Endoscopic assisted facial rejuvenation: a 35 year personal journey

Aim: Traditional facelift techniques rely on pulling. They approach the superficial or intermediate layers where the facial nerves and muscles are located, increasing the risk of facial nerve injury. They approach the central oval from the periphery and produce unnatural vectors of pull and aesthetic results. Alternative techniques that work on the subperiosteal plane using endoscopic techniques are described. Modern concepts of volume augmentation, beautification and rejuvenation of the facial expression are an inherent part of such techniques, or can be easily integrated.Methods: The central oval is approached via four small scalp incisions and additional intraoral, upper gingivo-buccal incisions. The interconnected frontal subperiosteal, temporal subfascial and midface subperiosteal areas are lifted, imbricated and suspended sequentially. The brow/forehead is suspended to the skull using cortical screws. The midface and lower periorbita are suspended to the fascia of the temporal muscle. The buccal fat pad is used to enhance the ogee line of the midface. Other three-dimensional volumetric maneuvers can easily be applied. In this setting, upper and lower lid blepharoplasties become more straightforward, skin only procedures. Actinic or nicotine damaged skin can be treated with lasers, peels or fluidified fat grafting in the same setting. The excess skin on the lower face and neck can be redrapped with standard cervicofacial techniques. Deep subplatysmal cervicoplasty can be done concomitantly, or at another time to complete comprehensive rejuvenation.Results: The procedures described herein has been performed in 824 patients with excellent aesthetic results and low complication rate. The average rate of rejuvenation was 18 years.Conclusion: These combination techniques are called Biplanar Endoscopic Assisted Mask and Triplanar Endoscopic Assisted Mask facial rejuvenation. They are advanced techniques of facial rejuvenation that provide comprehensive, natural, long lasting results