ABSTRACT
The structural rejuvenation has two goals: the treatment of the face and neck area as a whole, and the building up of the facial features. By treating the neck from the mandible to the "decolleté" (the clavicular region), the first goal gives harmony. It avoids a too smooth face being the cover up of a wrinkled turtle neck. The second goal tries to produce nature beautiful faces, instead of the "Barbie dolls" faces with their unfortunately well-known ageless flat blank look. It is then necessary to manage the two kinds of structural defects, the youth's and the aging ones. The first ones are the lack of the anterior cervical angle, malar, chin hypogenesia. The second ones are the vanishing of the structural features of the youth. Treating each layer separately, working with the grain or on the cross according to the tissues and the goal, gives a youthful and natural look. Just lifting them up provides a flat face, the same way spreading a sheet over an object flattens it. On the contrary turning around it produces a good enhancement. To obtain this result the author privileges two muscles, the platysma and the orbicularis oculi muscle. She uses them in the same way to treat not only the area, but the slackness of the muscles themselves. The author updates her first technique: the double flap cervical platysmaplasty (DFCP). Then, she describes the two versions of the orbicularis oculi plasty: simple or in association with the DFCP. She works with the orbicularis flaps as if they were the reins of a horse. She pulls them around turning points. She obtains some of them by not undermining the skin as for the "malar turning point". She makes the others by suturing the flaps to the fascia at specific points. The results over 500 cases, some of them 4 years old, rate good. The report shows no complications, particularly no permanent neither transient palsy.
