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    Algorithm aims to help surgeons more clearly communicate facelift options

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    One facial plastic surgeon has set out to categorize the facial rejuvenation system via a condition-specific classification algorithm, which would enable physicians to communicate with one another when discussing cases and the techniques they use in facelifting surgery.

    "A standardization of techniques matched to specific conditions is needed in facelift surgery. Using a specific algorithm, the surgeon can see a certain set of age-defining conditions in a cosmetic patient and accordingly choose a combination of procedures that are specifically designed to correct those problems," says E. Gaylon McCollough, M.D., F.A.C.S., McCollough Plastic Surgery Clinic, Gulf Shores, Ala. "It's a matter of tailoring techniques to a given patient's needs, at a specific time in his or her life."

    Facelifting techniques have diversified over the years, primarily to offer maximum lifting results with the most minimally invasive techniques possible. This diversification, however, has led to numerous descriptions and names of the varying facelift techniques, and at the end of the day, this may confuse surgeons and patients alike.


    Dr. McCollough
    According to Dr. McCollough, the term "facelift" can be very confusing because it means different things to different surgeons. As surgeons develop in their skills, a facelift might even be different during his or her career. Moreover, different patients have varying needs that clearly require an individualized approach for each patient and not a "one-technique-fits-all" treatment.

    "There are many surgeons who perform a standard facelift procedure regardless of the stage of aging. The problem is that the surgeon's standard procedure might be the wrong operation for some patients," Dr. McCollough says.

    "It also might be the wrong operation for the same patient at different times in his or her life, underscoring the need for a condition-specific algorithm detailing procedural choices that can be implemented for each individual patient," he adds.


    A 40-year-old patient before (left) and two months after a stage II temporal, cheek and neck lift as well as stage II upper and lower eyelid blepharoplasty and tip plasty. (Photos credit: E. Gaylon McCollough, M.D., F.A.C.S.)
    CONDITION-SPECIFIC SYSTEM Dr. McCollough's classification system aims to facilitate surgeons' procedure selection as it is matched to condition-specific characteristics seen in potential facelift patients. The system includes the following classes:


    Class 1 — younger patients (under age 30) who have little or no loose skin and may require only liposuction to remove unwanted fat or bulges, typically located along the jawline or in the submental region.



    A 57-year-old patient before (left) and five months after a stage III temporal, cheek and neck lift, stage III upper and lower blepharoplasty and full-face level III phenol peel.
    Class 2 — patients in their 30s or early 40s showing some sagging in the brows and cheeks, but not in the neck area. This group might only require a cheek lift and/or a minimal brow tuck.


    Class 3 — patients in their mid to late 40s who are beginning to exhibit a fair amount of sagging tissues in the brow, cheeks and the neck.



    A 72-year-old patient before (left) and one year and five months after a stage IV temporal cheek and neck lift and stage II upper and lower eyelid blepharoplasty.
    Class 4 — patients in their 50s who are beginning to have generalized facial and neck sagging and wrinkles. In addition to surgery, these patients may be candidates for skin-resurfacing procedures such as chemical peels, dermabrasion or laser therapy.

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