This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Tightening the Net

Gregory S. Keller, MD; Julene Cray, RN

Arch Otolaryngol Head Neck Surg. 1996;122(4):377-384.

Abstract
Objective
To design a facelifting technique that improves the safety of the facial nerve in extended facelifting; improves methods of fixation of the elevation of the nasolabial folds, the melolabial folds, the corner of the mouth, and the malar fat pad; and augments the malar and submalar areas without implants.

Design
After a retrospective review of previous modified "composite" technique facelift results (307 patients over 4 years), a suprafibromusular facelift technique was evolved through 22 fresh cadaver dissections. The resulting technique was applied to 73 patients, 61 females and 12 males, who were followed up for 6 to 18 months.

Methods
Preauricular dissection was subcutaneous for about 4 cm. An incision was made through the superficial musculoaponeurotic system (SMAS) at the level of the body of the zygoma. Dissection over the malar eminence was performed under the orbicularis muscle. Mid cheek dissection was performed over the fibromuscular SMAS in the layer of areolar tissue that lines it. A rotation of the fat pad of Bichat (or buccal fat pad) was used, when indicated, to augment the cheek. Stabilization of the elevation of the nasolabial fold, the melolabial fold, and the corner of the mouth was obtained by the use of suspension sutures from the SMAS to the malar eminence. Stabilization of the malar fat pad was provided by a laterally directed flap of SMAS that was sutured to the temporal fascia. These patients were followed up for 6 to 18 months and evaluated for stability of the correction and facial nerve complications.

Results and Conclusion
The facelift corrections (nasolabial fold, melolabial fold, malar fat pad shift) were stable over the follow-up period. No facial nerve injuries were seen.

(Arch Otolaryngol Head Neck Surg. 1996;122:377-384)

Author Affiliations
From the Keller Facial Plastic Surgery Clinic, Santa Barbara, Calif.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Surgical Anatomy of the Face: Implications for Modern Face-lift Techniques
Gassner et al.
Arch Facial Plast Surg 2008;10:9-19.
ABSTRACT | FULL TEXT  

Elevation of the Malar Fat Pad With a Percutaneous Technique
Keller et al.
Arch Facial Plast Surg 2002;4:20-25.
ABSTRACT | FULL TEXT