The Subperiosteal Facelift
26 February 2003 (online)
The subperiosteal facelift is a procedure designed to rejuvenate the upper and middle thirds of the face. Herein we describe our experience using this technique for facial improvement. The operative indication is significant midfacial aging. The subperiosteal facelift is performed in a series of six consecutive steps: (1) Using either a buccal sulcus or a subciliary incision, the subperiosteal dissection of the maxilla, zygoma, lateral orbital rim, and anterior half of the zygomatic arch is carried out; (2)The temporal dissection is performed over the superficial layer of the deep temporal fascia. With endoscopic assistance, the dissection is continued over the frontal bone, lateral orbital rim, and zygoma connecting with the anterior dissection.
(3)At the level of the temporal fascial fusion, above the arch, the sentinel vein is identified, cauterized, and transected on its fascial side. This vein serves as a landmark for the inferior limit of dissection; (4)The posterior arch is then exposed; (5)The periosteum over the posterior arch is incised and entered. The subperiosteal arch dissection is completed. A subperiosteal tunnel along the entire length of the arch is completed; (6)The fusion of fascia superior to the midarch is then divided. The entire subperiosteal dissection of the midface and arch is completed, making it possible to advance the soft tissues of the midface over the bony framework of the face.
Herein, a combination procedure using a superficial musculoaponeurotic system (SMAS) galeal flap in the temporal area and an SMAS flap in the lower face is described. Also, a description of fat contouring and platysma surgery is included. The overall aesthetic results of this technique in combination with an endoscopic browlift are reviewed as well.
Subperiosteal facelift - mid facelift - zygomatic arch dissection
- 1 Tessier P. Face lifting and frontal rhytidectomy. In: Ely JF, ed. Transactions of the Seventh International Congress of Plastic and Reconstructive Surgery Rio de Janeiro, September 1979
- 2 Tessier P. Subperiosteal face-lift. Ann Clin Plast Esthet . 1989; 34 193-197
- 3 Ramirez O M, Maillard G F, Musolas A. The extended subperiosteal facelift: a definitive soft-tissue remodeling for facial rejuvenation. Plast Reconstr Surg . 1991; 88 227-236
- 4 Ramirez O M. The subperiosteal rhytidectomy: the third generation facelift. Ann Plast Surg . 1998; 28 218