Face Lift & Fat Grafting Glossary of Terms
This term refers to cosmetic surgery for the upper and/or lower eyelid, as in “upper blepharoplasty” or “lower blepharoplasty”. Many techniques exist to enhance or alter the shape of the eyelids, especially to reverse aging. However, Dr. Lam believes that one of the principal methods to enhance a youthful eye area is not the traditional blepharoplasty done in isolation, which in essence is a blepherectomy, removing all the fat, muscle, and skin, but instead as a balance between removing excessive tissue only when needed, and to replace lost volume and deflation through targeted fat grafting.
The lower cheek region that falls below the cheek bone that can look particularly hollow with aging or weight loss. It is also known as the submalar region (see Malar). It is a critical area to correct with fat grafting in certain individuals. To better understand where this area is, suck your cheeks in hard with your lips closed and look in the mirror. The area that sinks in is the buccal region.
A brow lift is a term that refers to lifting a sagging brow. The brow encompasses not only the hairy eyebrow itself but also the soft tissue complex that blends confluently with the upper eyelid. Dr. Lam believes that brow lifts are over performed today to a large extent and prefers fat grafting to support and augment this region rather than traditional methods.
A cannula is a hollow tube with a blunt end and a tiny side hole through which fat and other injectable fillers like Restylane® are injected to restore lost volume of the face that occurs with facial aging. Dr. Lam uses cannulas that measure 0.9 and 1.2 mm in diameter to perform facial fat grafting and a specialized cannula he invented for Restylane® injections, which he has affectionately dubbed “the Laminator”. The reason that he does not use needles for injections of facial fillers and fat grafting is less tissue trauma and thereby less swelling, less bruising, and a smoother result.
These terms refer to reorientation or suspension of the outer canthus (see Canthus) of the eyelid used typically when performing a transcutaneous (through the skin) lower blepharoplasty (See Blepharoplasty). Dr. Lam does not make any skin incisions when performing lower blepharoplasty so he does not require a canthoplasty/canthopexy. His feeling is that canthoplasty/canthopexy can still lead to a rounded unnatural look to the lower eyelid or an overpulled, slanted look that can be equally unnatural.
The canthus refers to the sharp inner and outer angle or terminus of the eyelids, i.e., where the upper and lower eyelids merge and touch both toward the nose (inner or medial canthus) and toward the temple (outer or lateral canthus).
See Midface Lift
This term refers to the eyelid edge where the eyelashes emanate. The eyelashes are also referred to as the cilia, hence the term.
Composite Face Lift
A deeper face lift technique that incorporates lower eyelid lifting as well. Dr. Lam believes that the composite facelift is unnecessary in many respects. First, he does not believe that the lower eyelid and cheek should be lifted upward, as that maneuver can cause distortion that appears unnatural. Further, this much more invasive type of face lift leads to higher risk, longer recovery, and the potential for a more artificial look in Dr. Lam’s opinion.
Conform Silicone Implant
A silicone implant designed and manufactured by Implantech used for chin and cheek augmentation that features a flexible grid pattern permitting a smoother and more form-fitting result to the underlying bone structure. Dr. Lam prefers the Conform silicone implant when performing cheek and chin augmentation.
Deep-Plane Face Lift
The term deep-plane facelift is used in distinction to a standard SMAS lift. The SMAS lift simply lifts the deeper, sagging tissues into an improved position but it does not properly release ligaments that restrict tissues from optimal elevation. Accordingly, SMAS lifts do not show as improved a result in the jawline and neck, and the results do not last like a deep-plane facelift. Without releasing several key ligaments in the face, the tissues are restricted from free elevation. That is the key difference with a deep-plane facelift. Dr. Lam used to perform a SMAS facelift but felt that his results over the past 10 years have dramatically improved since he started to perform the deep-plane approach.
Ligaments are thick tissue attachments that stick two layers together and that do not allow unrestricted movement when left in place. In fact, after Dr. Lam has released these ligaments he checks to see that there is free movement of the tissue that he would like to lift. If he sees a lack of movement or a limited degree of movement, he knows that he has not sufficiently released these ligaments for proper elevation. He can literally see the tissues elevate freely when the ligaments are correctly released.
To perform a deep-plane facelift in Dr. Lam’s hands is not riskier nor does it take much longer to perform than a standard facelift. In skilled hands, this procedure offers far better results without a longer recovery period. With advances in techniques over the past 5 years, Dr. Lam has seen continuing decrease in the extent and time of recovery no matter what type of facelift he performs (see below).
Dr. Lam performs basically three types of facelifts depending on what needs to be done: a mini-lift, a standard lift, and a deep-neck lift. All three of these procedures use a deep-plane facelift technique for optimal results, so there is no difference there. The difference lies in a few other details. A mini-lift involves a slightly shorter facelift incision and is meant to manage only the jowls and jawline with a little gain in the neck as well. For saggier necks, he must perform a standard (deep-plane) facelift in which he also addresses the neck banding through an incision under the chin. A deep neck lift (not to be confused with the term deep-plane facelift) goes inside the neck muscles to remove some of the extra tissues like deep fat and glands that obstruct the neck from an improvement based on someone’s anatomical restrictions. Again, the mini-lift, standard facelift, and deep neck lift, all incorporate the use of the deep-plane approach but vary in other key ways. If this is at all confusing, Dr. Lam would be happy to address these questions with you in person and to see which of the sub-methods would be applicable for you.
*SMAS stands for Superficial MusculoAponeurotic System and is the tissue that is elevated whether done through a standard facelift or in a deep-plane facelift. The SMAS is a confluence of thick fascia (collagen tissue) and muscular structure that must be elevated during a facelift. The skin is never pulled but the SMAS is the hearty tissue that is elevated during a proper facelift procedure.
This is the medical term for bruising.
This is the medical term for swelling. The British spell this word oedema.
Extended Anatomic (Chin Implant)
A type of chin implant that extends longer than a “button implant” across the lower jawline. Dr. Lam believes that an extended anatomic implant is far superior to the old style button implant in that the extended anatomic type should not shift over years after implantation and creates a better jawline augmentation.
A face lift is a bit of a misnomer, as it really applies to a lift that encompasses both the jawline and neck. A midface lift addresses the cheek region (see Midface Lift), and a brow lift addresses the upper face (see Brow Lift). Dr. Lam today believes that only the lower face and neck need to be lifted and that the upper and midface should not be lifted through traditional methods but contoured appropriately with facial fat grafting. This persepective represents a new paradigm in our treatment of the aging face.
Same as “Face Lift”, see Face Lift.
Fat grafting involves harvesting fat from one’s own body (see Harvest), e.g., thighs, hips, abdomen, etc., to be used to augment depleted facial areas that occur with aging. Typically, areas of the face that would benefit from fat grafting include the brow, upper and lower eyelid, tear trough, anterior and lateral cheeks, buccal hollow (see Buccal), anterior chin, and prejowl (see Prejowl).
See Fat Grafting
Harvesting refers to the unique process by which fat is removed from one’s thighs, hips, abdomen, etc. to be used to augment the face during fat grafting (see Fat Grafting). Unlike liposuction (see Liposuction), Dr. Lam removes fat from the body by hand using a syringe and cannula. This process is much more gentle than liposuction that uses instead a machine to suction the fat and that typically would remove 10 times the fat volume that Dr. Lam removes during harvesting.
The jowl is the soft tissue that hangs over the jawline on either side of the mouth. Dr. Lam considers the jowl to be a phenomenon of aging that comprises excessive fat, gravitational sag of tissues, and loss of volume in front of the jowl in an area known as the prejowl (see Prejowl).
The labiomandibular fold is a line that extends downward from the corner of the mouth down toward the jawline and is also known more colloquially as the marionette or puppet line.
Liposuction stands in distinction to lipoharvesting (see Harvesting). Liposuction relies on a machine to mechanically remove unwanted fat from the face, neck, and body. Because fat is removed under high suction, the removed fat is destroyed and cannot be used for fat grafting (see Fat Grafting). Lipectomy is an alternative method of fat removal in which fat is excised with cautery or scissors rather than with suction. This technique is particularly helpful for fat that resides deep to the platysma muscle (see Platysma) that cannot be liposuctioned out.
The malar region is known more colloquially as the cheek and consists of the bony component, known as the zygoma, and the overlying soft-tissue mound. Dr. Lam conceptualizes the cheek into two areas: the anterior cheek that rests medial to the bony zygomatic prominence (“cheek bone”) and the lateral cheek that constitutes the zygomatic prominence.
A ligamentous attachment that runs from the inner corner of the eye down toward the outer jawline across the anterior cheek. This ligamentous structure typically correlates with the deepest anterior cheek depression that would benefit from fat grafting (see Fat Grafting). It must be mechanically softened with a cannula (see Cannula) during fat grafting to ensure even distribution across this important aesthetic zone.
Occlusion refers to how the upper and lower teeth align with each other when the teeth are touching. Malocclusion refers to the improper alignment of the upper and lower teeth that can be either due to an overbite (Class II occlusion) or underbite (Class III occlusion). With a Class II malocclusion, the surgeon should be careful with evaluating a prospective patient for chin implant, as the patient may benefit instead from orthodontic with or without orthognathic (jaw repositioning) surgery.
Although this term could be used to refer to the mind, in facial cosmetic surgery it is the adjectival form that refers to the chin.
The horizontal linear depression that runs between the chin and the lower lip.
The mentum is the medical term for chin. Hence, mentoplasty refers to changing the shape of the chin, typically for cosmetic purposes. The shape of the chin can be modified via a chin implant to increase its size or via orthognathic surgery (breaking the jaw and moving it) to increase or decrease the chin position.
The mentum is the medical term for chin.
This term refers to a small chin. To be technically precise, microgenia usually refers to a small chin with normal occlusion (see Malocclusion) compared with retrognathia that refers to a small chin with malocclusion.
The midface is a term that refers to the entire cheek area and is a facial zone that has been increasingly recognized for its importance in facial rejuvenation.
Midface lift, also known less formally as a cheek lift, refers to suspension of the cheek through sutures that can be positioned from the lower eyelid or through a temporal brow approach. Although Dr. Lam has written extensively about midfacial lifting in his first textbook, Comprehensive Facial Rejuvenation, and in related scientific articles, he has abandoned the technique approximately 4 years ago as the procedure he believes provides limited aesthetic gain, has a higher complication rate, is more invasive, and should be replaced through facial fat grafting (See Fat Grafting).
Mini Face Lift
A mini face lift is primarily a marketing term and does not convey too much information. Nevertheless, Dr. Lam imagines the mini face lift as a face lift that does not require any long incisions that, for example, remove hair, or extend into the temple or far down behind the hairline and does not require any deep cutting of tissues like in a Composite or Deep Plane face lift (See Composite Face Lift and Deep Plane Face Lift). Accordingly, Dr. Lam’s methodology for all of his face lifts fall into this category of a “mini face lift”, as he does not use long incisions, remove hair bearing tissues or cut into deeper facial structures.
The nasolabial fold is known more colloquially as the “smile line” and refers to the fold of tissue that runs roughly from the corner of the nose to the corner of the mouth. Although many patients believe that this fold can be easily lifted with a face lift or filled and eliminated with fat, these two treatment methods in general are not entirely successful in improving this line to a patient’s satisfaction. Filling the line with dermal fillers has been a more beneficial way to accomplish this task.
A neck lift is a component of every face lift (see Face Lift).
A negative vector eye refers to when the eyeball sits anterior to the bony orbital rim (eye socket) when viewed from the profile, making the eye appear to bulge out. This kind of eye can lead to lower eyelid problems with traditional transcutaneous blepharoplasty (see Transcutaneous Blepharoplasty). Because Dr. Lam does not perform this type of blepharoplasty, he can avoid this complications with this kind of eye. In fact, facial fat grafting (see Fat Grafting) can oftentimes actually improve this condition.
The confluence of tissues that separate the deeper structures like the eye fat (“postseptal fat”) and the levator muscle (in the upper eyelid) from the more superficial structures like the skin and orbicularis muscle.
The platysma muscle refers to the two muscle bands that hang down with aging and can be corrected with a platsymaplasty (see Platysmaplasty). Instead of sagging platysma muscles, they can also be overly active in some athletic individuals, which can be softened with BOTOX ®. The platysma muscle does not have much function in humans except to protect the deeper neck structures. The horse uses this muscle to swat flies away, and it is the bacon that we eat (or at least some of us do) from pigs.
Platysmaplasty is part of some submentoplasties (see Submentoplasty) in which the platysma muscle is tied together with sutures and then tucked upward under the chin with a face lift.
The prejowl is the area that lies just in front and adjacent to the jowl (see Jowl) along the jawline. It appears as a dip in the jawline that should be filled with fat grafting to improve the appearance of the jawline with or without a concurrent face lift (see Face Lift).
The degree to which a facial structure sits forward (anterior) relative to other structures. The most common use of this term is for the nose tip or the chin. It can also refer less commonly to the eye, cheek, or any other facial structure. The greater the projection, the more anterior that structure sits relative to the surrounding face.
Pseudoherniation of Fat
Ptosis (pronounced TOE-SIS, the p is silent)
Ptosis simply means that a structure has fallen and can refer to the brow (“brow ptosis”), the eyelid (blepharoptosis), the chin (“chin ptosis”), etc. However, when talking about the eyelid, it refers more specifically to the dysfunction of the eye opening muscle called the levator that can occur typically with aging in a few individuals.
This term is infrequently used and refers to the vertical lines/wrinkles that appear around the mouth, as in the perhaps redundant term “perioral rhagades”. In contrast, rhytid is a general term for a wrinkle.
Rhytid is a medical term for a skin wrinkle.
A rhytidectomy (or rhytidoplasty) is the medical term for a face lift (see Face Lift). It typically refers to the lifting of the lower face and is a bit of a misnomer as a face lift is intended to lift sagging tissues and not to eliminate or improve surface skin wrinkles.
SMAS stands for superficial musculoaponeurotic system (say that three times fast!). The SMAS was first identified as a unique anatomic structure in the 1970s by Mitz and Peyronie and controversy has surrounded exactly what constitutes the SMAS. The SMAS represents the confluence of muscle and fascia (connective tissue) that lies deep to the skin and is the structure which is lifted during a Face Lift. Also, when performing cancer operations for the nose or rhinoplasty, it is the structure below which surgical planes are elevated and dissected to maintain blood supply to the overlying skin flap. The equivalent in the scalp is the galea aponeurotica (see Galea under the Hair Restoration terms).
Stem cell is a cell that can transform into other cells (pluripotent) and also potentially represents a means of rejuvenation. It does not have anything to do with harvesting stem cells from fetuses, which is a politically controversial issue. The theory that a year or so after fat grafting there is a possibility that the skin actually looks better with fewer wrinkles and color problems has been credited to a “stem cell” effect on the surrounding tissues although this has not been firmly or rigorously established in any study.
The area right below the cheek bone, or malar region. Also see Buccal
Submentoplasty refers to a cosmetic improvement in the area below the chin, hence ‘sub” – below, “mento” – chin (see Mentum), “plasty”- to change the shape of. Typically a submentoplasty is one part of a face lift (see Face Lift) that comprises liposuction/lipectomy (see Liposuction) and platysmaplasty (see Platysmaplasty).
Superficial Musculo-Aponeurotic System (SMAS)
“Steato” (from Greek) refers to fat, and steatoblepharon is a medical term way for “eyebag” that can appear along the lower eyelid. (It can also appear in the upper eyelid typically only near the nose side). Because the fat that comprises an eyebag actually does not herniate through a structure known as the orbital septum, steatoblepharon is also referred to as “pseudoherniation” of fat. A new theory (to which Dr. Lam fully subscribes) is that the fat bag is not truly a bag but represents loss of fat around the fat bag due to aging that should be corrected more appropriately with fat grafting (see Fat Grafting) with or without a transconjunctival blepharoplasty (see Transconjunctival Lower Blepharoplasty) for fat removal.
The bony structure that forms the other portion of the cheek bone over which fat can be grafted to cover its exposed appearance that occurs with aging. It is also the firm structure to which Dr. Lam supports his Face Lifts. Dr. Lam refers to the zygomatic arch as a component of the “lateral cheek”.
The adjective is “temporal” and the noun is the “temple”, which refers to the structure in the lateral (or outer) forehead. The muscle in this area is known as the temporalis and is activated during chewing: bite down and feel this area, you will feel the muscle move. This area tends to become hollow with excessive aging and weight loss, and Dr. Lam performs fat grafting (see Fat Grafting) to this area to correct hollowing that may occur.
Transconjunctival Lower Blepharoplasty
Transconjunctival as the name implies means “through the conjunctiva”. Many physicians refer in an abbreviated way to this procedure as a “transconj. bleph.” Or “TC bleph”. The conjunctiva is the pink lining of the eyelid that is exposed when you pull the eyelid back and look inside. This is the way that Dr. Lam typically performs a lower eyelid procedure to remove fat. He prefers this method of lower eyelid surgery as compared with a transcutaneous lower blepharoplasty (see Transcutaneous Lower Blepharoplasty) for three reasons: 1) no skin incisions so no scars, 2) fast recovery, 3) little to no risk of changing the eyelid shape unfavorably. However, today Dr. Lam rarely performs a transconjunctival lower blepharoplasty alone. He almost always performs fat grafting (see Fat Grafting) with a transconjunctival blepharoplasty. More likely than not, the lower eyelid can be successfully addressed just with fat grafting and a transconjunctival blepharoplasty is superfluous unless there is a prominent degree of steatoblepharon (see Steatoblepharon, also known as “eyebag”). Also see Blepharoplasty.
Transcutaneous Lower Blepharoplasty
As the name implies, “transcutaneous” means an incision is made “through the skin” of the lower eyelid to remove the fat bag and to tighten the skin and muscle. It is also known as a “Skin-Muscle” lower blepharoplasty. Dr. Lam does not routinely perform a transcutaneous lower blepharoplasty for the three reasons enumerated above in a transconjunctival blepharoplasty: 1) risk of unfavorable eyelid positioning (the real reason that Dr. Lam does not perform transcutaneous blepharoplasty) 2) unacceptable scarring, and 3) long recovery process. Also see Transconjunctival Lower Blepharoplasty and Blepharoplasty.