A Systematic Review and Comparative Analysis of Reconstructive Rhytidectomy: Advantages, Disadvantages, and Patient Outcomes.

Reconstructive rhytidectomy, commonly known as facelift surgery, is a prominent cosmetic procedure aimed at rejuvenating facial appearance by addressing signs of aging. This paper critically evaluates the advantages and disadvantages of various surgical techniques involved in rhytidectomy, including the superficial musculoaponeurotic system (SMAS), deep plane facelift, and subperiosteal approaches. This systematic review of recent literature highlights key outcomes such as scar quality, postoperative pain management, and patient satisfaction.

Update: Prevention and Treatment of Parotid/Submandibular Gland Fistula/Sialocele Following Rhytidectomy with Botulinum Toxin A.

Dissecting deep to the superficial musculoaponeurotic system, SMAS, a popular option for facelifts, has the potential for injury to the parotid gland leading to post operative sialoceles and fistulas. Similarly, deep plane procedures in the neck which include partial submandibular gland resection may lead to salivary gland leaks. We previously described the management of sialocele following rhytidectomy.

Full SMAS: Endoscopy-Assisted Full Facial Rejuvenation.

Background: Every region of the face may bear the signs of aging. Treating isolated areas without adequate anatomical knowledge can lead to incomplete or artificial-looking results and decrease patient satisfaction. The authors' "Full SMAS" technique for complete rejuvenation addresses the anatomical continuity of the superficial musculoaponeurotic system (SMAS)-platysma to the deep-plane suspension of the face.

Limited Delamination Modifications to the Extended Deep Plane Rhytidectomy: An Anatomical Basis for Improved Outcomes.

This study introduces variations of a limited delamination approach to the deep plane face- and necklift. To report surgeons' perceptions of limited delamination deep plane rhytidectomy, define the anatomical basis to support these modifications, and report complication rates. This retrospective multi-institutional chart review study of patients undergoing a modified classical deep plane face- and necklift.

Evaluating the Effectiveness of the High-SMAS Facelift Technique: Objective Clinical Outcomes at 1-year.

Background: The primary goal of the facelift is to rejuvenate the face without changing its natural features. This involves working on the deeper layers to preserve the surface look while adjusting the fat pads beneath. Thus, we often use a modified High-SMAS facelift method, following this deep-layer approach.

Male Deep-Plane Face and Neck Lifting: Advanced and Customized Techniques.

In this article, the authors describe their preferred advanced deep-plane techniques and modifications that have universally improved outcomes and durability in both men and women. Performing a proper extended deep-plane facelift and neck lift avoids the need to camouflage scars and stigmata of lifts seen in superficial musculoaponeurotic system plication and other techniques. In the author's experience, vertical vector deep-plane surgery is more durable, natural, and less reliant on lipofilling and volume addition.

Why Deep Plane Face and Neck Lifting Results in the Maximum Short- and Long-term Results? My Primary Choice for Rhytidectomy in My Practice.

I converted to the extended deep plane facelift and neck lift with a shorter skin flap elevation in the face to achieve a more complete release of the facial ligaments to obtain more mobilization of the skin/superficial musculoaponeurotic system composite flap, and a more medial suspension resulting in improved correction of the midface, nasolabial fold, marionette fold and jowl. Treatment of the deep neck structures allowed for more refinement of the submentum in the deep neck lift procedures as well. In this article, we shall review the surgical technique of the deep plane facelift and neck lift as well as postoperative management pearls, the management of complications from the procedure, and the incorporation of ancillary procedures.

Anatomical Insights on the Cervical Nerve for Contemporary Face and Neck Lifting: A Cadaveric Study.

Background: Despite the significant roles it plays in the functions of the platysma and lower lip, the cervical branch of the facial nerve is often overlooked compared to other branches, but its consideration is critical for ensuring the safety of neck surgeries.

Objectives: The aim of this study was to clarify the anatomical discrepancies associated with the cervical branch of the facial nerve to enhance surgical safety.

Methods: The study utilized 20 fresh-frozen hemiheads.

An Innovative Treatment Using Calcium Hydroxyapatite for Non-Surgical Facial Rejuvenation: The Vectorial-Lift Technique.

Background: The facial aging process entails alterations in the volume, shape, and texture of all skin layers over time. Calcium hydroxyapatite (CaHA) is a well-established safe skin filler with unique properties to resolve some skin alterations by stimulating neocollagenesis. The vectoral-lift (V-lift) technique targets the global repositioning of facial structures by addressing distinct anatomical injection planes.

A New Multiplane Dissection Method for Frontotemporal Lift and Fixation.

Lifting procedures of the upper face have gained significant popularity, and various methods and dissection planes have been described. The deep temporalis fascia (DTF) is a crucial structure for securing lifting sutures and allowing horizontal tissue vectorization. However, achieving vertical eyebrow lifting often requires bone maneuvers and introduces potential complications.

CORE High-SMAS Extended Deep Plane Facelift Technique: How it Evolved.

Extended deep plane techniques have become the benchmark of facelift surgery. Yet these techniques assume release of the medial most of zygomatic retaining ligaments, which makes them rather complex and highly dependent on training and experience. In this article, we will review and describe the adapted extended high-superficial musculoaponeurotic system (SMAS) approach of the author and discuss the obstacles that can be encountered mastering this technique.

The Evolution of My Extended SMAS-Biplanar Deep Plane Facelift to a Composite Tissue Deep Plane Face and Neck Lift: Similarities and Differences.

In this article, Dr. Stephen W. Perkins, a seasoned facial plastic surgeon, presents his refined techniques in facelift surgery developed over four decades of practice.

Extended Composite Approach to Deep Plane Face Lifting with Deep Contouring of the Neck and the Nuances of Secondary and Tertiary Facelifting: Principles for Restoration of Natural Anatomy and Aesthetically Attractive Face and Neck Contour.

Patients seek second facelifts either due to dissatisfaction with the primary procedure or years later after continued face and neck aging following successful first surgery. Previous surgical anatomical disruption, deformity of tension and vector, scar formation and skin excision compounded by the proliferation of historical energy-based skin treatments, thread lift procedures, and injectables make revision rhytidectomy a complex process of causal identification and surgical repair. Patients seeking revision due to dissatisfaction with a primary procedure, or worse visible deformity, have a heightened sense of anxiety which necessitates accurate diagnosis, careful examination, comprehensive documentation, and confidence in any planned secondary intervention as well as conservative expectation management.

Vectorial Analysis of Deep Plane Face and Neck Lift.

Background: The vector of aging and consequently the vector of lift in rhytidectomy has aided surgeons in improving movement of tissues during facial rejuvenation procedures.

Objectives: The goal was to analyze the vector of lift in patients undergoing primary and revisional facelift to achieve proper vectorial lifting.

Methods: Patients undergoing deep-plane facelift surgery were included for analysis.

LigaSure-Assisted Submandibular Gland Excision in Deep-Plane Neck Lift: Review of 83 Patients.

Background: In performing a neck lift, the size and location of the submandibular gland (SMG) must be evaluated to achieve the ideal neck contour. Many surgeons, however, avoid SMG excision because of the technical difficulty and risks of hematoma and nerve damage. LigaSure (Valleylab, Boulder, CO) is a bipolar energy-based instrument that permanently seals vessels and connective tissue.

Advanced Deep-Plane Rhytidectomy: Advantages for Neck Treatment and Volumization of the Midface.

The aged neck is the most common motivator for patients seeking facial rejuvenation. Unlike the deflated midface, surgical treatment is still the gold standard for optimal outcomes. It is our view that the majority etiology of both the aged neck and deflated midface is gravity's effects on the superficial soft tissue envelope, leading to soft tissue redundancy.

Rotation of a Part of the Composite Flap for Simultaneous Gonion Reduction and Malar Augmentation During Rhytidectomy in Asians.

Background: The desired facial shape that Asians aim to achieve through plastic surgery differs from that of westerners.

Objectives: The author facilitates facial volume deflation by using the rotation of a part of the composite flap to the malar area resulting in volumetric augmentation during rhytidectomy; simultaneously, a volumetric reduction was implemented in the gonion.

Methods: Extended deep plane rhytidectomy with the rotation of a part of the composite flap was performed in 49 patients, whereas extended deep plane rhytidectomy without the rotation of a part of the composite flap was performed in 20 patients.

The Nuances and Techniques of Deep Plane Face and Neck Lifting to Maximize the Defined Neck and Jawline and Obtain a Sharp and Beautiful Neck Contour.

This article seeks to expand on our understanding of lifting by utilizing the benefits of deep plane release and repositioning. The deep plane is a more logical and natural approach to lifting of the face and neck, lifting along the natural anatomic glide planes. Deep plane face and neck lifting have demonstrated superior results in the authors' experience with less dependence on ancillary measures such as fat grafting or implantation for midface volumization.

The Detailed Anatomy of the Deep Plane of the Face and Neck with Current Nomenclature.

The fundamental goal of modern face and neck lifting is to enhance and restore a more youthful facial appearance by addressing soft tissue descent. There are variations in described facelift technique including superficial musculoaponeurotic system (SMAS) flaps, composite flaps, deep plane, skin flaps, and subperiosteal facelifts, among others. The term "deep plane rhytidectomy" was originally described by Hamra.

Facial Nerve Considerations for the Deep Plane Facelift and Neck Lift.

The surgical approach to facial rejuvenation has evolved significantly over the last century. As surgeons have deepened their understanding of facial anatomy over the last half century, so have their surgical approaches to the rhytidectomy, with increasingly extensive manipulation of the underlying soft tissue in the face. While these procedures have become more comprehensive and natural in their approach, the risk of temporary facial palsy also appears to be on the rise.