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Facial Plast Surg 2020; 36(04): 351-357
DOI: 10.1055/s-0040-1714267
Original Article

Demystifying the Deep Plane Facelift: What It Means Anatomically and Why It Works

Jonathan Sykes 
1   Department of Otolaryngology, UC Davis Medical Center, Davis, California
2   Department of Facial Plastic Surgery, The Roxbury Institute, Beverly Hills, California
,
Amanda Dilger
3   Department of Facial Plastic and Reconstructive Surgery, Roseville Facial Plastic Surgery, Roseville, California
,
Sebastian Cotofana
4   Department of Clinical Anatomy, Mayo Clinic, Rochester, Minnesota
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Abstract

Rhytidectomy is a common procedure performed by facial plastic surgeons. On well-selected patients, rhytidectomy rejuvenates the aging face by repositioning soft tissues and improving facial shape. The fundamental goal of rhytidectomy, or facelift surgery, is to provide a more youthful facial appearance by elevating soft tissues that often descend with aging. The success and longevity of any rhytidectomy procedure are based on the individual patient's anatomy and aging and on the mobilization, elevation, and fixation of the soft tissues during the facelift procedure. Although surgeons often use many terms to describe a given facelift technique, anatomical terms are best used to name the facelift procedure, as the plane of dissection and the vector of elevation are what determines the end result. This paper attempts to simplify and demystify the deep plane facelift procedure and to describe the anatomy that makes this technique successful.

Keywords

rhytidectomy - facelift - anatomy - deep plane facelift


Publication History

Article published online:
31 August 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Gosain AK, Amarante MT, Hyde JS, Yousif NJ. A dynamic analysis of changes in the nasolabial fold using magnetic resonance imaging: implications for facial rejuvenation and facial animation surgery. Plast Reconstr Surg 1996; 98 (04) 622-636
    CrossrefPubMedGoogle Scholar
  • 2 Gosain AK, Klein MH, Sudhakar PV, Prost RW. A volumetric analysis of soft-tissue changes in the aging midface using high-resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg 2005; 115 (04) 1143-1152 , discussion 1153–1155
    CrossrefPubMedGoogle Scholar
  • 3 Cotofana S, Lachman N. Anatomy of the facial fat compartments and their relevance in aesthetic surgery. J Dtsch Dermatol Ges 2019; 17 (04) 399-413
    CrossrefPubMedGoogle Scholar
  • 4 Sykes JM, Riedler KL, Cotofana S, Palhazi P. Superficial and deep facial anatomy and its implications for rhytidectomy. Facial Plast Surg Clin North Am 2020; 28 (03) 243-251
    CrossrefPubMedGoogle Scholar
  • 5 Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg 1992; 89 (03) 441-449 , discussion 450–451
    CrossrefPubMedGoogle Scholar
  • 6 Fomon S. The Surgery of Injury and Plastic Repair. Baltimore, MD: Williams & Wilkins; 1939
    Google Scholar
  • 7 Skoog T. Plastic Surgery: New Methods. Philadelphia, PA: Saunders; 1974
    Google Scholar
  • 8 Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg 1976; 58 (01) 80-88
    CrossrefPubMedGoogle Scholar
  • 9 Marten TJ. High SMAS facelift: combined single flap lifting of the jawline, cheek, and midface. Clin Plast Surg 2008; 35 (04) 569-603 , vi–vii
    CrossrefPubMedGoogle Scholar
  • 10 Trussler AP, Hatef D, Broussard GB, Brown S, Barton FE. The viscoelastic properties of the SMAS and its clinical translation: firm support for the high-SMAS rhytidectomy. Plast Reconstr Surg 2011; 128 (03) 757-764
    CrossrefPubMedGoogle Scholar
  • 11 Hamra ST. The deep-plane rhytidectomy. Plast Reconstr Surg 1990; 86 (01) 53-61 , discussion 62–63
    CrossrefPubMedGoogle Scholar
  • 12 Hamra ST. Composite rhytidectomy. Plast Reconstr Surg 1992; 90 (01) 1-13
    CrossrefPubMedGoogle Scholar
  • 13 Adamson PA, Dahiya R, Litner J. Midface effects of the deep-plane vs the superficial musculoaponeurotic system plication face-lift. Arch Facial Plast Surg 2007; 9 (01) 9-11
    CrossrefPubMedGoogle Scholar
  • 14 Litner JA, Adamson PA. Limited vs extended face-lift techniques: objective analysis of intraoperative results. Arch Facial Plast Surg 2006; 8 (03) 186-190
    CrossrefPubMedGoogle Scholar
  • 15 Kamer FM, Frankel AS. SMAS rhytidectomy versus deep plane rhytidectomy: an objective comparison. Plast Reconstr Surg 1998; 102 (03) 878-881
    CrossrefPubMedGoogle Scholar
  • 16 Jacono AA, Alemi AS, Russell JL. A meta-analysis of complication rates among different smas facelift techniques. Aesthet Surg J 2019; 39 (09) 927-942
    CrossrefPubMedGoogle Scholar
  • 17 Sykes JM, Liang J, Kim JE. Contemporary deep plane rhytidectomy. Facial Plast Surg 2011; 27 (01) 124-132
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Jacono A, Bryant LM. Extended deep plane facelift: incorporating facial retaining ligament release and composite flap shifts to maximize midface, jawline and neck rejuvenation. Clin Plast Surg 2018; 45 (04) 527-554
    CrossrefPubMedGoogle Scholar
  • 19 Jacono AA, Ransom ER. Patient-specific rhytidectomy: finding the angle of maximal rejuvenation. Aesthet Surg J 2012; 32 (07) 804-813
    CrossrefPubMedGoogle Scholar