On the issue of determining tactics for surgical facial rejuvenation

Introduction. Multiple conceptual approaches exist for understanding facial aging, with a primary focus on either skin changes, volume fluctuations, gravitational changes in soft tissues, or facial skeletal atrophy. Many techniques following the concepts of aging are often used and promoted by the authors as universal. However, different individuals age differently, and therefore a differentiated approach to the choice of technique is logical. Each patient represents a unique combination of treatment objectives that are associated not only with the initial physical characteristics of the patient, but also with their subjective self-perception. The search for classifications or algorithms that could provide guidance for tactics remains relevant.
Purpose of the study: to improve the planning of surgical correction of age-related changes in the face.
Material and methods. The study was carried out by analyzing existing concepts of age-related changes in the face and approaches to the selection of surgical correction tactics.
Results. The analysis of the literature showed that the classifications and assessment systems developed to date are not objective, given the diversity of facial structures, national characteristics, and subjective views on facial aesthetics. The main result of our work was the development of a surgical strategy based on identifying the individual needs of patients. It has been established that neither the presence nor the severity of certain signs of aging can determine the tactics. The correct approach is to determine the clinical significance of certain age-related changes in the face and, on this basis, to subordinate the options for surgical correction techniques (choice of incision line, detachment option, vectors of tissue movement and fixation, volumetric maneuvers) for each specific clinical situation individually. The algorithm for choosing a technique should be based on solving specific problems posed by a given patient. Each objective should correspond to its own technique, which may vary from person to person in the same area.
Conclusions. Aging is fragmentary and can be described by individual signs. Each sign corresponds to a specific objective for the surgeon. Surgeons tend to objectify the severity of signs (visual manifestations), although this is unreliable. The relevance of the signs (the significance for the patient) does not necessarily correlate with the severity, i.e. cannot and does not require to be objectified. Essential is not the quantification of severity, but the presence of a symptom (indication for surgical intervention, i.e., the objective) and the improvement resulting from achieving the objective, i.e., patient satisfaction. The correction of the same facial area in patients with different types of age-related changes can be approached in different ways and depends on individual needs. The tactics for surgical facial rejuvenation should be based on solving specific tasks set by the patient.
Key words: concepts of aging, aesthetic facial surgery, surgical rejuvenation tactics, correction of age-related changes, rejuvenation objectives
Conflict of interest. The authors declare that there is no conflict of interest.
Funding. The study has not received any funding.