Traditional rhytidectomy techniques provide rejuvenation of the aging face through oblique and lateral lifting or through vertical and superolateral lifting maneuvers. These standard techniques address rhytid formation and skin laxity but fail to address the volumetric "deflation" that is characteristic of facial aging. In addition, these two-dimensional or dual-vector techniques often give patients an exaggerated "windswept" or "operated" appearance. By contrast, our approach addresses the volumetric deficiencies associated with facial aging in addition to rhytid formation and skin laxity to provide a more natural three-dimensional rejuvenation of the face. This is accomplished by the addition of techniques developed to enhance the face in an anterior-posterior direction. Methods used to create this three-dimensional or volumetric rejuvenation include augmentation of the subcutaneous fatty layers, imbrication of facial soft tissues, repositioning of fat pockets as pedicle flaps, and/or augmentation of the skeletal framework with alloplastic implants (Fig. 43.2). The authors' approach to three-dimensional rejuvenation utilizes these methods individually or in combination. Proper
preoperative diagnosis of the aesthetic deficiencies, whether skeletal and/or soft tissue, will determine the most effective plan to achieve excellent results. Common sense dictates that restoration of deficient structures with similar tissues will provide the most natural and long-lasting result.
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