ABSTRACT
The central oval of the face is a distinct anatomic and aesthetic unit. Early signs
of aging and advanced features of aging are manifested primarily in this unit. Standard
face lift techniques are ineffective in treating this area. Intermediate layer (sub-SMAS,
[superior musculo-aponeurotic system], intermuscular, etc.) and deep layer (subperiosteal)
techniques were developed to treat this rather difficult part of the face. All variations
of the intermediate layer technique have negative features, primarily safety issues
related to potential nerve-muscle injury and protracted facial edema. Early described
subperiosteal techniques (open, first generation endoscopic) were also associated
with these types of complications. The author has outlined 14 principles of the ideal
technique for the rejuvenation of the central oval. The advances and modifications
to the first and second generation endoscopic central oval rejuvenation method comply
with these principles. There are several principles that distinctly separate it from
all other techniques: (1) direct approach to the central oval; (2) interconnected
subperiosteal plane of dissection to the upper and midface; (3) use of small hidden
slit incisions; (4) absence of eyelid incisions; (5) use of endoscopic techniques;
and (6) absence of traction on skin or SMAS from the peripheral hemicircle. Another
important advance made in this approach is the manipulation of soft tissues in the
brow, glabella, cheek, and chin to provide a tridimensional rejuvenation. This was
lacking in all previously described procedures. This method has been used with several
modifications in over 500 patients. Aesthetic results have been excellent, with minimal
sequela and a low complication rate. The subset of patients in whom this third generation
endoscopic subperiosteal approach has been used have also had a three-dimensional
remodeling and enhancement. The aesthetic results and safety factors surpass all other
previously described techniques done at the intermediate or deep layers of the face.
KEYWORD
Central oval - 3-D rejuvenation - Tridimensional rejuvenation - 3-D face lift
