Composite rhytidectomy.

Signs of aging in the face reflect the change in position of deep anatomic elements, which are the platysma muscle, cheek fat, and the orbicularis oculi muscle. These changes occur from progressive ptosis of these elements, which continue to keep their intimate relationship with each other throughout the aging process. Conventional face lift procedures disrupt this normal relationship by separating the skin from these elements. All SMAS techniques reposition only the platysma muscle without repositioning the cheek fat and orbicularis muscle. This composite rhytidectomy allows elevation of a composite musculocutaneous flap containing all three elements for repositioning while maintaining their intimate relationship with each other and with the skin. One-hundred and sixty-seven composite rhytidectomies have been done with impressive results and minimal complications.     

Male rhytidectomy incisions

Because the preauricular segment of a face lift incision is less noticeable when located behind the tragus, it is our preferred method in females. The desirability of preserving the normal hairless strip between the ear and sideburn precluded using the technique in males. In this report we describe a method of utilizing the retrotragal location in males. This has been accomplished by direct excision of the hair follicles and hair shafts.     

Subperiosteal and full-thickness skin rhytidectomy

Subperiosteal lateral brow and midface elevation, upper lid blepharoplasty, transconjunctival retroseptal fat removal, lower lid skin excision, and full-thickness skin rhytidectomy are combined in one operation to rejuvenate the entire face. This combination of procedures is designed to restore both anthropometric and subjective attributes of youth. The attributes of a youthful face may be summarized as brows with an apex lateral slant, eyes that are narrow, lower lids that are short, cheeks that are full, and necks that are well defined. In addition to restoring a youthful appearance, the techniques described avoid some common iatrogenic sequelae of facial rejuvenative surgery. In a clinical experience with 28 patients over 3 years, this combination of procedures has proved to be safe and predictable.