The deep plane facelift - A 20-year evolution of technique

Purpose: This report reviews the unique technical and conceptual oculoplast ic innovations in the discipline of facelift surgery by analyzing the evolu tion of facelift technique at a university-based oculoplastic program. Designed: Retrospective, noncomparative case series. Participants: We analyzed 313 patients undergoing a facelift from 1980 thro ugh 1997. Most procedures were performed by the senior author. Methods: Three primary eras of surgical technique were identified: limited skin flap with superficial musculoaponeurotic system plication (25 patients ), extended skin flap with neck dissection and superficial musculoaponeurot ic system plication (210 patients), and deep plane facelift with robust sup erficial musculo-aponeurotic system flap (78 patients). Results: The steps in the evolution were designed to improve the results of the surgery regarding rejuvenation of the neck, jowls, and nasolabial fold , and to reduce the "tattletale signs" of facelift surgery including postau ricular scarring, change in the position of the sideburn and temporal hairl ine, and unnatural results caused by pulling the tissues posteriorly, rathe r than repositioning them vertically. There were no complications in the sk in flap only group. In the extended skin flap and superficial musculo-apone urotic system plication group, there was one mandibular paresis which parti ally resolved. In the deep plane facelift (n = 78), there was one laceratio n of the parotid duct, successfully stented during surgery. Conclusions: The deep plane facelift, with vertical elevation of the midfac e, jowls, and neck, is a logical extension of the mid-facelifting technique s that have been used by oculoplastic surgeons. Compared with cutaneous und ermining with superficial musculo-aponeurotic system plication, we found pa tient and physician acceptance higher using the deep plane technique. (C) 2 000 by the American Academy of Ophthalmology.