Bryli is a consequence of the weakening of the skin tone and fatty tissue in the middle part of the face, leading to sagging tissues and disruption of the natural oval of the face. Swollen cheeks and “wings” weigh down the lower part of the face and visually add extra years. Usually, this aesthetic disadvantage is faced by people over 40 years old, since the production of collagen and elastin by skin cells decreases with age. This leads to a loss of elasticity and sagging of the skin of the cheeks and lower jaw. It is possible to fight with bryli with the help of hardware cosmetology (thermolifting, ultrasound SMAS lifting, etc.) or radical surgical techniques – various types of facelifting.
General information of bryli
The so-called “wings” are sagging areas of skin and subcutaneous fat in the area of the lower jaw and neck that violate the normal contour of the face. Their appearance is associated with a decrease in the overall tone of the face and a weakening of the chewing muscle, sagging on both sides of the chin, forming senile sacs (or, as they are also called, “bulldog cheeks”, or “brylki”).
Omission (ptosis) of the soft tissues of the face is a characteristic sign of age-related weakening of the skin skeleton. After 30-35 years, the content of collagen and elastin, the structures that support the skin, sharply decreases; the ligaments that fix the subcutaneous tissue weaken and cannot resist gravity. The fatty tissue on the face shifts downwards, stretching the skin. So gradually “wings” are formed along the edge of the lower jaw, giving the oval of the face an undulating contour.
In the process of age-related changes of the face, early, moderate and pronounced signs of aging are distinguished.
Early signs of age-related facial changes are observed at the age of 35-45. They are characterized by minimal flabbiness of the skin on the neck, a moderate degree of lowering of the soft tissues of the face, the appearance of the first signs of “bryli”, a slight deepening of the nasolabial fold and the appearance of so-called “folds of sadness” in the corners of the mouth. The appearance of a small amount of pigmentation is noted on the skin of the face. Ptosis of the soft tissues of the middle zone of the face is expressed minimally, therefore it is often invisible to the patient himself. Flabby skin in the cervical-chin area and deep nasolabial folds are clearly visible only when bending the neck and tilting the head forward.
Moderate signs of age-related changes in the face are noted at the age of 45-55 years. During this period, the skin in the neck area becomes more flabby and the edges of the lowered superficial cervical muscle – platysms – contour through it. The “wings” are clearly visible along the contour of the lower jaw, the folds in the corners of the mouth and nasolabial area are quite noticeable. Ptosis of soft tissues on the cheekbones and a change in the contour of the face are noticeable to the patient himself, but expressed moderately. Such patients may have a heavy physique and excess body fat.
Pronounced signs of facial skin aging can occur at any age, but they are more common in patients older than 55 years. The soft tissues of the neck are flabby, with low sagging edges of the platysma and often an excessive amount of excess fat on the neck. Pronounced “wings” are noticeable from any angle. The folds of the nasolabial region and the “folds of sadness” are deeply embedded in the skin and lowered. In the area of the cheekbones, there is significant ptosis of soft tissues and loss of volume. The elasticity of the skin is lost, pigmentation is significantly pronounced on it.
Face and neck lifting techniques
Elimination of “bryli” and other age-related facial changes can be performed using various facelift techniques.
- Endoscopic facelift (facelift) (Subperiosteal Facelift) is one of the most modern facial plastic surgery techniques that combines a good rejuvenating effect, the least amount of scars and a relatively short period of postoperative rehabilitation. The operation is performed with the help of special endoscopic equipment equipped with a video camera that allows you to monitor the work of a plastic surgeon on a monitor. In the area of the scalp and, if necessary, in front of the auricle, several small (up to 2 cm) incisions are made through which the surgeon performs a subcostal facelift of facial tissues. At the same time, excess skin is not removed, so an endoscopic facelift is possible, mainly with early age-related changes in the face.
- MACS-facelift (Minimal Access Cranial Suspension Lift) is a modern facelift technique that leaves a minimal scar just in front of the auricle. With the help of MASS-lifting, rejuvenation of the cervical and chin zones is performed, the folds of the nasolabial region are smoothed out, “wings” are eliminated. The rehabilitation period is minimal. With a MASS-lift, excess skin is removed, and a strong vertical fixation of the lowered tissues is carried out. This technique is applicable in patients with varying degrees of age-related skin changes and is most effective with pronounced signs of aging of the neck area.
- Short-Scar facelift (Short-Scar Lift, SSFL) is a face-lifting technique performed through an incision in front of the auricle. The indisputable advantages of a lift with a short scar are a small injury and a short postoperative rehabilitation. Like MASS-lifting, this technique is not used in the presence of pronounced neck flabbiness in patients.
- Advanced cervical-facial facelift (Superficial Muscular Aponeurotic System Lift, SMAS-lifting) is the most well-known and widely used facial plastic surgery technique worldwide. SMAS is a complex of muscular-aponeurotic facial tissues, also susceptible to aging and gravitational drooping. SMAS is involved in changing facial expressions, helping a person to express their emotions: smile, grin, frown, etc. In the course of an extended cervical-facial facelift, incisions are made in front and behind the auricle with a visit to the scalp. The complex of muscular-aponeurotic tissues is mobilized and fixed in a new vertical position. SMAS-lifting is accompanied by a long rehabilitation period, but it is effective as a method of the most complete facial rejuvenation at all stages of age-related changes.
- Deep facelift (facelift) –The Deep Plane Lift) is a technique for lifting deeper layers of the face than with SMAS lifting. Detachment (mobilization) of tissues during deep lifting is carried out under a complex of muscular-aponeurotic tissues. Carrying out a deep facelift smoothes the labial and nasolabial folds, relieves “bryli”. Since a large thickness of tissues is involved in deep facelift, blood supply improves in them, and performing a deep lift can be recommended for smokers. On the other hand, performing a facelift of the deep layers of facial tissues increases the risk of injury to the motor branches of the facial nerves.
- Mid-third Facelift (Mid-Face Lift) is an isolated facelift technique used in patients who do not yet need to perform a full facelift. With its help, a rejuvenating effect of the eye area, cheekbones, cheeks, nasolabial triangle is provided.
The lifting of the middle third of the face can be carried out by two main approaches– temporal and subcutaneous.
In the first case, the operation is performed by an endoscopic method of two accesses in the hairy part of the temporal regions and consists in a diagonal lifting of tissues. Temporal access is achieved by correcting the appearance of the eyes, eyebrows and zygomatic area. The second technique of the median facelift is performed through a small subcutaneous incision of the lower eyelid and allows you to lift the lowered tissues vertically upwards.
- SOOF Lift (Suborbicularis Oculi Fat Lift) – this facelift technique is designed to re-place adipose tissue in the subglacial region, which allows you to correct the “sunken” look formed after blepharoplasty, during which the removal of adipose tissue under the eyes was performed.
- Temporal Lift is a facelift technique for lateral diagonal facelift of the upper third of the face. With its help, the corners of the eyebrows, upper eyelids, zygomatic fatty tissue and lowered cheek tissues are lifted, wrinkles are smoothed in the corners of the eyes. The temporal lift is performed through a small incision in the temporal zone of the hair and involves the removal of excess skin, detachment and movement of tissues diagonally upwards.
- Neck lift (Platysma Lift, Neck Lift, Platysmaplasty) Neck braces contribute to the creation of a pronounced chin-neck angle, getting rid of the “wings”, the second chin, sagging skin on the neck. In combination with SMAS-lifting, this technique of rejuvenation of aging neck skin surpasses the others in cosmetic effect.