Rejuvenation of Facial Expression: The FINAL Goal in Facial Rejuvenation

Goals/Purpose: Facial expressions signal behavioral intentions. Correct interpretation of emotional expressions is crucial for social life. Emotional expressivity is easily decoded in younger individuals. However facial expression in older individuals are perceived differently. Wrinkles and folds impact on emotional communication. On the other hand, happy expression and emotional intensity are associated with increased longevity. Traditional face lift techniques reverse only partially the sad, tired expression of aging. We present methods of total facial rejuvenation including rejuvenation of facial expression that should be the ultimate goal in facial rejuvenation.

Methods/Technique: A retrospective analysis of the authors own cases and cases published in peer-review journals as well as cases posted in the internet was carried out. Comparison of facial expression pre and post-surgery was done. The changes that lead to improved facial expressivity from tired, sad, angry to rested, happy and easy smiling on neutral photographs were made. The surgical maneuvers that made possible the improved facial expressions were analyzed. From the close to 1500 cases in a 30 years span over 300 cases of patient’s photographs with more than a year of follow up were available for analysis. For comparison hundreds of photographs of other surgeon’s publications were also analyzed.

Results/Complications: The authors hypothesis is that the subperiosteal repositioning of the origin of the muscles of facial expression are the fundamental basis for these changes. The volumetric changes that occur are also secondary factors for these results. Since treatment of skin excess were also done in the traditional methods as well as in a subset of our cases a more meaningful comparison can be made. The pure endoscopic techniques without skin removal by itself attest to the changes that we are postulating

Conclusion: Rejuvenation of facial expression seems to be the “ultimate paradigm shift” in facial rejuvenative surgery.