Evolution of the rhytidectomy

Abstract

Since the advent of facelift surgery, there has been a progressive evolution in technique. Methods of dissection trended towards progressively aggressive surgery with deeper dissection for repositioning of ptotic facial tissues. In recent decades, the pendulum has swung towards more minimally invasive options. Likewise, there has been a shift in focus from repositioning alone to the addition of volumization for facial rejuvenation. The techniques in this article are reviewed in a chronologic fashion with a focus on historical development as well as brief discussion on efficacy in relation to the other existing options. There is currently no gold standard technique with a plethora of options with comparable efficacy. There is controversy over which approach is optimal and future research is needed to better delineate optimal treatment options, which may vary based on the patient.

Keywords: Autologous fat transfer; Facelift; Facelift techniques; Facial fillers; Facial rejuvenation; History of the facelift; Rhytidectomy.

Fig. 1

The subcutaneous lift. The flap is raised in a subcutaneous plane leaving the SMAS unaddressed. The lift is in a vertical vector.

Fig. 2

The buccal cerclage suture. A. The key suture in the buccal cerclage technique. The suture is placed in a stair step pattern with 6 bites along the SMAS of the lower face and affixed to the immobile peri-parotid SMAS. B. The buccal cerclage suture is tightened lifting the SMAS in a vertical vector.

Fig. 3

Pre- and post-operative facelift using the buccal cerclage. Top: Pre-operative photographs of a patient who underwent facelift using the Buccal cerclage technique. Bottom: 4 year post-operative photographs of the same patient.

Fig. 4

The deep plane technique. Subcutaneous dissection is performed to the point anterior to a line drawn from the lateral canthus to the mandibular angle. The dissection then precedes sub-SMAS over the zygomaticus major and minor.

Fig. 5

The MACS lift. A posterior narrow purse-string suture is followed anteriorly by a 30° oblique wider purse-string suture on through the SMAS and both sutures are anchored to the deep temporal fascia.

Fig. 6

Pre and post-op lower blepharoplasty and fat transfer. Top: Pre-operative photograph of a patient who underwent lower lid blepharoplasty and fat transfer. Bottom: 3-year post-operative photograph of the same patient.