The Release Zone in Facial Rejuventation Surgery
Methods/Technique:
A surgical strategy is described whereby facial rejuvenation is optimized by accessing an anatomic zone in the face where a predictable visible release occurs allowing the surgeon to achieve greater advancement without undue tension on the skin. In addition to the release of the zygomatico cutaneous ligaments in the cheek and the parotid-cutaneous ligaments in the neck below the earlobe, there is a series of fine ligamentous attachments located beneath the parotid fascia, beyond the anterior border of the parotid gland, which when divided allow a dramatic visible release of the overlying facial soft tissue. Once the deeper tissue plane is advanced and secured, more skin can be resected without giving the patient a stretched or unnatural appearance. This “Release Zone” is located invariably beyond the region where the facial nerve branches emerge from the parotid gland parenchyma. Once the release has been achieved, the parotid fascia is advanced posteriorly and secured to it’s incised edge anterior to the ear. It is also secured to the fascial origin of the parotid-cutaneous ligament in the neck. This is accomplished in continuity with advancement of the platysma muscle and the malar fat pad. Cutaneous incisions are designed to avoid hair loss.
Results/Complications:
By advancing the parotid fascia, the platysma, and the malar fat pad simultaneously, a natural neck outline\e is achieved; jowls are eliminated; cheek advancement is maximized; and a lateral browlift is achieved, thus reducing lateral upper eyelid overhang. Predictable rejuvenation of usually twenty years is achieved. Patients can return to their usual activities fourteen days from surgery. To date, in our series of 650 cases, there have been no instances of permanent nerve damage, and only one case of temporary mandibular branch loss.
Conclusion:
Maximum facial rejuvenation can be achi9eved by extending the dissection into the anatomic “Release Zone.” Facelift stigmata can be avoided. The greater the degree of youthfulness achieved equates to a longer lasting result. Because the “Release Zone” is also the danger zone, the surgeon who wishes to employ this technique is advised to do cadaver dissections before attempting this surgical approach to facial rejuvenation.