Abstract
Aim: Traditional facelift techniques rely on pulling. They approach the superficial or intermediate layers where the facial nerves and muscles are located, increasing the risk of facial nerve injury. They approach the central oval from the periphery and produce unnatural vectors of pull and aesthetic results. Alternative techniques that work on the subperiosteal plane using endoscopic techniques are described. Modern concepts of volume augmentation, beautification and rejuvenation of the facial expression are an inherent part of such techniques, or can be easily integrated.
Highlights
The procedures, concepts and principles described in this article were developed over a 35 year period, beginning during my Plastic Surgery residency at the University of Pittsburgh
The central oval is approached via four small scalp incisions and additional intraoral, upper gingivobuccal incisions
I first described my five experience into the subperiosteal technique at the 1989 Biannual Congress of the International Society for Aesthetic Plastic Surgery in Zurich, Switzerland, and the 1990 American Society for Aesthetic Plastic Surgery Annual Congress in Chicago Illinois[13]. Another paradigm shift that influenced my thinking was the endoscopic approach to the forehead pioneered by Luis Vasconez[14]
Summary
The procedures, concepts and principles described in this article were developed over a 35 year period, beginning during my Plastic Surgery residency at the University of Pittsburgh. I first described my five experience into the subperiosteal technique at the 1989 Biannual Congress of the International Society for Aesthetic Plastic Surgery in Zurich, Switzerland, and the 1990 American Society for Aesthetic Plastic Surgery Annual Congress in Chicago Illinois[13] Another paradigm shift that influenced my thinking was the endoscopic approach to the forehead pioneered by Luis Vasconez[14]. We began thinking more about the benefits of volume preservation and restoration in contrast to the pulling maneuvers of traditional methods[21,22,23,24,28,29] This created a new landscape for developing new minimally invasive techniques and non-invasive techniques, including the use of fillers and neuromodulators as temporary alternatives to surgical approaches[30,31]
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