June 2016 #PRSJournalClub Wrap-Up: A Comparison of the Full and Short-Scar Face-Lift Incision Techniques in Multiple Sets of Identical Twins

by Chad M. Teven, MD (@ChadTevenMD)

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Led by PRS Resident Ambassadors Amanda Silva (@AmandaKSilvaMD), Raj Sawh-Martinez (@docrfsm), and Sammy Sinno (@sammysinnoMD), the June 2016 #PRSJournalClub followed suit from the previous editions and provided for another thought-provoking and enlightening discussion on the current issues in plastic surgery. In the article “A Comparison of the Full and Short-Scar Face-Lift Incision Techniques in Multiple Sets of Identical Twins,” from the June publication of Plastic and Reconstructive Surgery, Antell and colleagues studied open facelift techniques, specifically addressing full vs. short-scar incisions. Thanks to our ambassadors and many participants, June’s was perhaps the most active #PRSJournalClub to date. What’s more, the article’s authors were incredibly interactive and receptive to receiving a multitude of questions that served to enrich and deepen the discussion.

In their study, Antell et al. compared full and short-scar face-lift incision techniques between several groups of identical twins over time. The authors reported similar efficacy between short-scar and full face-lift incisions in the short term with respect to appearance at the nasolabial fold, jawline, and neck region. However, short-scar facelifts were noted to be less durable over a longer period of time (5 years), specifically with respect to the neck region and cervical contour. What adds substantial strength to the conclusions made within this article are the fact that all surgeries were performed by the senior author, the incision technique was prospectively randomized among participants, and the different facelift techniques were compared between identical twins.

In addition to the online debate that took place from June 5-6, the June #PRSJournalClub was enriched in several ways. An expert discussion penned by Dr. James Stuzin accompanied the article in this month’s Journal. In his review, Dr. Stuzin critically analyzes the study and offers insights into its relative strengths and limitations. Also, Dr. Rod Rohrich discussed the article in a Plastic Surgery Hot Topic video and also joined the Resident Ambassadors as a special guest moderator during a podcast reviewing the article. All of these elements serve to complement each other and further stimulate interest in our field! Never before have both trainees and experienced surgeons alike been able to so easily find, read, discuss, and debate all things plastic surgery!

Best Face-Lift Techniques: Identical Twin Test-
Plastic Surgery Hot Topics with Rod J. Rohrich, MD

Best Face-Lift Techniques- Identical Twin Test:
PRS Journal Club Podcast June 2016- Part 3

#PRSJournalClub and Beyond

For those unacquainted with #PRSJournalClub, there are numerous opportunities to join the fun and get involved! Indeed, the Resident Ambassadors and PRS editorial board ought to be commended for creating incredible avenues to access the latest and hottest topics in the plastic surgery literature. And did I mention how much fun it is to have the opportunity to read an article, listen to a podcast as it is discussed by an expert, and take part in a conversation led by the article’s authors? As evidenced by recent #PRSJournalClub discussions, excitement to learn about plastic surgery is at an all-time high – let’s keep it up by keeping the discussion going!

  • The June 2016 PRS Journal Club contains 12 articles selected by the Resident Ambassadors that can be found here. This collection is comprised of the Ambassadors’ picks as well as classic PRS articles. They are ‘must reads’ and – oh by the way – they are FREE!
  • Each month, one article is chosen for a Twitter-based social media discussion with the authors and additional global experts. There is no better way to have your question answered! You can find and join the discussion by using the #PRSJournalClub hashtag.
  • Each article picked by the Resident Ambassadors is accompanied by a podcast discussion that can be found on our website, the YouTube PRSJournalClub channel, and iTunes!

For those who may not have had the opportunity to participate in June’s #PRSJournalClub or who want a recap of the action, below are the top tweets from the Q&A session over the two-day period. Stay tuned for the July edition, which is guaranteed to provide another enjoyable and enlightening discussion.

The article: A Comparison of the Full and Short-Scar Face-Lift Incision Techniques in Multiple Sets of Identical Twins

The authors:

Darrick E. Antell, M.D., D.M.D. (@DrDarrickAntell)

Jessica M. May, B.A. (@jessica_m_may)

Matthew J. Bonnano, M.D.

Norman Y. Lee, M.D.

Discussion Points:

Owing to the success of the previous journal clubs, enthusiasm for June’s edition was palpable!

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A Sampling of some of the Top Trending Tweets and Questions:@docrfsm – Which incision do you prefer for facelift incisions?

  1. @docrfsm – Which incision do you prefer for facelift incisions?

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2. @drheatherfurnas – What was difference in OR times?

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@jessica_m_may – great question! I believe averages for OR time were similar between the 2

@DrDarrickAntell – excellent ? and my recollection is that the 2nd twin surgery was quicker. We should go back and look. Rick.

@jessica_m_may – definitively have the data on this! To be confirmed

@jessica_m_may – although FI longer confined space w SS requires time consuming technical precision @DrDarrickAntell?

@DrDarrickAntell – You nailed it Jessica. I do recall the times were similar for SS and FI lifts for the reason you stated.

 

3. @shujashafqatmd – congrats on the paper! The results w/ MACS lift. Any future studies with that?

@jessica_m_may – Thanks! Not right now but would be interested FACEQ followup our current focus

@shujashafqatmd – thanks! Was any adjunctive fat grafting done in these patients?

@jessica_m_may – Not in this study, would be great to see how fat grafting could impact results

@DrDarrickAntell – Fat grafting was not performed to limit the number of variables in this study

@DrDarrickAntell – fat grafting can be an adjunct. I want to do a twin study with fat only vs a short scar face-lift.

@AmandaKSilvaMD – that would be very interesting!

@JordanFreyMD – That would be great to see!

@drheatherfurnas – Great idea! #fat vs Short-Scar #facelift #plasticsurgery

 

4. @JordanFreyMD – Congrats on a great paper! Any anecdotal diff seen in pt satisfaction w short v full incision?

@jessica_m_may – Thanks for the question. So excited about this follow up study.

@IbrahimKhansaMD – What will the follow up study look at? FACE-Q scores?

@jessica_m_may – FACEQ was a perfectly timed tool for this follow up

@jessica_m_may – Easy for patients to use Easy for us to score and compare anatomical areas

@JordanFreyMD – Thanks!

@jessica_m_may – No anecdotal difference between the groups long term. Look for full pub soon!

@JordanFreyMD – Thanks! Looking forward to it! Imagine FACE Q is useful tool to assess?

@jessica_m_may – FACEQ was perfect! Researcher & patient friendly tool

 

5. @sammysinnoMD – what is the cause of recurrent platysma bands after surgery?

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@DrDarrickAntell – further aging, sutures can come loose. Try Botox in the short term, or step cuts w local

 

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6. @IbrahimKhansaMD – Do you use adjuvant techniques, such as fibrin glue?

@AmandaKSilvaMD – 1 attending uses topical tranexamic acid in high risk pts

@danielbutzmd – He uses it for all facelift patents, see less edema and ecchymosis too!

 

7. @FrancescoEgro – was there a difference in pts’ co-morbidities (e.g. DM)?

@jessica_m_may – no DM noted either group in current records HTN x 2 in SS

@FrancescoEgro – Thank you very much!

@jessica_m_may – Sun smoke stress comorbids all important talking points 4 patients concerned by facial aging

@FrancescoEgro – Was there a significant difference in weight between twins?

@jessica_m_may – interesting question I’ll calculate baseline BMIs and get back to you!

@FrancescoEgro – Thank you!

@jessica_m_may – triplet with FI did note significant weight gain at longer followup

@FrancescoEgro – Thank you for looking into it!

 

8. @sammysinnoMD – do different techniques corset vs myotomy vs window have different results?

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@DrDarrickAntell – I do not believe that anyone has studied that yet…

@DrDarrickAntell – Suture platysma and short myotomy is my preferred technique

 

9. @JordanFreyMD – What is 1 thing you used to do in facelift that you would not do now?

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@DrDarrickAntell – Lighter sedation

@AmandaKSilvaMD – you prefer deeper sedation now?

@DrDarrickAntell – Prefer lighter sedation now…used to use heavier in the past.

@IbrahimKhansaMD – What do you use for sedation?

@DrDarrickAntell – Currently our #anesthesiologist uses a combo of benzodiazepine and propofol

 

10. @drheatherfurnas – More 2ndary #facelift requests in thin patients?

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@DrDarrickAntell – Yes, very astute! Heavier pts tend to have fuller faces. Fat transfer or fillers can be alts for thin pts

 

11. @shujashafqatmd – what is the overall preferred technique for the SMAS? Plication? SMASectomy?

@jessica_m_may – @DrDarrickAntell teaches SMAS assessment intraop as patient anatomy differences dictate management

@shujashafqatmd – are there any good videos/articles on how to assess SMAS intraoperatively?

@DrDarrickAntell – earlier paper concluded no noticeable difference

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@DrMatthewWhite – Nice paper @DrDarrickAntell

@jessica_m_may – If addressed in the study patients plication was the only treatment of the SMAS

 

12. @ChadTevenMD – In your experience is cost a signif factor in pt’s decision to have ss vs full?

@jessica_m_may – @DrDarrickAntell can confirm, but cost difference isn’t dramatic between SS and FI

@jessica_m_may – $$ can become a concern with need for multiple lifts or ancillary procedures

@AmandaKSilvaMD – so would you say pts actually prefer full bc more durable?

 

13. @sammysinnoMD – given these findings should we never perform short scar facelifts?

@DrDarrickAntell – some patients decline a posterior scar. A SSLift with fat can do a lot for many.

@jessica_m_may – We’d never say never short scar lift great option for the right patients

@FrancescoEgro – I imagine patient selection is key 🙂

@AmandaKSilvaMD – would you say indication for SSfacelift: isolated face concerns (exclude neck) &/or pt pref?

@jessica_m_may – randomized incision for study @DrDarrickAntell not necessarily what would have been chosen their anatomy

@jessica_m_may – we emphasize patient centered convo about individual aging concerns

@RajaMohanMD – Do you plan on comparing to other techniques in the future

@jessica_m_may – focused on FACEQ followup now mb fat transfer vs SS in future

 

14. @drheatherfurnas – Are Short Scar #facelift pts as happy now?

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@docrfsm – Great question…#ExpectationManagement!

@jessica_m_may – patient satisfaction more important to determine “best” lift?

@jessica_m_may – stay tuned for full pub soon!

 

15. @shujashafqatmd – do you prefer SS or FI on revision facelifts or does it depend?

@DrDarrickAntell – That is an excellent question – the best response to that would be that it really depends. Every situation is different.

 

16. @docrfsm – Who is the ideal candidate for short scar facelift?

@RajaMohanMD – What is your opinion on SS lifts in younger patients (~40-50yrs)

@jessica_m_may – Thoughts on SS as an early intervention for younger patients @DrDarrickAntell to slow aging process?

@DrDarrickAntell – I have many patients that over a 10 to 15 year period have had 2 short lifts. ? Might not need more ?

 

17. @IbrahimKhansaMD – Did full incision pts have more bruising/longer recovery?

@jessica_m_may – we didn’t track for this study definitely important

@jessica_m_may – certain twin sets have more frequent postop photos could help us assess

@jessica_m_may – assessing “recovery” bigger challenge 2/2 subjective nature

@jessica_m_may – having validated objective tool to assess would be great for patient care

@jessica_m_may – interesting to compare what patients vs surgeons consider recovery

@IbrahimKhansaMD – I think looking at amount of bruising, and when they can go back to work or social events

 

18. @DamianMarucci – How were so many twins recruited? Unique practice clientele

@FrancescoEgro – Great question!

@jessica_m_may – The annual twins day festival in Twinsburg OH

 

19. @pallabc – Apart from facial change, was any study of scarring done in full incision technique?

@jessica_m_may – no formal study of scarring great idea! Might be possible through postop photos

@pallabc – More important is the satisfaction of patients How did SSlift patients feel about their results?

@DrDarrickAntell – Both twins were satisfied with the results.

@jessica_m_may – always important to keep in mind surgeon and patient perspective may differ

@pallabc – Do you reckon that subcutaneous lift only in elderly is sufficient procedure?

@DrDarrickAntell – it most certainly can be sufficient in many cases.

@pallabc – Thanks! That helps.

@pallabc – 1. It is accepted that nasolabial folds are merely softened with facelift. May not be appropriate to study.

@jessica_m_may – would you consider injectable filler in this area for additional enhancement @DrDarrickAntell ?

@DrDarrickAntell – NLF is difficult to efface with lifting alone. Add filler for best results.

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20. @ChadTevenMD – Congrats on a great study! Any plans to reeval these pts? Perhaps at 10 years?

@jessica_m_may – if possible! great group of patients certainly my favorite part of the research

 

21. @DrNikkiPhillips – What skin care regimen do u recommend to facelift patients before/ after surgery?

@DrDarrickAntell – I recommend lymphatic drainage at least 10-14 days after surgery for post-op care

 

22. @shujashafqatmd – any tips for the surgeon just starting out doing #facelift?

@DrDarrickAntell – Do No Harm!

 

LISTEN TO THE COMPLETE JUNE #PRSJOURNAL CLUB PODCAST HERE:

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