Aesthetic and Safety Considerations in Composite Rhytidectomy: A Review of 145 Patients over a 3-Year Period

Abstract

Since Hamra described the composite rhytidectomy, many surgeons have been using the technique, but few have published their experience concerning this subject. A series of 145 composite rhytidectomies (133 primary, 8 secondary, and 4 tertiary) in a 3-year period (from September of 1992 through October of 1995), including male and female patients ranging in age from 40 to 74 years, was selected to evaluate my personal approach to the technique, the indications, the aesthetic results, and complications. In this series, all patients were operated on by the same surgeon, from incision to complete closure of the skin. All the preoperative and postoperative photographs were taken by the same photographer. The tripronged hallmark of my contribution to the original technique is (1) cheek fat undermining through the upper approach instead of the lateral approach (easy to perform with low risk of nerve injury), (2) systematized surgical steps (reduced amount of anesthetic solution, low surgical risk, significant reduction in bleeding, lower cost, and easier and quicker recovery phase), and (3) a low complication rate. The postoperative results have been improved with this technique, satisfying both patient and surgeon.

Medical Malpractice and Facial Nerve Paralysis

“…[15][16][17][18] All of these procedures have been refined over the years to identify, avoid, or otherwise protect and preserve the facial nerve. 17,19,20 Proper training and careful surgical technique are indispensable, but facial nerve injuries happen to even the best surgeons. Dawes et al 12 state that patients have a high expectation of a successful outcome and are more inclined to sue for an unsatisfactory outcome.…”

An Evidence-Based and Case-Based Comparison of Modern Facelift Techniques

“…The initial search returned 3479 articles, which was reduced to 229 articles after review of title and abstract for relevant context. Full-text review yielded 65 relevant articles 3–7,11,21–27,29–35,37,41–87 (Fig. 1).…”

“…Antell and Orseck 26 published a retrospective review of face lifts performed on eight sets of High SMAS Frontal and oblique 3 Barton 5 High SMAS Frontal and oblique 3 Guyuron et al 42 High SMAS with SMAS plication Frontal and oblique 4 Marten 43 High SMAS Frontal and oblique 4 Stuzin 44 Extended SMAS Frontal and oblique 9 Hoefflin 11 Extended SMAS Frontal and lateral 3 Jones 45 Extended SMAS Frontal and oblique 2 Liu and Owsley 46 Extended SMAS Frontal and lateral 4 Lemmon and Hamra 47 Composite Frontal and lateral 5 Pina 48 Composite Oblique and lateral 3 Duffy and Friedland 25 SMAS plication Frontal, oblique, and lateral 2 Mottura 49 SMAS plication Frontal and lateral 4 Robbins et al 3 SMAS plication (medial) Frontal, oblique, and lateral 2 Baker 6 SMASectomy (short scar) Frontal and lateral 4 Rohrich et al 37 SMASectomy and SMAS plication Frontal, oblique, and lateral 4 Rohrich et al 50 SMASectomy and SMAS plication Frontal, oblique, and lateral 2 monozygotic twins. Face lift techniques included subcutaneous, SMASectomy, SMAS plication, and SMAS flap.…”

Triple-Anchoring Sub-SMAS Face-lift

“…Each of the fat aesthetic units of the face should have a carefully chosen anchoring point. Dissection to reach the periosteum is safe just above the radix of the ear, near the zygomatic arch/lateral orbit junction [14,17,29] and over the mastoid as shown in Fig. 5.…”