types of face surgery in Mumbai, including:
Traditional Face Lift: The traditional facelift in India is the most common type of face lift surgery. Its procedure involves making incisions in the hairline, around the ear, and under the chin to access the underlying tissues.
Mini Face Lift: A mini facelift is a less invasive option that is ideal for patients with mild to moderate signs of aging. This procedure involves making smaller incisions and lifting the tissues in a more targeted area.
Thread Lift: Thread Lift is a non-surgical procedure that involves inserting dissolvable threads under the skin to lift and tighten the tissues. This procedure is ideal for patients who do not want to undergo surgery.
However, the face lift surgery cost in India depends upon the nature of the treatment and the complexity of the procedure.
Mumbai is a popular destination for face lift surgery. Several experienced and qualified plastic surgeons like Dr. Mohan Thomas Aesthetics have expertise in face surgery in Mumbai. The face lift surgery cost in Mumbai is also relatively affordable compared to other cities. Face surgery cost in Mumbai varies depending on several factors, such as the type of procedure, the surgeon’s experience, and the clinic's location.
In conclusion, if you are looking for face lift surgery in Mumbai, Dr. Mohan Thomas Aesthetics provides the best face surgery in Mumbai that will restore a youthful appearance by removing sagging skin and major wrinkles. Our team has expertise in providing the best cosmetic surgeries, including face lift surgery, at affordable face surgery cost in Mumbai and face lift surgery cost in India.