COSMETIC

Asian Face Lift with the Composite Face

Lift Technique
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Chin-Ho Wong, M.Med. Background: The composite face lift is becoming increasingly popular follow-
(Surg.), F.A.M.S.(Plast.Surg.) ing recent advances in understanding of facial anatomy that enable safe sub-
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Michael Ku Hung Hsieh, superficial musculoaponeurotic system (SMAS) dissection. This article presents
M.D., M.R.C.S.(Ed.), M.Med. the authors’ technique for composite face lift in Asian patients and reviews
(Surg.) their experience and outcome with this procedure.
Bryan Mendelson, Methods: Composite face lifts were performed on 128 Asian patients between
F.R.C.S.(Ed.), F.R.A.C.S., January of 2010 and June of 2020. Ninety-four were primary face lifts, and 34
F.A.C.S. were secondary or tertiary face lifts. The authors’ surgical technique and adap-
tations for the specific requirements of Asian patients are described in detail.
Singapore; and Toorak, Victoria,
Australia
The mean follow-up was 26 months (range, 6 to 108 months). Fat grafting was
an integral part of our procedure, with 95 percent having concomitant facial
fat grafting with their face lift.
Results: Patients were followed up in accordance with a standardized schedule.
The majority of patients reported high satisfaction with the aesthetic outcome of
the technique, with natural, long-lasting results. The face lift plane of dissection
is through the facial soft-tissue spaces, which provide atraumatic sub-SMAS access
with precise release of the intervening retaining ligaments for effective flap mobi-
lization. By emphasizing tension on the composite flap with no tension on the skin
closure, the scars were discrete in the great majority of patients. Complications
were few, with no hematomas or skin flap necrosis. The temporary nerve injury
rate was 1.5 percent, with no patient having a permanent nerve injury.
Conclusion: The composite face lift is an ideal technique for Asian patients, as
it delivers natural, long-lasting results; a quick recovery; and high patient satis-
faction. (Plast. Reconstr. Surg. 149: 59, 2022.)
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

T
he face lift in Asian patients is a unique Asian anatomy and tissue characteristics. Many
procedure because of the differences in techniques have been used in Asian face lifts.12–17
the skeletal structure and soft-tissue qual- In general, these techniques may be divided into
ity of Asian patients compared to white patients. two broad categories: (1) superficial techniques
Accordingly, the performance of face lift tech- that dissect only above the superficial musculo-
niques developed primarily for white patients aponeurotic system (SMAS) and (2) deep plane
may be different in Asian patients.1–11 These tech- techniques that require sub-SMAS dissection. The
niques have to be modified and adapted for the

Disclosure: The authors have no financial interest

From W Aesthetic Plastic Surgery; the Department of Plastic to declare in relation to the content of this article.
Reconstructive and Aesthetic Surgery, Singapore General
Hospital; and the Centre for Facial Plastic Surgery.
Received for publication January 15, 2021; accepted July
13, 2021. Related digital media are available in the full-text
Copyright © 2021 The Authors. Published by Wolters Kluwer version of the article on www.PRSJournal.com.
Health, Inc. on behalf of the American Society of Plastic
Surgeons. All rights reserved. This is an open-access article dis-
tributed under the terms of the Creative Commons Attribution-
Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), A Video Discussion by Alan Matarasso, M.D.,
where it is permissible to download and share the work provided accompanies this article. Go to PRSJournal.com
it is properly cited. The work cannot be changed in any way or and click on “Video Discussions” in the “Digital
used commercially without permission from the journal. Media” tab to watch.
DOI: 10.1097/PRS.0000000000008686

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 Plastic and Reconstructive Surgery • January 2022

composite face lift belongs to the latter group of

procedures that involve juxtafacial nerve dissec-
tion. Understandably, while a profoundly power-
ful technique, the potential risks of nerve injury
remain a significant deterrent to surgeons in
adopting this approach. However, the composite
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face lift technique has experienced a resurgence

in popularity recently because of improved under-
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standing of the surgical anatomy, which allows for

greater safety in performing the procedure.18 The
composite face lift has certain inherent character-
istics and technical features that make it ideal for
Asian patients. This article reports our experience
with the composite face lift for Asian patients.

APPLIED ANATOMY OF THE FACE FOR

COMPOSITE FACE LIFT
The soft tissues of the face and neck are con-
structed in five concentric layers: (1) skin, (2) sub-
cutaneous fat, (3) the musculoaponeurotic layer,
(4) the loose areolar layer, and (5) deep fascia or
periosteum. These five layers, as summarized by
the mnemonic SCALP, are bound together and
supported by a system of facial retaining ligaments
(Fig. 1).19,20 Functionally, however, the face is
divided into two fascial layers, the superficial and
deep fascia, with the muscle of facial expression
located in the superficial fascia, while the muscles
of mastication and the associated glandular struc-
tures (e.g., the parotid gland) are located under
the deep fascia.21 The superficial fascia is made
up of the outer three layers: skin, subcutaneous
layer, and the musculoaponeurotic layer bounded Fig. 1. The face is constructed of five basic soft-tissue layers.
together by the retaining ligaments. The muscu- These five layers are bound together by a system of retaining
loaponeurotic layer (layer 3) is the SMAS in the ligaments that secures the soft tissues to the facial skeleton and
lateral cheeks, orbicularis oculi in the periorbital deep fascia. The outer three layers function as a single unit, a
area, and platysma in the anteromedial lower face composite flap that is the superficial fascia. Layer 4 contains
and neck.22 The deep fascia (layer 5) is the peri- the gliding plane in the form of soft-tissue spaces alternating
osteum and deep facial layers covering the muscle with areas of fixation provided by the retaining ligaments. This
of mastication, the temporalis, and masseter. The facilitates movement of the superficial fascia independent of
loose areolar layer (layer 4) is for the most part a the underlying deep fascia. Surgically, this is the “ideal” plane for
gliding plane that allows the superficial fascia to dissection because it is avascular, may be opened bluntly with
glide and hence move freely over the deep fascia. minimal trauma, and is safe, as it is devoid of any vital structures.
A series of facial soft-tissue spaces, from the lat- Accordingly, it is the plane of dissection in our composite face
eral cheek to the neck (i.e., prezygomatic, upper lift technique. The facial nerve branches travel through layer 4,
and lower premasseter, and subplatysmal spaces) where they remain outside the spaces. They ascend to layer 3 in
located within layer 4, are designed for this pur- close relationship with the retaining ligaments. These are loca-
pose.19,23 Because of the inherent mobility of this tions where the nerves are at risk of injury (insert) (© EFE).
plane, it is the anatomical location most predis-
posed to laxity and sagging with aging (Fig. 2). 4, through the facial soft-tissue spaces (the glid-
Accordingly, it is also the location that, when ing plane), with precise release of the retaining
directly tightened, results in the most natural res- ligaments in layer 4 to allow for tightening of the
toration of the contours of youth. The compos- superficial fascia as a single composite from the
ite face lift is an approach that dissects in layer underside of the composite flap.

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Fig. 2. Layer 4 is the natural gliding plane between the composite superficial fascia and the deep fascia
and the masticatory apparatus below. In youth, this layer, while allowing for mobility, is firm and taut
(left). With aging, because of the predisposition for laxity and tissue relaxation, expansion and sagging
develop over the roof of the facial soft-tissue spaces (right). Accordingly, as this is the main anatomic site
of laxity that develops with aging, directly tightening the superficial fascia is the most effective and logi-
cal way to perform the face lift. This also delivers the most natural and harmonious facial rejuvenation
by restoring the superficial fascia to its location in youth (© EFE).

SURGICAL TECHNIQUE entrance into the lower premasseter space is con-

The skin incision is as shown in Figure 3 firmed by visualization of fibers of the masseter on
(above, left). In the face, a line for the deep plane the floor of the space and fibers of the platysma
entry is marked, extending from the lateral can- in the roof of the space. Once these landmarks
thus to the angle of the mandible. In the neck, are visualized, the space is bluntly opened with a
the key point is marked. This key point, usually Trepsat dissector to its anterior boundary (Fig. 3,
located along the uppermost neck crease at or above, right). The SMAS incision is then extended
slightly anterior to the angle of the mandible,24,25 upward to the body of the zygoma along the rest of
is the location on the neck that, when traction is the planned incision. The upper premasseter space
applied, will optimally lift the submental and neck located approximately 10 mm above the upper
areas simultaneously. Subcutaneous dissection is boundary of the lower premasseter space is then
performed to these markings only to the extent opened using the same dissection technique.27
necessary to access these deep plane entry points. Once opened, the upper space is tented upward
Visually, the posterior border of platysma in the with a retractor, and the retaining ligaments in the
lower face and neck and the lateral border of the interval separating the lower and upper spaces are
orbicularis oculi marks the anterior limit of the sharply released near the roof of the space (Fig. 3,
subcutaneous dissection. [See Video 1 (online), center). Dissection is then shifted to the upper
which shows skin incisions and limited subcuta- extent of SMAS dissection over the body of the
neous dissection, only to the extent necessary to zygoma (step 2). The orbicularis oculi is bluntly
access the sub-SMAS dissection plane.] elevated off the body of the zygoma, aiming the
Facial sub-SMAS dissection is performed with a tip of the Metzenbaum scissors toward the lateral
three-step approach. This is initiated with entrance canthus. This then takes the dissection into the
into the lower premasseter space, as this is easiest prezygomatic space. The prezygomatic space may
to access, being the largest and most distinct soft- be opened further with blunt finger dissection.28–30
tissue space in the face.26 An initial 2-cm incision The next release is the zygomatic retaining liga-
at 10 mm above the angle of mandible along the ments inferior to the pre-zygomatic space (step 3).
planned SMAS incision line is made with a no. 15 Using retractors in the prezygomatic space above
blade. The space is bluntly opened using vertical and the premasseter spaces below, the interven-
spreading of the Metzenbaum scissors. Correct ing zygomatic ligaments are sharply released with

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Fig. 3. (Continued ).

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 Volume 149, Number 1 • Asian Face Lift with Composite Technique

scissors, staying closer to the roof of the spaces as over the parotid gland. In the lower face, a more
the nerves are still running deep under the floor superolateral vector is used. As fixation progresses
of the spaces at this location and under the zygo- up to the zygoma, a more lateral vector is used
maticus major. Dissecting in this plane brings the (Fig. 3, below). In general, five fixation sutures
release over the zygomaticus major toward the are placed: from lower face to the zygoma, in the
nasolabial fold.31,32 Anteriorly, dissection may be roofs of the lower premasseter, upper premasseter
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stopped when the zygomatic ligament medial to space, in the location of the zygomatic ligaments,
zygomaticus major and the key masseteric liga- and in the lateral roof of the prezygomatic space
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ments more anteriorly and inferiorly have been respectively, fixing into the fixed SMAS slightly pos-
released and one can see the branches of the facial terior to cut edges of the SMAS incision. The high-
nerves transitioning from deep to superficial in est fixation suture in the roof of the prezygomatic
close association with the key retaining ligaments. space delivers the cheek lift or “high-SMAS” effect.
The adequacy of release is then confirmed by not- Ethibond 3-0 sutures (Johnson & Johnson Medical
ing good mobility of the superficial fascia, which Devices, Irvine, Calif.) are used for this, and the
results in correction of the jowl, corner of the sutures are tied firmly under strong tension.37 The
mouth, and nasolabial folds and elevation of the next fixation is the posterior platysma in the neck.
lower eyelid with traction on the composite flap. The platysma is transected over the previously ele-
The neck dissection is then started by sharply vated tunnel, at the location of the key point, for
releasing the cervical retaining ligaments along the approximately 4 cm, raising an inferior and a supe-
posterior border of the platysma, mobilizing the rior platysma flap. The superior flap is fixated with
platysma off the sternocleidomastoid muscle.33,34 two figure-of-eight sutures to the Lore’s fascia ante-
This allows the platysma to be lifted off the ster- rior to the tragus.24 The inferior platysma flap is fix-
nomastoid and deep cervical fascia with a Trepsat ated to the mastoid fascia with two fixation sutures.
dissector in the subplatysma space, completing For the face, a second row of fixation is performed
the usual extent of the surgical release. Buccal fat from the cut edge of the SMAS on the compos-
removal, if indicated, is performed. The capsule of ite flap to the fixed SMAS just anterior to the ear.
the buccal fat pad is opened, and the excess buccal Using 3-0 Vicryl sutures (Ethicon, Inc., Raritan,
fat is gently teased out for excision. Care should be N.J.), this second row reinforces the anterior fixa-
taken not to injure the buccal branch of the facial tion and also functions to obliterate dead space to
nerve, which runs over the capsule of the buccal fat prevent the occurrence of hematoma. [See Video 3
pad.35 [See Video 2 (online), which shows sub-SMAS (online), which shows composite flap fixation in
dissection. To maximize safety, dissection was per- multiple vectors to achieve the face and neck lifts.]
formed using a technique that bluntly opens the The excess skin flap is precisely trimmed and inset
facial soft-tissue spaces followed by precisely releas- around the ear and the retroauricular and poste-
ing the retaining ligaments to effectively mobilize rior prehairline for a tension-free skin closure.
the composite face and neck lift flaps.] Structural fat grafting is done as needed at the end
Fixation of the composite flap to achieve the of the procedure using the Coleman technique.38–41
face lift may now be performed.36 This is started at No drains are used. [See Video 4 (online), which
the lower face on the underside of the platysma to shows the skin flap inset and closure in a tension-
robustly fix the composite flap to the fixed SMAS free manner.]

Fig. 3. (Continued). (Above, left) Our skin incisions design. The MATERIALS AND METHODS
dotted line marked the anterior extent of our subcutaneous dis- From June of 2009 to June of 2020, 128 Asian
section to reach our sub-SMAS entry locations. (Above, right) The patients underwent a composite face lift. Ninety-
facial soft-tissue space is a preferred plane of dissection, as it may four patients underwent primary face lifts, and
be opened safely and atraumatically with vertical spreading of 34 underwent secondary or tertiary face lifts. The
the Trepsat dissector. (Center) Release of the retaining ligament mean follow-up was 26 months (range, 6 to 108
in the sub-SMAS plane should be performed with the ligaments months). The neck lift was achieved using the
under tension. Cutting should be performed near the roof of the lateral approach only as described in our surgi-
spaces, as facial nerves are running under the floor of the spaces cal technique in majority of our patients (102
and out of harm’s way. (Below) Vector of fixation is more vertical patients, 79 percent). This was accompanied by a
in the neck and lower face. As we progress up the cheek, a more submental approach in 21 percent of our patients
lateral vector is used. This optimally tightens the superficial fascia when indicated to enhance the surgical results in
and avoids excessive skin bunching in the temporal area (© EFE). the neck. Patient satisfaction was assessed from 6

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 Plastic and Reconstructive Surgery • January 2022

months after surgery. A simple, targeted survey measure of the aesthetic outcome from the
spanning two domains, appearance and quality patient’s perspective.
of life, was administered to patients. The ordinal
scale ranged from dissatisfied, neutral, satisfied,
and very satisfied for each parameter within a RESULTS
domain. An “overall satisfaction” rating based on Figures 4 and 5 show long-term results of
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the same ordinal scale allowed for a qualitative our patients treated with this technique. (See
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Fig. 4. (Above, left and below, left) This 63-year-old Chinese woman underwent a composite face lift with full face fat
grafting. Twenty milliliters of fat were injected for her. At the same time, upper blepharoplasty with levator advancement
for upper eyelid ptosis correction was performed. Additional procedures performed included an extended transcon-
junctival lower blepharoplasty (Wong CH, Mendelson B. Extended transconjunctival lower eyelid blepharoplasty with
release of the tear trough ligament and fat redistribution. Plast Reconstr Surg. 2017;140:273–282), an upper lip lift, and
a chin implant via an intraoral approach. No submental incision was performed. The patient is shown at one year after
surgery. The composite face lift delivers a natural rejuvenation. (Above, center, and below, center) Three-quarter view of
our patient. Note the restoration of the Ogee curve of youth and long-term correction of the jowl and jawline. (Above,
right and below, right) Lateral views of our patient with good long-term results. The temporal hairline and retrotragal
incisions healed well, being imperceptible when closed in a tension-free manner.

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Fig. 5. (Left) This 57-year-old Chinese woman underwent a composite face lift with facial
fat grafting A chin implant was placed via the intraopral approach. No submental incision
was performed. Fourteen cc of fat were injected into her centrofacial areas. (Right) She is
shown here at 2 years postoperatively. Note the restoration of the Ogee curve of youth and
long-term correction of the jowl and jawline. (See Figure, Supplemental Digital Content
1, which shows the patient’s frontal and side views, http://links.lww.com/PRS/E760.)

Figure, Supplemental Digital Content 1, which buccal branch neuropraxia, and one developed
shows the frontal preoperative and 2-year postop- a temporal branch neurapraxia. Both recovered
erative photographs of the patient presented in fully in within 4 weeks. No patient developed a
Fig. 5, http://links.lww.com/PRS/E760. See Figure, permanent nerve injury.
Supplemental Digital Content 2, which shows the
side view before-and-after photographs of the
patient. In addition to the good long-term results, DISCUSSION
scars are well hidden and acceptable. This is most Asian patients seeking face lifts want natural
predictably attainable with tension-free closure results with no tell-tale signs of surgery. They are
of the incisions, http://links.lww.com/PRS/E761.) also most concerned about scarring and minimiz-
Most patients (121 out of 128, 95 percent) had ing their down time. Face lift techniques used for
facial fat grafting performed together with their Asian patients should deliver on these objectives.
face lift. The mean volume of structural fat grafted The anatomy of the Asian face is unique, with
was 29 cc (range, 14 to 46 cc of fat). Ninety-six wider bizygomatic distance with a more abrupt
percent of patients were satisfied or highly satis- or acute transition from the lateral to the ante-
fied with their result. The scars healed well and rior face over the body of the zygoma and a flatter
were discrete. Only three patients, with strong or more retruded central face. This character-
tendency toward scarring, developed prominent istic of the Asian face results in loss of effective
hypertrophic scars after surgery. These were suc- mechanical lifting force in the anterior face for
cessfully treated in all three with intralesional forces applied from the preauricular or temporal
steroid injections and laser treatments (Nd:YAG areas of the lateral face.12 It is, therefore, mechani-
laser; Cutera, Brisbane, Calif.).42 cally necessary for the lifting and fixation to be
The complication rates were low, compared applied more anteriorly in Asian patients. To opti-
to usual reported rates.43,44 There were no hema- mally fulfill these requirements and circumvent
tomas requiring surgical drainage, nor was there the challenges peculiar to the Asian anatomy,
any case of skin flap necrosis. Our nerve injury our technique of composite face lift has been
rate was low with a 1.5 percent temporary nerve adapted to address these specific considerations.
injury rate. One patient developed a temporary The advantages include the following: (1) the

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Fig. 6. (Above, left and below, left) A-59-year old woman underwent a composite face lift with a temporal brow lift, upper
lid blepharoplasty, extended transconjunctival eyebag removal (Wong CH, Mendelson B. Extended transconjunctival lower
eyelid blepharoplasty with release of the tear trough ligament and fat redistribution. Plast Reconstr Surg. 2017;140:273–282),
and full-face fat grafting. Forty-six cc of fat were grafted. No submental approach was performed for her. She is shown at 1
year postoperatively with natural and harmonious facial rejuvenation and discrete scars. (Above, center, and below, center)
Three-quarter views of our patient. (Above, right, and below, right) Lateral views of our patient with good long-term results.
The temporal hairline and retrotragal incisions healed well, being imperceptible when closed in a tension-free manner.

composite face lift restores the superficial fascia keeping the skin, subcutaneous tissue, and SMAS
to its youthful location as tension is placed on intact as a single composite flap, the thickness
the support layer of the face (i.e., the SMAS). (2) and effective strength of the SMAS may be com-
The results are profoundly rejuvenating and yet pletely preserved. The vascular supply of the com-
completely natural.19 (3) The unnatural stretched posite flap is, therefore, more robust. This allows
and taut appearance that may be seen with more for greater tension on the skin flaps to lift the
superficial procedures that rely on directly tight- thicker and heavier tissues in Asian patients. This
ening the skin to achieve the desired lift is not is in contrast to face lift techniques that either
seen with this technique. (4) With the composite elevate the SMAS as an isolated flap or dissect
face lift, because of the anatomical advantage of on the surface of the SMAS, which may thin the

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 Volume 149, Number 1 • Asian Face Lift with Composite Technique

flap and hence reduce its ability to hold tension

placed on it. Lifting and fixation of the composite
flap—independent of skin closure—enable the
skin to be closed in a tension-free manner. This
provides the required tension-free condition for
optimal skin healing and minimizes scarring.
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Composite face lift dissection is performed in

layer 4, the loose areolar plane that is the inter-
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face between the superficial and deep fascia.19

Adequate release of the retaining ligaments is
important to give the required mobility to the
superficial fascia to achieve effective, long-lasting
lifting of the flaps.36 To maximize safety from
nerve injury, the release of the retaining liga-
ments should be performed when they are under
tension and at the level of the ligament that is
furthest away from the path of the facial nerve.
To achieve this, the sub-SMAS dissection is started
by bluntly opening the facial soft-tissue spaces, as
these spaces are devoid of any vital structures and,
therefore, the safest areas to dissect.45 This is then
followed by retraction of the roof of the adjacent
spaces to put the target retaining ligament under
tension. The ligaments can then be precisely Fig. 7. This diagram illustrates the layer 4 (sub-SMAS) anatomy of the
released closer to the roof of the space, while the face. We perform the sub-SMAS release in a three-step approach.
nerves are protected, running close to the floor Step 1 is dissection in the lower face, accessing the lower and upper
of the dissected space. With the three-step dissec- premasseter spaces with release of the retaining ligaments that
tion approach as described (Fig. 7), the surgical separate them. The lower premasseter space is the widest and easi-
release may be performed safely with minimal est to access. This is followed by opening of the upper space then,
risks of nerve injury.46,47 with both spaces retracted, the retaining ligaments between them
We place the fixation sutures more anteriorly can be sharply released. Here, lower buccal branches of the facial
on the face. The mechanical advantage of this is nerve are running deep under the parotidomasseteric fascia, so the
that fixation is closer to the primary targets for release of the retaining ligaments should therefore be done high,
correction (i.e., the jowl, nasolabial fold, and at the level of the roof of the soft-tissue spaces. Step 2 directs the
cheek). The strong lifting of the lower face with dissection to the upper extent of the release by blunt dissection
direct fixation of the platysma to the dense fas- under the orbicularis oculi and opening the prezygomatic space.
cia over the parotid (the “fixed SMAS”) provides Blunt finger dissection may be used to completely open the space
good contouring of the lower face and jowls. In (FAME, finger assister malar elevation, technique) toward the naso-
the midcheek, direct tightening of the prezygo- labial folds. Step 3 is the key step to sharply release the zygomatic
matic space effectively lifts the cheek over the retaining ligaments. As there are no facial soft-tissue spaces here,
prominence of the body of the zygoma.31 The the release has to be done with sharp dissection. To do this safely,
“vector” of the lift is determined on a case-by-case retractors are placed in the spaces, under the roof of the prezygo-
basis depending on the direction that provides the matic and premasseter spaces, above and below this area, respec-
tissue with the most significant lifting and correc- tively, so that the zygomatic ligaments are placed under tension.
tion of the targeted areas of laxity.36,48 In the neck As the nerves are located in the floor of the dissection (under the
and lower face, a more vertical lift is used, and as parotidomasseteric fascia), release is performed high, closer to the
one progress toward the body of the zygoma and roof of the spaces, releasing the zygomatic ligaments and taking
lower eyelid, a gradual transition to a more super- the dissection over the zygomaticus major toward the nasolabial
olateral vector is applied.7 This is beneficial, as lax- fold, keeping the nerves safely down on the floor of the dissection.
ity develops to a different extent and directions This extent of release allows for the complete mobilization of the
in different areas of the face. In techniques that face composite flap.
rely on a single vector, en-bloc lifting of the skin
flaps, areas of suboptimal tightening, and pockets anteriorly and using a gradually transitioning vec-
of laxity will develop, resulting in early relapse at tor from the neck to the cheek allows for optimal
these locations. This approach of tightening more tightening of the composite flap, while avoiding

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 Plastic and Reconstructive Surgery • January 2022

the tendency to excessive skin bunching in the dissection to only the extent necessary to access
temporal region. Fixation is performed using these spaces and subsequently excising a signifi-
braided, nonabsorbable, Ethibond sutures for cant portion of the undermined skin subsequent to
greater strength of the fixation. The additional tightening the soft tissues, most of the skin flaps on
benefit of permanent sutures is that they serve the face and neck would have been dissected atrau-
as markers for location of the deep plane entry matically in the plane of the facial soft-tissue spaces.
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points in future secondary face lifts.37 With the composite face lift technique, most of our
The necks of Asian patients tend to hold up patients are able to gradually return to their social
hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/25/2023

better, with aging with less skin laxity and sagging engagements in about 3 weeks after surgery.
seen. For most of our patients (81 percent), the lat-
Chin-Ho Wong, M.Med.(Surg.), F.A.M.S.(Plast.Surg.)
eral approach alone to neck lifting, with platysma W Aesthetic Plastic Surgery
transection at the key point and suspension to the 06–28/29, Mount Elizabeth Novena Specialist Center
Lorre’s and mastoid fascia as described above, is 38 Irrawaddy Road
able to predictably deliver the desired neck lift Singapore 329563
for our Asian patients. We do perform the ante- drwong@waesthetics.com
Facebook: chinho.wong.7
rior/submental approach to the neck in selected Instagram: @wchinho1975
patients to enhance our results in the neck. These
include patients with very obtuse necks and who
do not mind having an additional submental inci- PATIENT CONSENT
sion. In addition to deep anterior neck structures Patients provided written consent for the use of their
manipulation, an added benefit of the submental images.
approach is that a chin implant, when needed,
may be easily placed via this incision.
Facial fat grafting is an integral part of our pro- REFERENCES
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