The eutrophic rhytidoplasty: Subdermal tunneling and minimal skin undermining

Abstract

BACKGROUND: Patients submitted to rhytidectomy usually relay their desire for briefer surgical procedures and a shorter post-operative period with faster recovery. In view of this, a technique in which the skin of the cervico-mandibular region is not undermined but only detached by blunt dissection was developed. METHODS: A retrospective study of the senior author's experience in eutrophic rhytidoplasty (EUR), the technique proposed herein, for facial rejuvenation was conducted. Patients submitted to EUR over a 10-year period were included in this study. A total of 224 interventions were performed. The procedure consists of using subdermal tunneling, performed with a cannula along the neck region and the midface area (combined or not with liposuction in certain areas, as needed), thus preserving nervous and vascular connections. The conventional skin undermining is minimal, just 4 cm around the auricular pavilion. Data were collected from the patients' medical records at Interclínica-Centroplástica Clinic in Rio de Janeiro, Brazil. RESULTS: Due to the skin eutrophic conditions, the operated patients, using the EUR technique, presented promising esthetical results. The mean rate of complications associated with the proposed technique was 1.7 %. The author found that this technique offers very promising results, a fact evidenced by the lower rate of complications among patients submitted to it. CONCLUSIONS: The EUR is a reliable option for facial rejuvenation due to the fact that it is less invasive, with a low morbidity and rate of complications. Its surgical time is reduced by 50 %, it has a shorter down-time, and yields natural results. Level of Evidence: Level IV, therapeutic study.

Fig. 1

a EUR facial landmarks. Black dotted line nasogenian fold. Blue dotted line limit of tunneling with cannula. Green dotted line limit of the undermining with scissors. Red line plicature lina. b Trans-operative landmarks. All compromised regions in the demarcated areas show the tunneling with a cannula

Fig. 2

Flat tip cannula, 2-mm diameter (“shark head”)

Fig. 3

Aspects of subdermal tunneling performed with a cannula in the cervico-mandibular region

Fig. 4

a Submandibular sculpting through submental liposuction of fat deposits, done before subdermal tunneling. b Subdermal tunneling up to the mandibular line. Observe the fat deposit areas already sculpted

Fig. 5

a, b Area of approximately 4 cm around the auricular pavilion undermined with scissors to allow SMAS plicature and excess skin resection

Fig. 6

Details of SMAS plicature. Plication is parallel to the nasogenian fold or slightly divergent in the cervical region if the surgeon desires to emphasize the vertical traction using separated inverted stitches with nylon 3-0

Fig. 7

Traction of excess skin in a posterosuperior direction

Fig. 8

a Minimal skin undermining performed with scissors approximately 4 cm around the auricular pavilion. b After plication, the undermined area is reduced from 4 to 2 cm

Fig. 9

a Image showing the lifted skin exposing the trabeculae and blood vessels. b Tunnels and trabeculae aspects after tunneling

Fig. 10

Left pre-operative photographs of a 48 years old woman. Right post-operative photographs taken 9 months after the patient underwent to EUR. In two basic postures: straight on and profile. Blepharoplasty and malar lipofilling were performed

Fig. 11

Left preoperative photographs of a 46 years old woman. Right late postoperative photographs taken 36 months after the patient underwent to EUR, in frontal and lateral views. Blepharoplasty, liposuction of fat deposits areas, lipofilling of malar area, mandibular angle and lips were associated