The Zygorbicular Dissection in Composite Rhytidectomy: An Ideal Midface Plane

Abstract

Composite rhytidectomy added the repositioning of the orbicularis oculi muscle to the deep plane face lift to achieve a more harmonious appearance of the face by adding periorbital rejuvenation. By not separating the orbicularis oculi from the zygomaticus minor and by extending the dissection under medial portions of the zygomaticus major and minor muscles, a more significant improvement in composite rhytidectomy can now be achieved. A thin nonrestrictive mesentery between the deep plane face lift dissection and the zygorbicular dissection still allows vertical movement of the composite face lift flap without interrupting the intimate relationship between the platysma, cheek fat, and orbicularis oculi muscle. This modification eliminates the occasional prolonged edema and occasional temporary dystonia previously observed. It allows the continuation of the use of the arcus marginalis release, which has also been modified by resetting the septum orbitale over the orbital rim. These two modifications allow a more predictable and impressive result. They reinforce the concept of periorbital rejuvenation as an integral part of facial rejuvenation, which not only produces a more harmonious immediate result but prevents the possible unfavorable sequelae of conventional rhytidectomy and lower blepharoplasty.

Recent Advances in Face Lift to Achieve Facial Balance

“…Since then the techniques have evolved from skin only, skin SMAS, modifications of the SMAS, skin platysmal flap, composite, deep plane, subperiosteal, endoscopic, suture suspension and short scar procedures [9][10][11][12][13][14][15].…”

Presto lift—a facelift that preserves the retaining ligaments and SMAS tethering

“…The further development of the primary SMAS technology according to Skoog [30] into a super extended rhytidectomy technique according to Hamra [31] or into a subperiostal technique according to Ramirez [22], with endoscopic support or the opening of the retaining ligaments according to Stuzin [32], shows that constant efforts are being made to detach and to fixate tissues anew, either with cutaneous SMAS preparation and marginal SMAS extension or from a subperiostal aspect using volume compression. These different techniques have in common that they all involve complete preparation and new fixation of margins.…”

Liposuction and Suspension of the Orbicularis Oculi for the Correction of Persistent Malar Bags: Description of Technique and Report of a Case

“…On the other hand, Furnas [7] raised a myocutaneous flap with excision of the cephalic part of orbicularis, which may dissolve the festoons but not the localized edema. The technique proposed by Hamra [8][9][10][11] combines a deep-plane facelift and excision of the lower part of the orbicularis. However, there is a high rate of facial nerve injury with this technique.…”