Composite Rhytidectomy

Demystifying the Deep Plane Facelift: What It Means Anatomically and Why It Works

“…This technique involves dissection in the sub-SMAS plane in the inferior cheek with a supra-SMAS dissection superficial to the zygomaticus muscle in the superomedial cheek, creating a compound skin, muscle, and fat flap. 11,12 Advancement and resuspension of this flap allow for elevation of the midfacial soft tissues. Several studies support Hamra's findings that the deep plane technique is superior to SMAS imbrication and plication techniques in terms of increasing malar volume and improving melolabial folds.…”

Midface-Lifting: Evolution, Indications, and Technique

“…7,[17][18][19] In 1992 Hamra and Choucair 1 described the composite rhytidectomy, incorporating a lower blepharoplasty approach with undermining of the orbicularis oculi muscle, along with facelift dissection, creating a composite flap of orbicularis oculi, malar fat, and SMAS allowing for correction of three midfacial components. 20 Hamra later added zygorbicular dissection to the composite rhytidectomy to eliminate the occasional prolonged edema and occasional temporary dystonia previously observed. 21 Thus, one could accomplish repositioning of all the layers of the face while maintaining their anatomical integrity and furthermore, by repositioning the malar fat over the orbital rim, achieve a more youthful contour of the lower lid-cheek continuum.…”

“…An orbicularis oculi muscle flap is elevated and fashioned into a triangular muscle flap and tunneled under a skin bridge and sutured to the thick condensation of deep temporal fascia as it blends with the superolateral orbital rim. 20,21 For additional support to the lateral canthal tissues in the early healing phase, a transcanthal canthopexy is performed. 20,21 A variety of midface-lifting techniques are available, and the specific choice depends on the patient's indications and the surgeon's ability to generate movement of the tissues to achieve the desired rejuvenation.…”

Ritidoplastia con cicatrices cortas: ligamentos de retención y vectores de corrección

“…La primera (preauricular), es de fácil libera- ción y la segunda (medial) es de difícil disección, porque incluye a los músculos más importantes de la expresión facial y es el área donde se evidencia el envejecimiento ( Fig.1) Originalmente, la cirugía del SMAS se limitaba a la disección de la parte más lateral de la cara, no traspasando el límite ligamentoso vertical, por lo cual no producía ningún efecto en la parte medial de la mejilla. Las llaves de la evolución fueron las técnicas del SMAS extendido, donde la disección liberaba las fijaciones de retención (12)(13)(14)(15). Una forma simple de cumplir con el mismo cometido es mediante la tracción del SMAS medio desde el SMAS lateral con puntos de remolque, que salten la línea de fijación en forma de puente anulando el efecto de retención.…”