Facial rejuvenation: A scarless technique

The goal of facial rejuvenation surgery is to provide a youthful contour to an ageing face. Facelift surgery has gone through a variety of modifications during the past 20 years. Initially, only skin lifts were performed, then modification of the submuscular aponeurotic system (SMAS) and platysma surgery. This endangered the facial nerve and parotid gland. Subsequently, adjunctive procedures were done that attempted to improve difficult areas of correction (Figure 1). Extended SMAS operations were done to correct the nasolabial fold, and on some occasions dermal grafting was done in the nasolabial fold area to reduce the prominence of the fold. Hoping to achieve long lasting results in rejuvenation of the neck, neck contouring surgery was further enhanced by platysmaplasties, both anteriorly as well as posteriorly, with liposuction. All of these procedures have demonstrated some beneficial results but with less than ideal results in the nasolabial fold and jowl areas, particularly in the junction between the chin and cheek (Figure 2). Long term follow-up has demonstrated scars that have drifted down in the retroauricular and occipital areas, leaving telltale signs of previous facelift surgery. Facial rejuvenation with the minimal scar technique is presented to show improved facial results with minimal or no scars in the retroauricular area of the face. The face is evaluated by dividing it into three parts, the upper, middle and lower thirds of the face. By enhancing youthfulness in the upper third of the face, an endobrowlift can be considered to correct the corrugator and procerus muscles with medial brow elevation centrally, while the lateral brow position is improved by a lateral temple lift, thus enhancing the upper third of the face. The midfacial correction is achieved by lower eyelid blepharoplasty with canthoplasty and a subperiosteal facial dissection, as initiated by Hester (1), aiming to improve the nasolabial fold and to correct the lower cheek and chin jawline using this technique (Figure 3). This not only improves the nasojugal fold, but also repositions the cheek pad onto the malar area, giving a malar augmented look while eliminating the jowl on the cheek-chin junction (1). The lower third of the face is improved by an anterioplatysmaplasty via the submental approach with concomitant liposuction, which contours the anterior part of the neck. The posterior occipital area is improved by an occipital scalp incision with posterior platysmaplasty and platysma-mastoid suspension with sutures. This eliminates scars in the retro-