Two-dimensional (2-D) face-lifting techniques provide the basic construct upon which 3-D rejuvenation procedures are performed. The 2-D techniques allow rejuvenation through oblique and lateral lifting or through vertical and superolateral lifting. The addition of enhancement in an anterior-posterior (A-P) direction defines the 3-D facial rejuvenation tech- nique. There are four methods available to create THREE-DIMENSIONAL FACE LIFTING: (i) augmentation of the subcutaneous fatty layers, (ii) imbrication of facial soft tissues, (iii) repositioning of fat pockets as pedicle flaps, and (iv) augmentation of the skeletal framework (Fig. 1).
The ‘ approach to THREE-DIMENSIONAL FACE LIFTING utilizes these methods individually or in combination. Proper diagnosis of the aesthetic deficiencies, whether skeletal 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 result
Bidimensional lifting in vertical and lateral planes provides the foundation of the endoscopic face-lift. Weak skeletal support can be corrected with alloplastic implants as shown in the upper left corner of the diagram. Fat grafting, as shown in the upper right corner, is commonly used to enhance areas not corrected by lifting techniques. In addi- tion, fat grafting is used to treat small areas of depression or creases caused by subdermal damage. Imbrication of soft tissues is amenable in the brow, maxillary malar area, and mentum, as shown in the lower left corner. The lower right corner of the diagram shows the areas useful for augmentation by adjacent vascularized fat mobilization. These include upper orbital rim augmentation with the upper eyelid fat pads, the infraorbital rim tear trough area with the lower eyelid fat pads, and cheek augmentation with the Bichat’s fat pad