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Alternative to deep-plane rhytidectomy combines proven techniques

Article-Alternative to deep-plane rhytidectomy combines proven techniques

Dr. Beeson
Orlando, Fla. — Traditionally, a problem area with facelifts has been the persistent nasolabial or buccolabial fold, and because it's also an area where the earliest aging changes are often seen in the post-facelift patient it's important for cosmetic surgeons to structure their approach to the aging face and to facelift patients.

"The main thing we need to do is tailor a procedure to match what the patient's specific problem is and also take into account our technical surgical skills, the degree of risk and the convalescent morbidity that's associated with the procedure," says William Beeson, M.D., clinical professor of dermatology and otolaryngology, head and neck surgery, at Indiana University School of Medicine, Indianapolis. "That allows you to develop the technique that's most acceptable to both you and the patient."

In the standard facelift procedure the surgeon stays in one anatomic plane, which facilitates repeat surgery because the plane dissects more easily and the anatomy is familiar. With the deep plane facelift the surgeon tran-scends the traditional anatomical planes which results in some trans-actions and positioning of the musculature, making repeated surgery more difficult.

While the deep plane method was thought to address the nasolabial area more effectively than the standard facelift procedures, in the hands of many surgeons, "it really isn't very effective," Dr. Beeson says, and can even result in injury to the neuropraxia nerve and prolonged recovery.

Procedure from existing pieces

The new procedure that Dr. Beeson has employed combines parts of existing procedures and techniques.

"This procedure capitalizes on the refinements and techniques that other people have employed in a favorable way and also addresses the ability to reposition the buccolabial fold more strategically," he says.

"At the same time, it preserves those anatomic planes that we're familiar with. The result is less potential injury to the nerve and associate structures, with a quicker recovery."

According to Dr. Beeson the aging process results in a variable anterior caudal decent of the nasal mandibular prominences.

"This descent accentuates the nasolabial folds and eventually creates the labial mandibular folds, or what are commonly referred to as 'marionette lines.' The difficulty in achieving initial and long-lasting correction of this problem has been well documented."

During a presentation at the 22nd Annual Scientific Meeting of the American Academy of Cosmetic Surgery (AACS) in January, Dr. Beeson outlined 10 key aspects of the new, alternative facelift:

  • 1. Frontal temporal incision
  • 2. Wide undermining in a subdermal plane
  • 3. Open liposuction
  • 4. Positioning of plication sutures
  • 5. Release of mandibular ligaments along anterior one-third of body of mandible
  • 6. Malar suspension suture
  • 7. Platysma suspension suture
  • 8. Effective management of tragus
  • 9. Klein tumescent infiltration
  • 10. Multilayer skin closure

"It's not earth-shattering," Dr. Beeson tells Cosmetic Surgery Times, "but when you take these parts of other procedures and put them together, there's a synergism that takes place."

Be realistic

Dr. Beeson cautions that a realistic approach with patients is best and, especially, with the alternative to deep plane facelifts.

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