Brief Report

Hatem’s Spade Facelift Scissors-A Technical Note

by Hatem Elfieshawy*

MScSurg, Aesthetic Surgeon, The Hamilton Health Hub, Hamilton, Queensland 4007, Australia

*Corresponding author: Hatem Elfieshawy, MScSurg, Aesthetic Surgeon, The Hamilton Health Hub, Hamilton, Queensland 4007, Australia

Received Date: 16 Jul, 2023

Accepted Date: 19 Jul , 2023

Published Date: 24 Jul, 2023

Citation: Elfieshawy H (2023) Hatem’s Spade Facelift Scissors-A Technical Note. Plast Surg Mod Tech 7: 169. https://doi. org/10.29011/2577-1701.1000169

Abstract

This article introduces the Hatem spade face-lift scissors (HSFS) which are a modification of the spatula-tipped scissors originally proposed by Trepsat. This tool can be used for safe blunt dissection in facelift surgery and is available in three sizes based on surgeon preference. Other tools exist for blunt dissection in facelift surgery such as the dilation wands proposed by Dilson and Luz and the dissectors proposed by Viterbo. These tools are well suited for blunt dissection, however for the fine sub-SMAS dissection we believe that the HSFS provides distinct advantages. The HSFS minimizes injury to neurovascular structures, reduces the need to switch instruments frequently, and increases surgeon comfort.

KeyWords: Scissors; Facelift; Rhytidectomy; Blunt Dissection; Deep Plane Facelift; SMAS; Surgical Tool. 

Introduction

The facelift is still one of the most common cosmetic surgeries performed; being the 3rd most common procedure in the United States in 2020 [1]. It is necessary when performing soft tissue dissection to exercise utmost care to ensure the preservation of neuro-vascular supply and minimize lymphatic disruption. Complications from facelift such as haematomas, nerve damage, and chronic oedema can all be reduced by careful handling of tissues which includes careful blunt dissection with the proper instruments [2-6]. In 2001, Trepsat described the spatula-shaped scissors used to perform the face-lift [7]. This article introduces the Hatem spade face-lift scissors (HSFS) which are a modification of the spatula-tipped scissors originally proposed by Trepsat.

The HSFS has a dual sized spade tip design and an ergonomically angulated shaft allowing better surgical visualization. During facelift procedures, the HSFS allow for versatility in blunt dissection, reduces the need to switch instruments frequently, minimizes injury to neurovascular structures, and increases surgeon comfort. This tool can be used for safe blunt dissection in face lift surgery especially in the sub-SMAS plane and is available in three sizes based on surgeon preference.

Design - Hatem Spade Facelift Scissors

Taking inspiration from the Trepsat flap scissors, which are available in various oval and pointed tip shapes, a spade tip scissor specifically for facelift procedures was designed (Figure 1). The HSFS are constructed from German high carbon steel and are gold plated around the finger holes and finger rests.The HSFS spade tip combines two diameters in one tip discouraging the need to frequently change instruments during procedures. The base of the tip gradually blends into the shaft to facilitate smooth gliding of neuro-vascular structures when retracting. The shaft of the scissor is angulated at 159° to maximize visualization of the field and improve comfort. The HSFS tips have been designed in three sizes which allow the user to pick the desired tool size.

Figure 1: Hatem Spade Facelift Scissors Design and Dimensions in Millimeters (unless stated in degrees). This Product is Designed in Three Different Sizes and is Made from High Carbon German Steel and is Gold Plated Around the Finger Holes and Finger Rest.

Discussion

To optimize surgeon function and cosmetic outcome, it is important to utilize the appropriate instrument [8]. The tool described in this technical note sets out to improve surgeon comfort and minimize complications while performing rhytidectomy. Several tools have been implemented in the safe undermining of the superficial musculoaponeurotic system dissection with the most notable being the spatula tipped scissors proposed by Trepsat [7]. The HSFS spade tip is entirely blunt, the spreading technique with the wider base of the spade combined with gentle force application allows for effective dissection. The HSFS tips are available in three sizes which allows the user to adapt the tool as necessary.

The HSFS provide several proposed advantages. The Trepsat scissors have a spatulated tip that is ideal to facilitate tissue disjunction during facelift. One issue is the attachment of the tip to the scissor shaft creates a sharp angle and a locus for tissue catching and damage. During retraction of Trepsat scissors, structures could tear if caught by the shoulders of the spatula tip where it meets the shaft. The HSFS spade tips have been designed to gradually blend into the shaft to avoid catching and facilitate smooth gliding of neuro-vascular structures. The tip shape also combines two diameters in one tip discouraging the need to frequently change instruments during procedures saving time and energy.

Other tools such as the Dilson Luz Vascular Dilation Wands [9] have been proposed to have benefits including reduced hematoma formation and facial nerve injury; however, are not as ergonomic and can result in surgeon fatigue [10]. Viterbos’s dissectors are yet another option for blunt dissection in facelift surgery [10]. This tool is less bulky than the Trepsat tip and uses a leveraged mechanical design to replace the spreading movement with a crunching hand movement engaging more proximal parts of the hands and fingers. Despite this being potentially an advantage in a firm layer like the subperiosteal layer, the sub-SMAS layer requires a finer dissection while navigating between the branches of the facial nerve. This is more achievable when using distal hand muscles. The force applied by the spreading movement using the traditional rings for distal fingers are more stable pivoting points than the straight arms of the Viterbo dissectors.

Moreover, the HSFS are ergonomically designed with an angulated shaft. This design enables improved visualization of the surgical field and offers a more comfortable hand position during the dissection process. As a result, there is reduced strain on the proximal and core muscles, allowing for a more relaxed posture during operations.

Conclusion

In conclusion, the Hatem spade face-lift scissors offer significant advantages in facilitating safe and effective blunt dissection techniques during facial surgeries. These scissors, inspired by Trepsat’s spatula-shaped scissors, feature a spade tip design and an ergonomically angulated shaft that promote a rested posture and enable better visualization of the surgical field. The availability of three sizes caters to individual surgeon preferences and applications. The use of HSFS mitigate the potential for neurovascular injuries, ensuring a safer surgical procedure. Overall, the Hatem spade face-lift scissors represent a valuable advancement in facelift surgery instrumentation.

References

  1. American Society of Plastic Surgeons. Plastic Surgery Statistic Report 2020 2021.
  2. Grover R, Jones BM, Waterhouse N (2001) The prevention of haematoma following rhytidectomy: A review of 1078 consecutive facelifts. Br J Plast Surg 54: 481-486.
  3. Salisbury CC, Kaye BL (1998) Complication of Rhytidectomy. Plast Surg Nurs 18: 71-7.
  4. Baker TJ, Gordon HL (1967) Complication of Rhytidectomy. Plast Reconstr Surg 40: 31-9.
  5. Roostaeian J, Rohrich RJ, Stuzin JM (2015) Anatomical Considerations to Prevent Facial Nerve Injury. Plast Reconstr Surg 135:1318-1327.
  6. Jacono AA, Alemi AS, Russell JL (2019) A Meta-Analysis of Complication Rates among Different SMA Facelift Techniques. Aesthet Surg J 39: 927-942.
  7. Trepsat F (2001) Volumetric Face Lifting. Plast Reconstr Surg 108:1358-1370.
  8. Gandhi SA, Kampp JT (2017) Dermatologic Surgical Instruments: A History and Review. Dermatol Surg 43:11-22.
  9. Ferreira Da Luz D, Wolfenson M, Figueiredo J, Didier JC (2005) Fullface undermining using progressive dilators. Aesthetic Plast Surg 29: 95-99.
  10. Viterbo F (2013) Improved Blunt Dissectors for Greater Safety in Face Lift Surgery. Plast Reconstr Surg 131: 858e-859e.

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Plastic Surgery and Modern Techniques