Extended Deep Plane Facelift: Incorporating Facial Retaining Ligament Release and Composite Flap Shifts to Maximize Midface, Jawline and Neck Rejuvenation

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Key points

  • Deep plane facelifting targets the mobile medial superficial muscular aponeurotic system, bypassing the lateral fixed superficial muscular aponeurotic system dissected in these techniques.

  • Releasing facial and cervical retaining ligaments allows greater redraping of the superficial muscular aponeurotic system and platysma during rhytidectomy.

  • Extending the deep plane flap inferiorly into the neck and incorporating a platysmal myotomy creates a platysma hammock to define the inferior mandibular

Retaining Ligaments

Fully understanding the function and anatomy of the facial retaining ligaments is paramount to successful rejuvenation of the aging face. If not released, the mobility of facial tissues will be greatly inhibited. With ligamentous release, any applied traction to the lateral rhytidectomy flap can be fully transmitted to the medial facial soft tissues, allowing a natural and complete redraping. These concepts can be viewed as a natural extension to the same reconstructive principles used when

Preoperative Marking

The patient is positioned upright to be marked preoperatively (Fig. 8). The rhytidectomy incision is marked as well as the path of the temporal branch of the facial nerve, and the deep plane entry point. The deep plane entry point is marked as a line extending from the angle of the mandible to the lateral canthus. This places the area of SMAS manipulation anterior to the fixed lateral SMAS. A horizontal line is drawn across the neck at the level of the cricoid to mark the minimal inferior

Summary

The volumizing extended deep plane rhytidectomy is a safe procedure with superior outcomes in facial rejuvenation. A comprehensive understanding of the facial anatomy and pathophysiology of aging is imperative to incorporate this procedure successfully. The extended deep plane facelift incorporates additional ligamentous release of the face and neck to create durable redraping of face and neck ptosis redraping. This includes the zygomatic cutaneous, masseteric cutaneous, mandibular cutaneous,

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    Disclosure: The authors have nothing to disclose.

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