Face expressive lifting (FEL): an original surgical concept combined with bipolar radiofrequency

Abstract:
Background Aging can lead to changes in facial expressions, transforming the positive youth expression of happiness to negative expressions as sadness, tiredness, and disgust. Local skin distension is another consequence of aging, which can be difficult to treat with rejuvenation procedures. The “face expressive lifting” (FEL) is an original concept in facial rejuvenation surgery. On the one hand, FEL integrates established convergent surgical techniques aiming to correct the agerelated negative facial expressions. On the other hand, FEL incorporates novel bipolar RF technology aiming to correct local skin distension. Methods One hundred twenty-six patients underwent FEL procedure. Facial expression and local skin distension were assessed with 2 years follow-up. Results There was a correction of negative facial expression for 96 patients (76 %) and a tightening of local skin distension in 100 % of cases. Conclusions FEL is an effective procedure taking into account and able to correct both age-related negative changes in facial expression and local skin distension using radiofrequency. Level of Evidence: Level IV, therapeutic study.

Introduction:
The recent years have seen a better understanding of the physiopathogenesis and manifestations of facial aging such as sagging due to gravity, fat loss and redistribution, and loss of bone volume [1–5]. However, aging can also lead to changes in facial expressions, transforming the positive youth expressions (happiness) to negative expressions (sadness, tiredness, and disgust) overtime [6, 7]. These projected “negative emotions” can impact other’s views of us and social interaction. This might explain that a high number of patients ask not only for cosmetic improvement but also for improvement of unattractive facial expression. Almost no studies have clearly analyzed and shown how to correct the age-related changes on facial expression. The FEL concept was developed upon the convergence of effects of rejuvenation surgical procedures on different levels of the face with priority given to the re-establishment of “vitality” in both the eyes and the smile, which are the key of emotions expressions. The present study aimed to address the question of wether the FEL could correct negative facial expressions of the aging face. Secondly, the skin of the face loses its tonicity over time. Although a lift can eliminate remaining folds after musculocutaneous tightening, simple redraping is not always sufficient in cases of local distension. The application of bipolar radiofrequency (RF), using FaceTite™ (Invasix Ltd., Yokneam, Israel) makes it possible to obtain stable quantitative and qualitative effects on the skin over time through the regeneration of the deep dermis and superficial subdermal septo-fascial fat [12]. The second question addressed was whether we could correct local skin distension on zones of weak facial skin (malar crescent, labio-jugal, and submental) using radiofrequency.