Rhytidoplasty: My Current Techniques, Biplane Extended Facelift, and Microlift

Abstract

The recent history of facelifts has undergone a major revolution with the development of biplane facelifting operations, based on a good anatomical knowledge of the SMAS fibromuscular structure.

The anatomical studies practiced in France by VLADIMIR MITZ since 1973 have been accelerated, in 1974, thanks to the impetus of Professor Paul Tessier, with the constitution of a dedicated team, very motivated and devoted to the entire face fibromuscular superficial components, following SKOOG’s early work on the mobilization of platysmas during cervical facelifts; the first international publication was made in 1976 in the PRS by V.MITZ and M. PEYRONIE.

It thus appeared that SMAS is a surgical rather than an anatomical structure, allowing an operative exploitation during major cervicofacial facelifts.

Numerous International studies have confirmed the reality of the SMAS a reliable and resistant multilayer anatomical structure, of mixed fibrous and muscular components.

The exploitation of the SMAS has conducted several leading surgeons to cut and exploit in various ways; mine has been preferably to perform an incision under the horizontal zygomatic arch, reaching the great zygomatic muscle origin in depth, supplemented by a vertical preauricular incision, leading to divide the platysma downward, and cutting it, if necessary, horizontally about 7 cm below the mandible. Thus a large SMAS-PLATYSMA flap is opened, ready for mobilization in various vectors, mostly vertical in the face and oblique in the neck.

In certain particular cases, it may be useful to perform segmental facelifts, more limited, but always biplane; their postoperative courses are simpler.

But the postoperative consequences of these major facelifts are not simple; this led me in 2014 to publish in the annals of French plastic surgery the new technique of MICROLIFT, a lifting of the skin and the underlying SMAS, without peeling them off from each other; this new composite technique also combines a small dissection under the SMAS, without cutting the Furnas ligaments. A double superposed layer of SMAS results in front of the ear, adding resistance for the following years.

So, thanks to these anatomical studies, it was possible to modernize the facial rejuvenation surgery, without forgetting the other volumetric developments, or specific rejuvenating acts associated with other parts of the face, or thanks to the help of aesthetic medicine.