Current practices in cervicofacial rhytidectomy

Although newer resurfacing techniques have expanded the horizons of facial plastic surgery, cervicofacial rhytidectomy remains the gold standard for rejuvenation of the aging face. A series of articles by a variety of authors during 2000 on cervicofacial rhytidectomy present several issues for discussion. Controversy exists as to whether facelift and cutaneous laser resurfacing can be safely performed at the same time. The rationale used by several articles to support combined rhytidectomy and laser resurfacing is partially to avoid the cost and risk associated with a second procedure. This method also avoids demarcation between resurfaced and untreated skin caused by selective resurfacing. The benefits and drawbacks of performing simultaneous procedures are elucidated in this review. Recent technologic advances have allowed progress in midfacial rejuvenation with endoscopic subperiosteal facelift techniques. Although this method was introduced in 1988, modifications have been made to improve results and decrease morbidity. One of the major benefits of deep plane facelift proposed by its advocates is that tension is placed on a thicker flap, obtaining a superior longer lasting effect than that achieved with standard superficial musculoaponeurotic system techniques. Until now, no articles have been presented on the incidence of major and minor hematomas in deep plane facelifts. This incidence was reported in 2000 in a large series by a single surgeon.