Video-endoscopic facelift.

We report on our experience with 22 video-endoscopic facelift cases. We prefer the term facelift to rhytidoplasty because with the endoscopic facelift facial wrinkles are not eliminated by resecting skin but by elevating facial structures, treating the facial muscles, and improving facial contour. We treat the frontal region subperiosteally by elevating the eyebrows, minimizing wrinkles, and avoiding the coronal incision. The midthird of the face is treated subcutaneously by dissecting the skin from the SMAS, from the ear to the nasolabial fold. The endoscope is inserted through one incision and a cautery through the other. Blood vessels are cauterized. Plicating the SMAS and premalar fat pads to the temporal fascia treats the nasolabial fold and the "jowl." In the cervical region we treat the plastysma, and, with superficial liposculpture, remove excess fat and provoke skin retraction, which allows us to treat older patients who have a more flaccid skin tone. The endoscope is used to help the cauterizing and the suturing. The platysma can be sutured in the midline, if necessary. The cervical mental angle can be redefined with a Goretex 0 suture that passes from mastoid to mastoid. Modified instruments and different approaches to this technique can be expected, but we believe video endoscopy is going to have an important impact on the future of plastic surgery.