Endoscopic assisted facial rejuvenation: a 35 year personal journey

Abstract

Aim: Traditional facelift techniques rely on pulling. They approach the superficial or intermediate layers where the facial nerves and muscles are located, increasing the risk of facial nerve injury. They approach the central oval from the periphery and produce unnatural vectors of pull and aesthetic results. Alternative techniques that work on the subperiosteal plane using endoscopic techniques are described. Modern concepts of volume augmentation, beautification and rejuvenation of the facial expression are an inherent part of such techniques, or can be easily integrated.

Methods: The central oval is approached via four small scalp incisions and additional intraoral, upper gingivo-buccal incisions. The interconnected frontal subperiosteal, temporal subfascial and midface subperiosteal areas are lifted, imbricated and suspended sequentially. The brow/forehead is suspended to the skull using cortical screws. The midface and lower periorbita are suspended to the fascia of the temporal muscle. The buccal fat pad is used to enhance the ogee line of the midface. Other three-dimensional volumetric maneuvers can easily be applied. In this setting, upper and lower lid blepharoplasties become more straightforward, skin only procedures. Actinic or nicotine damaged skin can be treated with lasers, peels or fluidified fat grafting in the same setting. The excess skin on the lower face and neck can be redrapped with standard cervicofacial techniques. Deep subplatysmal cervicoplasty can be done concomitantly, or at another time to complete comprehensive rejuvenation.

Results: The procedures described herein has been performed in 824 patients with excellent aesthetic results and low complication rate. The average rate of rejuvenation was 18 years.

Conclusion: These combination techniques are called Biplanar Endoscopic Assisted Mask and Triplanar Endoscopic Assisted Mask facial rejuvenation. They are advanced techniques of facial rejuvenation that provide comprehensive, natural, long lasting results.

Keywords

Endoscopic face lift / videoendoscopy / facial rejuvenation / high definition face / picograft / ogee face / midface

References

[1] Skoog T. Useful Techniques in Face-lifting. Presented at the meeting of the American Association of Plastic Surgeons; San Francisco, Calif. April 1969

[2] Lemmon Mark L(Mark Leonard).Color atlas of SMAS rhytidectomy..Thieme Medical, G. Thieme Verlag1993;

[3] Mitz V.The superficial Musculo-Aponeurotic System (SMAS) in the parotid and cheek area..Plast Reconstr Surg1976;58:80-8

[4] Hamra ST.The deep-plane rhytidectomy..Plast Reconstr Surg1990;86:53-61discussion 62-3

[5] Hamra ST.Composite rhytidectomy..Plast Reconstr Surg1992;90:1-13

[6] Baker DC.Deep dissection rhytidectomy: a plea for caution..Plast Reconstr Surg1994;93:1498-9

[7] Tessier P.Le lifting facial sous-perioste..Ann Chir Plast Esthet1989;34:193-7(in French)

[8] Psillakis JM,Camargos A.Subperiosteal approach as an improved concept for correction of the aging face..Plast Reconstr Surg1988;82:383-94

[9] Ramirez OM,Musolas A.The extended subperiosteal face lift: a definitive soft-tissue remodeling for facial rejuvenation..Plast Reconstr Surg1991;88:227-36discussion 237-8

[10] Ramirez OM.The subperiosteal rhytidectomy: the third-generation face-lift..Ann Plast Surg1992;28:218-32discussion 233-4

[11] Krastinova D.Lifting facial sous-perioste..Ann Chir Plast Esthet1989;34:199-211

[12] Santana PSM.Metodologia craneomaxilofacial en Ritidoplastias..Cirugia Plastica Ibero-Latino Americana1984;10:321

[13] Ramirez OM. Extended Subperiosteal Facelift. Presented at the Xth Biannual Congress of the International Society of Aesthetic Plastic Surgery. Zurich, Switzerland. September 1989

[14] Vasconez LO,Gamboa-Bobadilla M,Askren C.Endoscopic techniques in coronal brow lifting..Plast Reconstr Surg1994;94:788-93

[15] Ramirez OM.Anchor subperiosteal forehead lift: from open to endoscopic..Plast Reconstr Surg2001;107:868-71

[16] Ramirez OM.Endoscopic techniques in facial rejuvenation. An overview: Part I..Aesthetic Plast Surg1994;18:141-7

[17] Ramirez OM.Endoscopic full facelift..Aesthetic Plast Surg1994;18:363-71

[18] Ramirez OM.Subperiosteal minimally invasive laser endoscopic rhytidectomy: the SMILE facelift..Aesthetic Plast Surg1996;20:463-70

[19] Ramirez OM.Subperiosteal endoscopic techniques in secondary rhytidectomy..Aesthet Surg J1997;17:22-6

[20] Ramirez OM.Laser resurfacing as an adjunct to endo-forehead lift and biplanar facelift..Ann Plast Surg1997;38:315-22

[21] Ramirez OM.High-tech facelift..Aesthetic Plast Surg1998;22:318-28

[22] Ramirez OM.Full face rejuvenation in three dimensions: a “face-lifting” for the new millennium..Aesthetic Plast Surg2001;25:152-64

[23] Ramirez OM.Three-dimensional endoscopic midface enhancement: a personal quest for the ideal cheek rejuvenation..Plast Reconstr Surg2002;109:329-40

[24] Ramirez OM.The central oval of the face: tridimensional endoscopic rejuvenation..Facial Plast Surg2000;16:283-98

[25] Aiche AE.The suborbicularis oculi fat (SOOF): an anatomical and clinical study..Plast Reconstr Surg1995;95:37-42

[26] Ramirez OM.Spatial orientation of motor innervation to the lower orbicularis oculi muscle..Aesthetic Surg J2000;107-13

[27] Knize DM.An anatomically based study of the mechanism of brow ptosis..Plast Reconstr Surg1996;97:1321-33

[28] Ramirez OM.Fourth generation subperiosteal approach to the midface: the tridimensional functional cheek lift..Aesthetic Surg J1998;8:133-5

[29] Ramirez OM.Buccal fat pad pedicle flap for midface augmentation..Ann Plast Surg1999;43:109-18

[30] Carruthers A.Aesthetic indications for botulinum toxin injections..Plast Reconstr Surg1995;95:427-8

[31] Narins RS,Leyden J,Rubin M.A randomized, double-blind, multicenter comparison of the efficacy and tolerability of Restylane versus Zyplast for the correction of nasolabial folds..Dermatol Surg2003;29:588-95

[32] Ramirez OM. What is wrong with aesthetic approach to facial volumization: a judgement to the hollywood legacy. Presented at the 54th Brazilian Congress of Plastic Surgery. Florianopolis, SC Brazil. November 15-18, 2017

[33] Ramirez OM.Panfilov DE.Double ogee facial rejuvenation..Aesthetic surgery of the facial mosaic.2007;BerlinSpringer-Verlag288-99

[34] Hurwitz DJ.Reducing eyelid retraction following subperiosteal face-lift..Aesthet Surg J1997;17:149-56

[35] Ramirez OM,Ersoy B.The Peruvian fisherman’s knot: a new, simple, and versatile self-locking sliding knot..Ann Plast Surg2009;62:114-7

[36] Ramirez OM.Treating the aging face: “high definition-high tech” comprehensive facial rejuvenation..MKG-Chirug2019;12:68-77

[37] Ramirez OM. Super rich stem cell-fat grafting procured by a novel laser technology: a paradigm shift in aesthetic surgery and regenerative medicine. Presented at the 2018 Bi-Annual ISAPS Congress. November, 2018, Miami, Florida

[38] Ramirez OM. Super Rich Stem Cell-Fat Grafting Procured by a Novel Laser Technology: A Paradigm Shift in Aesthetic Surgery and Regenerative Medicine. Abstract at the Annual Meeting of the American Society for Aesthetic Plastic Surgery. New Orleans, LA. May, 2019

[39] Ramirez OM. Rejuvenation of the Facial Expression: The Ultimate Paradigm Shift in Facial Surgery. Presented at the International Symposium, “All About Face 2019”, Curitiba, Brazil, August 2019

[40] Ramirez OM.Advanced considerations determining procedure selection in cervicoplasty. Part two: surgery..Clin Plast Surg2008;35:691-709

[41] Ramirez OM.Multidimensional evaluation and surgical approaches to neck rejuvenation..Clin Plast Surg2014;41:97-105

[42] Ramirez OM.Mandibular matrix implant system: a method to restore skeletal support to the lower face..Plast Reconstr Surg2000;106:176-89