The fight for the eternal youth is one of the most ancient of the human race. At present the progress of the surgery and of the anesthesia as well as the exaltation of the youth for the mass media, increase and it reinforced the desire to support in more time the aspect of youth.

The basic operation of the facial rejuvenation is the ritidoplastia or plastia of the wrinkles, associated or not to other surgical procedures since it is the surgery of the eyelids, of the nose, liposuction of the dewlap, suture of the platisma, rejuvenation of the orbit, suspension of the tail of eyebrow, placement of fat in the ruts nasogenianos, placement of implant in malar region, in angle of jaw, in mentón.

The facial rejuvenation is a constant process, along the anuses. The human being can be kept with younger aspect if it had motivation and resources for this. The process of aging is constant, therefore palucha against this also it it must be.

It is a patient says that I fulfil a ritidoplastia, can need a deep peeling, a blefaroplastia and another ritidoplastia years afterwards. In spite of all the technical progresses of the plastic surgery, in spite of numerous operations you will complement, the ritidoplastia or facial rejuvenation, it is a palliative aeration, that leda to the patient a younger aspect. The best results happen in younger persons.

The changes of the facial aging, they produce a decrease of the elasticity of the skin, which produces flacidez and the consistent fall of the skin. Also the skin appears thinner, dry, descamativa. The cellular subcutaneous fabric diminishes of volume and consistency, tending to suffer a process of reabsorption. The sebaceous and sudoriferous glands also enter a process of atrophy, diminishing the mechanism of lubrication and hydration of the skin.

The constant action of the musculature of the mime that is inserted directly in the dermis, produces the formation of the facial wrinkles that are called dynamic wrinkles.

The physical examination must be detailed, beginning for the forehead to observe the presence of transverse wrinkles, vertical wrinkles in the space between the eyebrows, transverse wrinkles in the root of the nose, the position of the tail of the eyebrow, the presence or not of remaining skin in eyelids, the presence and quantity of bags of fat in the top and low eyelids, the quantity of lateral wrinkles in the eyes known as legs of hen, the depth of the ruts nasogenianos, attends of vertical wrinkles in the lips, loss of the line of the jaw, presence of fat in the neck, skin flácida and transverse ruts in the neck.

All that must be carefully described in the clinical history and converse with the patient of his expectations and offer him the result the nearest thing to his surgical possibilities.

Decided the operation, all the examinations are requested preoperatorios, between them blood sugar, tests of coagulation, hematocrito, electrocardiogram and cardiological checkup, to avoid any complication. It is important to know if the patient is a chronic smoker what can cause necrosis of the hanging tatters, is necessary to warn the patient of this complication and to request that it stops smoking 15 days before and 15 days after the surgery, to diminish the risks, as well as to stop the use of aspirin or of vitamin E.

The type of anesthesia that is decided to use will depend on the preference of the doctor, it can be realized by local anesthesia or by general anesthesia.

The ritidoplastia understands in general outlines, a great descolamiento of the skin and of the subcutaneous one of the face, followed by a rotation for above and for out, with resection of the leather excess and suture. The classic ritidoplastia understands a frontal incision in the hairy skin, arrives of the frontal region, the incision goes down for the temporary region, happens ahead from the ear, contornea the lobe, rises and goes to the occipital region.

For the frontal incision they can treat the wrinkles of the forehead by means of the deshinsercion of the muscles corrugadores and of the procerus, likewise the tail of the eyebrow rises. Now also this surgery is realized by route endoscopica, with the advantage of not leaving scars in the head and of obtaining a more natural result.

The temporary incision and preauricular allows us to treat the average third of the face, doing a subfacial descolamiento with traction and resection of the leather excess. The incision retroauricular allows us to come and to treat the adiposity of the angle of the jaw and of the neck, as well as to withdraw the leather excess.

The ritidoplastia can associate to blefaroplastia, rinoplastia, osteoplastia of mentón, myoplasty of the platisma and resection or aspiration of cervical fat for an incision submentoniana. Also it is possible to do peeling or dermoabrasion to treat them to wrinkle vertical of the lips. Implants of fat or dermis in the ruts nasogenianos or also implant heterologos since it is the Acid Hialuronico, PMMA, Cosmogel, between others. The resection of Bichat’s ball to perfect the cheeks also is an additional surgery and with good results. The elegant postoperatory ones are basically of cleanliness of the wounds, relative rest and medication.

Since any surgery the ritidoplastia can have complications since they are the bruises, seromas, unaesthetic scars, alopecias, necrosis, infections and injuries of nervous branches, mas the percentage of the same ones are low.

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