A case for superficial rhytidectomy

Abstract

The first written accounts of the development of face-lift operations are credited to surgeons such as Miller, Kolle, and Bettman.le5 These early rejuvenation techniques were primarily designed to rid the patient of lateral facial wrinkling. Over the past two decades, the need for superficial musculoaponeurotic system (SMAS) manipulation during rhytidectomy has been widely accepted by most surgeons. In recent years, more complex aesthetic facial procedures, such as the deep-plane and composite rhytidectomies, have been popularized in the literature. Although numerous articles have attempted to show the benefits of these more complex, multilayered face-lift techniques, none definitively show a longer-lasting result.6-10 It is not the intent of this article to describe in detail the various rhytidectomy techniques in current use, but rather to present evidence supporting the superficial plane rhytidectomy with SMAS manipulation as the procedure of choice for facial rejuvenation. We believe it provides predictable, long-lasting results with minimal risks and a short recovery period. To avoid confusion in discussing this issue, the nomenclature used in rhytidectomy must be reviewed. Most authors categorize major rhytidectomy techniques into four generations (Table 1).7111 The subcutaneous rhytidectomy (first-generation) involves total subcutaneous undermining, while leaving the deep anatomic structures unchanged.5J2-14 Secondgeneration rhytidcctomies use various SMAS and platysmal suturing techniques (plication or imbrication) to reposition the facial soft tissues.11115-18 The deep-plane techniques (third generation) involve both platysmal and cheek fat repositioning; the classic planes of dissection are prezygomaticus in the cheek, subplatysmal in the lower face, and preplatysmal in the neck.6,7 The