Secondary Upper Blepharoplasty: Converting Static Folds Into Dynamic Folds.

Background: For the patients seeking secondary upper blepharoplasty, a static double-eyelid fold featuring an immobile lower flap and depression of the fold is common.

Objectives: In this study, the authors propose a novel technique of reconstructing pretarsal tissue defects (PTDs) to converting static folds to dynamic folds.

Methods: A total of 203 patients with static folds underwent revision surgery.

Building the Composite Face Lift: A Personal Odyssey.

This article is a 42-year history of the development of a comprehensive face-lift technique by the author. It describes how the composite rhytidectomy has been constructed, anatomical area by anatomical area, over the author's lifetime career as a plastic surgeon. Over the course of these years, beginning with Skoog's 1973 description of using the platysma muscle of the lower face, it describes how progressively the other significant structures of anatomy necessary to be used in achieving significant rejuvenation have been analyzed by the author and in turn surgically repositioned.

Cosmetic Body Lift.

Background: High-tension lateral abdominoplasty provides ideal central contouring of the abdomen, but it inadequately addresses laxity and fullness in the flank and lateral thigh. The adjunct of liposuction improves abdomen contour, but excess flank soft tissue often persists. Small case series in the literature have suggested an extended abdominoplasty to address these deficits with variable outcomes.

Nuances of the Composite Face-lift Technique.

The composite face-lift is a well-described, comprehensive facial rejuvenation technique that results in harmonious repositioning of all components of the aging face. It is distinguished by the superior-medial movement of the cheek and the septal reset maneuver. The composite rhytidectomy reverses the unbalanced vectors of the traditional face-lift in patients with the lateral sweep and may reestablish the youthful convexity in patients with hollow eyes.

Identical twin face lifts with differing techniques: a 10-year follow-up.

To evaluate the efficacies of four different surgical techniques in facial rejuvenation, two sets of identical twins were operated on by four different surgeons. The technical approaches to facial rejuvenation included lateral superficial musculoaponeurotic system (SMAS)-ectomy with extensive skin undermining, composite rhytidectomy, SMAS-platysma flap with bidirectional lift, and endoscopic midface lift with an open anterior platysmaplasty. All patients were photographed by an independent surgeon at 1, 6, and 10 years postoperatively.

Extended superficial musculaponeurotic system dissection and composite rhytidectomy.

The composite facelift represents a comprehensive technique for facial rejuvenation with tissue repositioning of essentially every deep structure of the aging face, addressing the neck, lower face, mid face/lower eyelid junction, and forehead. The superior lateral vector of the lower face is "balanced" with a superior medial vector of the cheek and lower eyelid region. Patients who have stigmata of a previous facelift, such as the lateral sweep and hollow eyes, may be corrected with the composite facelift.

Continuing medical education article-facial aesthetic surgery: Septal reset in midface rejuvenation.

Septal reset in midface rejuvenation creates a youthful lower eyelid-cheek junction, shortening the vertical height of the lower eyelid. The author recommends this technique in secondary procedures to correct hollow lower eyelids and lateral sweep of the lower face, and in primary procedures to prevent these face lift stigmata.

The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation.

Resetting of the septum orbitale over the orbital rim, or "septal reset," is the latest step in achieving periorbital rejuvenation in composite rhytidectomy. The first significant step was the addition of orbicularis repositioning to conventional lateral vector deep plane rhytidectomy, followed by orbital fat preservation using the arcus marginalis release and fat transposition over the orbital rim. Those early procedures have been further refined to include the zygomaticus muscles with the orbicularis oculi in the composite flap, or zygorbicular cheek flap, and a septal reset.

A study of the long-term effect of malar fat repositioning in face lift surgery: short-term success but long-term failure.

In 1990, the author reported on a series of 403 cases of deep plane face lifts, the first published technique describing the repositioning of the cheek fat, known as malar fat, in face lift surgery. This study examines the long-term results of 20 of the original series in an attempt to determine what areas of the rejuvenated face (specifically, the malar fat) showed long-term improvement. The results were judged by comparing the preoperative and long-term postoperative views in a half-and-half same-side hemiface photograph.