Male Deep-Plane Face and Neck Lifting: Advanced and Customized Techniques.

In this article, the authors describe their preferred advanced deep-plane techniques and modifications that have universally improved outcomes and durability in both men and women. Performing a proper extended deep-plane facelift and neck lift avoids the need to camouflage scars and stigmata of lifts seen in superficial musculoaponeurotic system plication and other techniques. In the author's experience, vertical vector deep-plane surgery is more durable, natural, and less reliant on lipofilling and volume addition. The subtleties of examination and analysis, surgical technique, clinical outcomes, and gender-specific considerations in the reconstruction of gonial and cervicomental angles, deep planar volumetric reduction, facial volumetric change, limited skin delamination, and revision techniques are discussed.

Assessment of deep plane facelift combined with fascia lata graft for the static treatment of facial palsy: A preliminary report.

Addressing facial palsy (FP) presents intricate challenges in achieving natural expressions. Although free functional muscle transfers (FFMT) offer effective smile restoration, age impacts their efficacy. The optimal FFMT age range of 5-55 years is limited by physical fitness, which extends beyond age boundaries. Unilateral FP demands vary; younger patients require dynamic solutions like FFMT, whereas older individuals prioritize public appearance due to baseline distortion. The aim of this study is to describe and to assess a new static technique combining deep plane facelift and fascia lata graft for FP treatment. We conducted a prospective pilot study enrolling unilateral FP patients aged >55 and declining FFMT. Exclusions encompassed prior FP surgery, recent injections, uncontrolled diabetes cognitive deficits, and patients unable to quit smoking. To evaluate this technique, the Glasgow Benefit Inventory (GBI), along with two objective scales, the Face- and Neck-Lift Objective Photo-Numerical Assessment Scale and the eFACE scale, were used. Interrater reliability and intrarater reliability were assessed. Fifteen patients (mean age: 60.9 years) underwent the procedure. Both static and dynamic symmetry significantly improved (p < 0.05), including check volume and position, oral commissure, and jawline. Notably, eye closure enhancement was observed. GBI scores also significantly increased (p < 0.05). Interrater reliability and intrarater reliability were minimal (p = 0.12 and p = 0.13). This combined approach offers a static FP treatment option, especially for the elderly or FFMT-ineligible patients. The relatively brief procedure yields immediate and satisfactory results, suggesting its potential value in FP management. Further comprehensive studies are encouraged to validate the technique's long-term efficacy and applicability across larger populations.

El lifting cervicofacial de plano profundo: Presentación de la técnica y resultados

Objetivo: El lifting cervicofacial es una técnica que busca devolver una apariencia juvenil y descansada al rostro del paciente. Originalmente, esta técnica se limitaba solamente a una disección en el plano cutáneo. El lifting de plano profundo o deep plane facelft, en cambio, utiliza un plano de disección anatómico por debajo del sistema musculoaponeurótico superficial (SMAS), permitiendo la lisis de los ligamentos de retención faciales y la máxima movilización de los tejidos superficiales, confiriéndole ventajas frente a otras técnicas. Se describe la técnica y se presenta nuestra experiencia. Material y Método: Serie de casos retrospectiva de pacientes sometidos a lifting de plano profundo en nuestro centro. Se describe la técnica quirúrgica, datos demográficos, antecedentes médico quirúrgicos y complicaciones post-operatorias. Resultados: Entre enero de 2021 y junio de 2023 se operaron 18 pacientes, todos de sexo femenino con un promedio de edad de 58,7 años. Solo 2 pacientes presentaron complicaciones (hematoma). Ningún paciente presentó lesión del nervio facial transitoria o permanente. Ningún paciente necesitó re-operación. Discusión y conclusión: La técnica de lifting de plano profundo o deep plane facelft es un método seguro y efectivo para tratar los signos del envejecimiento facial. Las complicaciones descritas por nuestro grupo son acordes a la literatura.

Aim: The facelift is a technique that aims to restore a more youthful and rested appearance to the aging face. Originally it was limited to a skin dissection only. The deep plane facelift, on the other hand, uses an anatomical dissection plane below the superficial muscular aponeurotic system (SMAS), allowing lysis of the facial retention ligaments and maximum mobilization of superficial tissues, with better outcomes than other techniques. The technique is described and our experience is presented. Material and Method: Retrospective case series of patients undergoing deep plane facelift. The surgical technique, demographic data, surgical medical history, and postoperative complications are described. Results: Between January 2021 and June 2023, 18 patients were operated, all female with an average age of 58,7 years old. Only 2 patients presented complications (hematoma). No patient presented facial nerve injury. No patient required re-operation. Discussion and Conclusion: The deep plane facelift is a safe and effective method to treat the signs of the aging face. The complications described are consistent with the literature.

Assessment of deep plane facelift in facial feminization surgery: A prospective pilot study.

Facial feminization surgery (FFS) is often the first procedure requested by patients wishing to undergo gender-affirming surgery. This study aims to evaluate the applicability and effectiveness of deep plane facelifts in FFS. The authors conducted a prospective study that included patients who requested a deep plane facelift as a standalone procedure to achieve a more feminine facial appearance as the only procedure of FFS. These patients underwent deep plane facelifts to achieve a more feminine oval face shape and increased tissue projection of the zygomatic-malar region. To assess the effectiveness of the procedure and patient satisfaction, the Face-Q scales, Face and Neck lift Objective Photo-Numerical Assessment Scale, the Satisfaction With Life Scale, and the Subjective Happiness Scale were applied preoperatively and one year after surgery. Thirty-six patients were included in the study. A statistically significant difference (p < 0.005) was observed between pre and postoperative scores. The repositioning of the malar fat pads increased the malar volume, providing a more oval overall shape of the face, which is typically feminine. No major complications were observed. Despite our encouraging results, new studies with a larger sample of patients are needed to support the benefits of the deep plane facelift as part of FFS to elevate this technique from an ancillary to a routine procedure for patients undergoing gender affirmation surgery.

Deep Plane Anatomy for the Facelift Surgeon: A Comprehensive Three-Dimensional Journey.

Strong command of facial anatomy is paramount for all facelift surgeons. A comprehensive understanding of how aging impacts facial anatomy is equally important for effective preoperative evaluation of the patient undergoing facelift surgery. Key areas for assessment of the patient undergoing facelift surgery are addressed. This article highlights and summarizes the high-yield anatomic pearls in facelift surgery, particularly in sub-SMAS (superficial musculoaponeurotic system) dissection techniques. Emphasis is placed on the depth and transitions of the facial nerve branches and the sub-SMAS potential spaces and their role in deep plane facelift dissection. Key anatomic structures in the deep neck are described.

Extended Superficial Musculoaponeurotic System Flap Rhytidectomy.

The various rhytidectomy techniques share a common goal of safe repositioning of the facial soft tissues with a lasting effect. This article reviews rhytidectomy approaches and the current methods and practice patterns of the senior author. It includes a discussion of the extended sub-superficial musculoaponeurotic system rhytidectomy technique, which, in the opinion of the senior author, offers the best result with respect to neck rhytids, cervicomental angle and jawline definition, and improvement of jowling. With its ability to be readily coupled with a deep plane dissection, when indicated, this technique becomes indispensable in the facial plastic surgeon's armamentarium.

A Novel Volumizing Extended Deep-Plane Facelift: Using Composite Flap Shifts to Volumize the Midface and Jawline.

Traditional superficial musculoaponeurotic system (SMAS) facelifting surgery uses a laminar surgical dissection. This approach does not treat areas of facial volume loss, and requires additional volume supplementation with fat grafting or fillers. The novel volumizing extended deep-plane facelift uses a composite approach to the facelift flap. By incorporating a platysma myotomy in the extended deep-plane flap, a novel composite transposition flap can be created that revolumizes the posterior jawline, recreating a defined convex jawline of youth. Special attention is paid to the deep anatomy of the face, and the need for release of the facial ligaments.

Extended Deep Plane Facelift: Incorporating Facial Retaining Ligament Release and Composite Flap Shifts to Maximize Midface, Jawline and Neck Rejuvenation.

This article describes our extended, deep plane facelift technique. This procedure releases 4 key retaining ligaments in the face and neck, the zygomatic cutaneous, masseteric cutaneous, mandibular cutaneous, and cervical retaining ligaments. Once released, the composite deep plane flap is repositioned to volumize the midface and gonial angle. Important anatomic considerations during deep plane dissection are discussed. In the neck, focus is on extending the deep plane dissection of the platysma, releasing the cervical retaining ligaments, creating a platysmal hammock to support the submandibular gland, defining the inferior mandibular contour, and minimizing the need to open the neck.

Vertical neck lifting.

The authors' vertical neck lifting procedure is an extended deep plane facelift, which elevates the skin and SMAS-platysma complex as a composite unit. The goal is to redrape cervicomental laxity vertically onto the face rather than laterally and postauricularly. The authors consider this an extended technique because it lengthens the deep plane flap from the angle of the mandible into the neck to release the cervical retaining ligaments that limit platysmal redraping. This technique does not routinely use midline platysmal surgery because it counteracts the extent of vertical redraping. A majority of aging face patients are good candidates for this procedure in isolation, but indications for combining vertical neck lifting with submental surgery are elucidated.