eMedicine Specialties > Plastic Surgery > Rhytidectomy

Facelift, Subperiosteal: Follow-up

Author: Keith M Robertson, MD, LRCSI, LRCPI, FACS, Consulting Staff, Chesapeake Plastic Surgery Associates, Suburban Hospital, Esthetique Internationale; Consulting Staff, Department of Plastic Surgery, Greater Baltimore Medical Center
Coauthor(s): Oscar Ramirez, MD, Clinical Assistant Professor, Department of Plastic Surgery, Johns Hopkins University, University of Maryland
Contributor Information and Disclosures

Updated: Oct 3, 2006

Outcome and Prognosis

Endoscopic facial surgery has been performed at this practice for approximately a decade, and no patient has yet required re-elevation of his or her mid face or forehead. The operation produces reliable and reproducible results that can improve transverse forehead creases, glabella frown lines, brow position, position of the lateral canthus, and the corners of the mouth. It can improve the tear trough and projection of the cheek. It is the technique of choice for patients younger than 45 years and when implants are to be placed.

Future and Controversies

Although the subperiosteal facelift has been used for many years, it was the advent of endoscopic surgery that has made this technique more popular. Initially, the technique was plagued by reports of persistent facial edema. This problem has been overcome with increasing speed of dissection and decreasing soft tissue trauma. The authors believe the subperiosteal plane allows better optical cavity than subgaleal or subcutaneous dissection. The bone is bright and almost bloodless, allowing for light reflection rather than light absorption.

The bony landmarks and attachments of muscles useful for orientation are clearly seen. These landmarks are not always available in the subgaleal or intermediate plane techniques. The subperiosteal plane allows the forehead and mid face to be dissected in the same plane. This plane does not contain branches of the facial nerve. The vascularity of the face is not compromised. This may be a consideration in patients who smoke. It is the only technique that allows repositioning of the soft tissues with relation to their bony attachments. These advantages combined with the longevity of the procedure make it the procedure of choice for facial rejuvenation.

 


More on Facelift, Subperiosteal

Overview: Facelift, Subperiosteal
Treatment: Facelift, Subperiosteal
Follow-up: Facelift, Subperiosteal
Multimedia: Facelift, Subperiosteal
References
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References

  1. Besins T. The "R.A.R.E." technique (reverse and repositioning effect): the renaissance of the aging face and neck. Aesthetic Plast Surg. May-Jun 2004;28(3):127-42. [Medline].

  2. De La Plaza R, Valiente E, Arroyo JM. Supraperiosteal lifting of the upper two-thirds of the face. Br J Plast Surg. Jul 1991;44(5):325-32. [Medline].

  3. Ramirez OM. Full face rejuvenation in three dimensions: a "face-lifting" for the new millennium. Aesthetic Plast Surg. May-Jun 2001;25(3):152-64. [Medline].

  4. Ramirez OM, Robertson KM. Update in endoscopic forehead rejuvenation. Facial Plast Surg Clin North Am. Feb 2002;10(1):37-51. [Medline].

  5. Ramirez OM. Subperiosteal endoscopic techniques in facial rejuvenation. In: Guyuron B, ed. Plastic Surgery Indications, Operations and Outcomes. Vol 5. St. Louis:. Mosby;2000.

  6. Ramirez OM. Mandibular matrix implant system: a method to restore skeletal support to the lower face. Plast Reconstr Surg. Jul 2000;106(1):176-89. [Medline].

  7. Tessier P. [Subperiosteal face-lift]. Ann Chir Plast Esthet. 1989;34(3):193-7. [Medline].

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Further Reading

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Keywords

subperiosteal facelift, rhytidectomy, forehead and mid facelift, endoscopic facelift, scarless facelift, face lift, face-lift

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Contributor Information and Disclosures

Author

Keith M Robertson, MD, LRCSI, LRCPI, FACS, Consulting Staff, Chesapeake Plastic Surgery Associates, Suburban Hospital, Esthetique Internationale; Consulting Staff, Department of Plastic Surgery, Greater Baltimore Medical Center
Keith M Robertson, MD, LRCSI, LRCPI, FACS is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Oscar Ramirez, MD, Clinical Assistant Professor, Department of Plastic Surgery, Johns Hopkins University, University of Maryland
Oscar Ramirez, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

Medical Editor

David W Furnas, MD, Clinical Professor Emeritus, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California at Irvine
David W Furnas, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Head and Neck Society, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society of Transplantation, California Medical Association, Phi Beta Kappa, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None

 
 
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