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Deep plane facelifting targets the mobile medial superficial muscular aponeurotic system, bypassing the lateral fixed superficial muscular aponeurotic system dissected in these techniques.
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Releasing facial and cervical retaining ligaments allows greater redraping of the superficial muscular aponeurotic system and platysma during rhytidectomy.
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Extending the deep plane flap inferiorly into the neck and incorporating a platysmal myotomy creates a platysma hammock to define the inferior mandibular
Extended Deep Plane Facelift: Incorporating Facial Retaining Ligament Release and Composite Flap Shifts to Maximize Midface, Jawline and Neck Rejuvenation
Section snippets
Key points
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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2022, Facial Plastic Surgery Clinics of North AmericaCitation Excerpt :As an ancillary procedure, the release of the mandibular retaining ligaments (Fig. 7) effectively addresses the prejowl sulcus and marionette lines and is often a prerequisite. Due to its proximity to the marginal branch of the facial nerve, a subcutaneous plane through a midline submental incision is preferred as a safe approach.72 Additional procedures may be beneficial for the management of mid-facial volume either through restoration by autologous fat transfer or reduction with buccal fat pad removal in some ethnicities/individuals.
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2021, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :By sampling the skin of nine patients post rhytidectomy, histology provided sufficient evidence that—epidermal thickness significantly increased and collagen and elastic fibers were more condensed after surgery than before—suggesting a dermal regeneration after face lift. It has echoed dozens of previous reports that subperiosteal dissection of the facial soft tissues and upward repositioning allow an efficient, natural, harmonious, and long-lasting result.17 The major limitation of this method is the potentially steep learning curve required to conduct extensive subcutaneous dissection through a distant and short incision.
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Disclosure: The authors have nothing to disclose.