ABSTRACT
Techniques for facial rejuvenation have long involved specific remedies for each facial
segment affected by the aging process. Traditional facial rejuvenation techniques
have addressed the anterior neck and platysma complex as well as the acquired jowl
deformity. These techniques often left the nasolabial complex and the “infraorbital
hollow” unaddressed. Modern techniques, including the composite rhytidectomy, the
subperiosteal midface lift, and the deep-plane and the triplane rhytidectomy, have
contributed to redefining the challenge of correcting the problem of the orbicularis-malar
soft tissue complex descent and as such focus on a particular segment of the facial
rejuvenation. This evolution of the facelift demonstrates that one size does not fit
all and that surgeons should consider their rejuvenations to be not a generic facelift
but a midface, lower face, and neck lift. This concept has evolved into our appreciation
of distinct surgical zones. This is especially important in males, and adjunctive
techniques such as the ones we describe may add benefit and enhance the final result
in male patients. As discussed, the male anatomy, because of its increased surface
area and weight, is more difficult to gain leverage with in rejuvenation procedures.
The author describes his preferred technique for facial rejuvenation in males, the
subperiosteal deep plane rhytidectomy (SPDPR), which combines a deep plane rhytidectomy
with a subperiosteal dissection. Although combining subperiosteal “release” of midfacial
anatomy has been reviewed by other authors, the combination of subperiosteal release
and deep-plane rhytidectomy has not been previously reported or advocated. The operative
technique, complications, and results of this combined technique are reviewed. The
procedure as described is used as an isolated procedure for midfacial descent as well
as an incorporated technique when completing a “full” rhytidectomy.
KEYWORDS
Rhytidectomy - cheek lift - midface lift - facelift - subperiosteal facelift - fat
repositioning - deep plane rhytidectomy - jawl fat extraction - platysma
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