Suprafibromuscular facelifting with periosteal suspension of the superficial musculoaponeurotic system and fat pad of Bichat rotation. Tightening the net.

[OBJECTIVE] To design a facelifting technique that improves the safety of the facial nerve in extended facelifting; improves methods of fixation of the elevation of the nasolabial folds, the melolabial folds, the corner of the mouth and the malar fat pad; and augments the malar and submalar areas without implants.

[DESIGN] After a retrospective review of previous modified "composite" technique facelift results (307 patients over 4 years), a suprafibromuscular facelift technique was evolved through 22 fresh cadaver dissections. The resulting technique was applied to 73 patients, 61 females and 12 males, who were followed up for 6 to 18 months.

[METHODS] Preauricular dissection was subcutaneous for about 4 cm. An incision was made through the superficial musculoaponeurotic system (SMAS) at the level of the body of the zygoma. Dissection over the malar eminence was performed under the orbicularis muscle. Mid-cheek dissection was performed over the fibromuscular SMAS in th layer of areolar tissues that lines it. A rotation of the fat pad of Bichat (or buccal fat pad) was used, when indicated, to augment the cheek. Stabilization of the elevation of the nasolabial fold, the melolabial fold, and the corner of the mouth was obtained by the use of suspension sutures from the SMAS to the malar eminence. Stabilization of the malar fat pad was provided by the laterally directed flap of SMAS that was sutured to the temporal fascia. The patients were followed up for 6 to 18 months and evaluated for stability of the correction and facial nerve complications. RESULTS AND CONCLUSION; The facelift corrections (nasolabial fold, melolabial fold, malar fat pad shift) were stable over the follow-up period. No facial nerve injuries were seen.