Historical Background

At present we are approaching the first century of surgical attempts to achieve a rejuvenation of the face. Eugen Holländer [24], professor in Berlin, described in 1912 that he "succumbed to a patient's art of persuasion, to remove segments of skin at the hairline and at the natural folds with the purpose to refresh the wrinkles of aging and ptotic cheeks, to the pleasure of the bearer". According to Holländer, the surgery was performed in 1901 on a Polish aristocrat.

In the following decades many French and German plastic surgeons, namely Passot [36], Lexer [30], Joseph [26, 27] and Noël [35], improved the technique by removing skin after dissection, either at the hairline or also in front of the ear and in the neck. The results of this subcutaneous rhytidectomy progres

  1. 41.1. The vertical rhytidectomy by means of a short scar preperiostal and pretemporal lateral forehead dissection with elevation of the lateral two thirds of the brow and infrabrow segment in continuity with a subcutaneous midface dissection down to the naso-labial fold. As the purpose was mainly to improve the result of a blepharoplasty by correction of the frame of the eyelids and midface, it was called "extended blepharoplasty" [10, 11]
  2. 41.1. The vertical rhytidectomy by means of a short scar preperiostal and pretemporal lateral forehead dissection with elevation of the lateral two thirds of the brow and infrabrow segment in continuity with a subcutaneous midface dissection down to the naso-labial fold. As the purpose was mainly to improve the result of a blepharoplasty by correction of the frame of the eyelids and midface, it was called "extended blepharoplasty" [10, 11]

sively improved by extending the dissection and by meticulous technique trying to hide the incisions.

Hector Marino [34] suggested in 1963 that the result of a forehead lift could possibly be improved by deep dissection and upward displacement of the soft temporal tissues lateral to the orbit, which he called the "meso temporalis" owing to its content of vessels and nerves.

In 1969 I published a short scar temporal incision technique, which I had described in 1966 as "extended blepharoplasty", as the main purpose was to improve the result of a blepharoplasty by correction of the frame of the eyelids and midface. Through a pre-periostal and pretemporal dissection, the lateral two thirds of the brow and infrabrow segment were elevated in continuity with the vertical subcutaneous midface dissection down to the naso-labial fold (Fig. 41.1).

However, it was Tord Skoog [40] who first used a deep-plane technique with a lateral approach to displace and stabilize the buccal fascia and also the pla-tysma for improvement of the lower face and neck, independent of the skin plane displacement.

This was followed by Paul Tessier's technique [42] in 1979 based on his outstanding craniofacial experience. Tessier performed a deep-plane subperiostal lifting from a coronal incision downward and also through a small vestibular approach upward, the "mask lift". He wanted to bring the whole soft tissue "mask" upward together with the periosteum, a technique which was a great step forward and had many followers.

In 1983 I thought that the soft tissues should be elevated preperiosteally, instead of lifting them through the periosteum, developing the sub-superficial musculo-aponeurotic system (SMAS) modification of my vertical periocular and midface rhytidectomy of 1969. The technique was first published in the transactions of the ISAPS congress in Madrid in 1985, and extensively in 1987 in the Annals of Plastic Surgery, with the denomination "blepharo-periorbito-plasty" [17, 23].

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