Facelift and patterns of lymphatic drainage.
BACKGROUND
It has commonly been assumed that deeper facelift dissection causes greater and more prolonged swelling.


OBJECTIVE
In this preliminary report, the authors compare the lymphatic reconstitution after multiple techniques of rhytidectomy by means of dynamic lymphoscintigraphy.


METHODS
Three patients were enrolled in this study. All three were female, were similar in age, and exhibited similar signs and degrees of facial aging. Each woman underwent a facelift with a different technique: (1) subcutaneous dissection with superficial musculoaponeurotic system (SMAS) plication, (2) subcutaneous dissection with SMASectomy, and (3) a "high SMAS" composite facelift. Postoperatively, (99m)Tc-sulfur colloid was injected into a standardized infraorbital location in each patient to compare patterns of lymphatic drainage using lymphoscintigraphy. Postoperative scans at two weeks, six weeks, three months, six months, and one year were compared to the preoperative scans taken seven days prior to surgery.


RESULTS
All rhytidectomy techniques appeared to temporarily create a significant and similar degree of interruption in lymphatic drainage. There was a subtotal recovery of lymphatic pathways within three months and complete return to baseline drainage pattern after six months, regardless of surgical technique.


CONCLUSIONS
Based on the results of this study, it appears that the extent of facial dissection, rather than the depth, is the most significant factor in postoperative edema.
The University of Texas Southwestern Medical Center, Dallas,TX, USA. ricardo.meade@dpsi.org
Ricardo A
RA
Meade
Sumeet S
SS
Teotia
Landis K
LK
Griffeth
Fritz E
FE
Barton
D005260:Female; D006801:Humans; D061305:Lymphoscintigraphy; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D015361:Rhytidoplasty / Q000379:methods*; D013671:Technetium Tc 99m Sulfur Colloid / Q000008:administration & dosage; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid