eMedicine Specialties > Plastic Surgery > Rhytidectomy

Facelift, Subperiosteal: Multimedia

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

Multimedia

The upper part of the subperiosteal facelift (end...Media file 1: The upper part of the subperiosteal facelift (endoscopic forehead lift) is performed in the sequence indicated. An incision is made over the temple. The upper part of zone 1 may be dissected without endoscopic assistance. Then the anterior part of the zygomatic arch is dissected and the lateral canthal area, if indicated. The posterior third of the arch is carefully dissected followed by the middle third. Zones 2 and 3 may be dissected blindly with a curved periosteal elevator. Zone 4 must be dissected with endoscopic assistance since many patients have small accessory nerves here.
The upper part of the subperiosteal facelift (end...

The upper part of the subperiosteal facelift (endoscopic forehead lift) is performed in the sequence indicated. An incision is made over the temple. The upper part of zone 1 may be dissected without endoscopic assistance. Then the anterior part of the zygomatic arch is dissected and the lateral canthal area, if indicated. The posterior third of the arch is carefully dissected followed by the middle third. Zones 2 and 3 may be dissected blindly with a curved periosteal elevator. Zone 4 must be dissected with endoscopic assistance since many patients have small accessory nerves here.

Subperiosteal facelift. (A) This endoscopic view ...Media file 2: Subperiosteal facelift. (A) This endoscopic view shows the frontal bone (F) and the raised periosteum (P). An endoscopic instrument is retrieving a gauze pack. One of the accessory nerves may be seen exiting the frontal bone in the foreground. If these nerves must be cut this is done as far from the bone as possible to decrease the distance that the nerve must regrow.(B) The supraorbital nerve (SON) can be clearly seen after removal of the corrugator muscles from around it.
Subperiosteal facelift. (A) This endoscopic view ...

Subperiosteal facelift. (A) This endoscopic view shows the frontal bone (F) and the raised periosteum (P). An endoscopic instrument is retrieving a gauze pack. One of the accessory nerves may be seen exiting the frontal bone in the foreground. If these nerves must be cut this is done as far from the bone as possible to decrease the distance that the nerve must regrow.(B) The supraorbital nerve (SON) can be clearly seen after removal of the corrugator muscles from around it.

Subperiosteal facelift. Before. Anteroposterior v...Media file 3: Subperiosteal facelift. Before. Anteroposterior view. This patient wished to eliminate the slightly tense appearance to her glabella. She has mild hooding of her left eye and some ptosis of the left lateral canthus.
Subperiosteal facelift. Before. Anteroposterior v...

Subperiosteal facelift. Before. Anteroposterior view. This patient wished to eliminate the slightly tense appearance to her glabella. She has mild hooding of her left eye and some ptosis of the left lateral canthus.

Subperiosteal facelift. After. Anteroposterior vi...Media file 4: Subperiosteal facelift. After. Anteroposterior view. After an endoscopic subperiosteal facelift she now has a more pleasing appearance with a slightly higher brow. The asymmetry of the lateral canthi has been corrected.
Subperiosteal facelift. After. Anteroposterior vi...

Subperiosteal facelift. After. Anteroposterior view. After an endoscopic subperiosteal facelift she now has a more pleasing appearance with a slightly higher brow. The asymmetry of the lateral canthi has been corrected.

Subperiosteal facelift. Before. Three-quarter vie...Media file 5: Subperiosteal facelift. Before. Three-quarter view. The hyperactivity of the corrugator supercilii muscles can be clearly seen. She has early hooding of the lateral orbit.
Subperiosteal facelift. Before. Three-quarter vie...

Subperiosteal facelift. Before. Three-quarter view. The hyperactivity of the corrugator supercilii muscles can be clearly seen. She has early hooding of the lateral orbit.

Subperiosteal facelift. After. Three-quarters vie...Media file 6: Subperiosteal facelift. After. Three-quarters view. The tense appearance of the forehead has improved. The hooding has improved. She has a slight lift to the corner of the mouth, and a fuller appearance of the cheek.
Subperiosteal facelift. After. Three-quarters vie...

Subperiosteal facelift. After. Three-quarters view. The tense appearance of the forehead has improved. The hooding has improved. She has a slight lift to the corner of the mouth, and a fuller appearance of the cheek.

Subperiosteal facelift. Before. Close-up three qu...Media file 7: Subperiosteal facelift. Before. Close-up three quarter view.
Subperiosteal facelift. Before. Close-up three qu...

Subperiosteal facelift. Before. Close-up three quarter view.

Subperiosteal facelift. After. Close-up three-qua...Media file 8: Subperiosteal facelift. After. Close-up three-quarter view.
Subperiosteal facelift. After. Close-up three-qua...

Subperiosteal facelift. After. Close-up three-quarter view.

Subperiosteal facelift. Before. Anteroposterior v...Media file 9: Subperiosteal facelift. Before. Anteroposterior view. This man requested correction of his transverse forehead rhytides, glabellar rhytides, brow ptosis, infraorbital hollowing, early left nasolabial creases, full submental region, and poor cheek and chin projection.
Subperiosteal facelift. Before. Anteroposterior v...

Subperiosteal facelift. Before. Anteroposterior view. This man requested correction of his transverse forehead rhytides, glabellar rhytides, brow ptosis, infraorbital hollowing, early left nasolabial creases, full submental region, and poor cheek and chin projection.

Subperiosteal facelift. After. Anteroposterior vi...Media file 10: Subperiosteal facelift. After. Anteroposterior view. After an endoscopic subperiosteal facelift including placement of small beaded polyethylene implants and an anterior approach cervicoplasty, he has a more relaxed appearance. His brows have been raised a little. His glabellar rhytides and nasolabial crease have almost disappeared, while the transverse rhytides have softened. His infraorbital hollowing has been greatly improved.
Subperiosteal facelift. After. Anteroposterior vi...

Subperiosteal facelift. After. Anteroposterior view. After an endoscopic subperiosteal facelift including placement of small beaded polyethylene implants and an anterior approach cervicoplasty, he has a more relaxed appearance. His brows have been raised a little. His glabellar rhytides and nasolabial crease have almost disappeared, while the transverse rhytides have softened. His infraorbital hollowing has been greatly improved.

Subperiosteal facelift. Before. Three-quarter vie...Media file 11: Subperiosteal facelift. Before. Three-quarter view. The rhytides on the forehead, glabella, and nasolabial area are all visible. He has a marked tear-trough deformity and loss of cheek volume with a full lower cheek.
Subperiosteal facelift. Before. Three-quarter vie...

Subperiosteal facelift. Before. Three-quarter view. The rhytides on the forehead, glabella, and nasolabial area are all visible. He has a marked tear-trough deformity and loss of cheek volume with a full lower cheek.

Subperiosteal facelift. After. Three-quarter view...Media file 12: Subperiosteal facelift. After. Three-quarter view. The rhytides are greatly improved, as is the infraorbital hollowing. His upper cheek volume has been increased while the lower cheek is now more concave.
Subperiosteal facelift. After. Three-quarter view...

Subperiosteal facelift. After. Three-quarter view. The rhytides are greatly improved, as is the infraorbital hollowing. His upper cheek volume has been increased while the lower cheek is now more concave.

Subperiosteal facelift. Before. Lateral view. The...Media file 13: Subperiosteal facelift. Before. Lateral view. The hooding, tear-trough, lower cheek fullness, and neck fullness are all obvious.
Subperiosteal facelift. Before. Lateral view. The...

Subperiosteal facelift. Before. Lateral view. The hooding, tear-trough, lower cheek fullness, and neck fullness are all obvious.

Subperiosteal facelift. After. Lateral view. His ...Media file 14: Subperiosteal facelift. After. Lateral view. His lateral brow has a better relationship to the lateral orbit. The tear-trough is improved. His lower cheek is flatter. The chin has better projection. The submental area is less full. There is a better cervicomental break.
Subperiosteal facelift. After. Lateral view. His ...

Subperiosteal facelift. After. Lateral view. His lateral brow has a better relationship to the lateral orbit. The tear-trough is improved. His lower cheek is flatter. The chin has better projection. The submental area is less full. There is a better cervicomental break.

More on Facelift, Subperiosteal

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

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].

Further Reading

Keywords

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

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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