The 4-Dimensional Rhytidoplasty

Abstract

Introduction: The 4-dimensional facelift is an advanced rhytidectomy technique using a combination of the subperiosteal and multiplanar/multivector facelift techniques simultaneously with CO2 and erbium:YAG laser resurfacing for maximal facial rejuvenation. The combination of these procedures produces a rejuvenation that has synergistic benefits. The facelift alone does not rejuvenate fine rhytids around the mouth and infraorbital regions. In addition, laser resurfacing does not address the rhytids caused by deeper ptotic anatomic structures, nor lines of animation. The 4-dimensional rhytidoplasty provides the ultimate in subtle release of the anatomic facial planes. This concentric release of the various anatomic planes reduces unnecessary tension and unnecessary vascular compromise on any particular layer. This results in increased safety of the technique, allows for simultaneous laser resurfacing, and gives a more natural and improved facial rejuvenation. Materials and Methods: Thirty-two patients (4 males and 28 females) underwent the 4-dimensional facelift between November 1998 and December 1999. This includes simultaneous laser resurfacing and a deep-plane multivector facelift, including an extended subperiosteal release. After all adjunctive procedures had been performed and the superficial musculoaponeurotic system had been stabilized, the redundant preauricular skin was lasered, keeping the energy densities the same, but altering the number of passes. The edges were then trimmed and submitted for histologic examination. Conclusions: The authors are not aware of any previous publications combining all the anatomic planes of the face into a single operation. It has also been the accepted dictum by various experts in the field that laser resurfacing over the undermined flap was a contraindication. However, on the basis of our experiences and results, it is our opinion that this can be done and that the clinical endpoint is safely achieved, resulting in a superior cosmetic result and an assumed increased longevity.