Prevention and correction of the "face-lifted" appearance.

In spite of the increasing demand and popularity of facial rejuvenation procedures, there has been little real change of traditional techniques over the past few decades. Face lifts continue to be lateral vector techniques, whether skin lifts, superficial musculoaponeurotic system (SMAS) lifts, or deep plane malar fat maneuvers are done. Lower eyelid procedures continue to include removal of orbital fat in most cases. Laser blepharoplasties combine transconjunctival fat removal with laser skin abrasion. Forehead lifts continue to be optional in most cases, in spite of clear indications. The unfortunate results of these traditional procedures that may occur are becoming easy to recognize. The unopposed tension of lateral vector face lifts allows the cheek tissues to descend eventually over the tightened jawline, creating a "lateral sweep" or pulled appearance of the face. A crescent-shaped mound over the malar area is the inferior orbicularis oculi muscle, not repositioned with conventional procedures. Following conventional blepharoplasty, the lower eyelid contour becomes deeper, and often an hollow appearance develops. A composite face lift combined with an arcus marginalis release can correct these typical problems. The primary vector of the face is superiomedial, which will reverse the unopposed tension of lateral vector techniques and reposition the cheek tissues to their original position. The arcus marginalis release combined with repositioning of the complete orbicularis muscle in a zygorbicular midface flap can be used to correct the most severe hollow lower eyelid. Unwanted and unattractive results are not the fault of the surgeon or the patient but are caused by the surgical technique. As a primary rejuvenative procedure, a composite rhytidectomy will deliver an impressive result that will disallow the ultimate lateral sweep and hollow eyes. In patients that have the unhappy signs of surgery this procedure can effectively correct the face-lifted appearance.