What it means for a patient
- This is a deep plane face lift variation that lifts the cheek and the lower eyelid area as one unit.
- The author reports that the change removed occasional long-lasting swelling and temporary muscle movement problems.
- The author presents eyelid-area rejuvenation as part of the face lift, and states it can prevent unfavorable results of a conventional face lift plus lower blepharoplasty.
- Limits: one surgeon's technique description with no numbers, comparisons or measured outcomes in the abstract.
Why this paper matters
It defines a midface dissection plane for composite rhytidectomy and presents periorbital rejuvenation as an integral part of facial rejuvenation.
Overview
Composite rhytidectomy added repositioning of the orbicularis oculi muscle to the deep plane face lift so that the eyelid area is lifted with the face. This paper describes a change in the midface dissection, called the zygorbicular dissection, and a change to the arcus marginalis release. The abstract reports no patient numbers.
Findings
- The orbicularis oculi is not separated from the zygomaticus minor.
- The dissection is extended under the medial portions of the zygomaticus major and minor muscles.
- A thin, nonrestrictive mesentery is left between the deep plane dissection and the zygorbicular dissection.
- This still allows vertical movement of the composite face lift flap without breaking the link between platysma, cheek fat and orbicularis oculi.
- The modification eliminates the occasional prolonged edema and the occasional temporary dystonia previously observed.
- The arcus marginalis release is kept, modified by resetting the septum orbitale over the orbital rim.
- The author states the two modifications give a more predictable result.
Terms
- Composite rhytidectomy: a deep plane face lift that also repositions the muscle around the eye.
- Deep plane face lift: a face lift that lifts skin and the deeper tissue layer together as one flap.
- Orbicularis oculi: the ring muscle around the eye that closes the eyelids.
- Zygomaticus major and minor: cheek muscles that lift the corner of the mouth and upper lip.
- Mesentery: here, a thin bridge of tissue left intact between two dissected areas.
- Arcus marginalis release: freeing the tissue attachment at the bony rim below the eye.
- Septum orbitale: the thin sheet that holds the eye socket fat in place.
- Dystonia: abnormal or poorly controlled muscle movement.