title: Triplane rhytidectomy. Combining the best of all worlds.
abstract: OBJECTIVE
  To combine certain aspects of the sub-superficial musculoaponeurotic system (sub-SMAS) and subperiosteal rhytidectomies to maximize the advantages while minimizing the disadvantages of each.
  
  
  METHODS
  The subperiosteal rhytidectomy is used to reposition the ptotic malar fat pad concomitantly with the elevation of the corner of the mouth by means of shifting upward the origin of the zygomatic major muscle. The sub-SMAS rhytidectomy is used to maximize elevation of the jowl.
  
  
  METHODS
  Ambulatory surgical facility.
  
  
  METHODS
  Preauricular and temporal dissection is subcutaneous to the malar eminence above and angle of mandible below. A subperiosteal dissection of the middle part of the face is then accomplished through a sublabial approach combined with an incision over the malar eminence. An incision is made through the SMAS from the malar eminence to the mandibular angle and sub-SMAS dissection is accomplished under the jowl. The subperiosteal dissection is suspended to the temporal fascia and the SMAS dissection is imbricated with 2 suspension suture lines.
  
  
  CONCLUSIONS
  Follow-up in patients who are 1-year postoperative demonstrates a continued youthful elevation and flattening of the melolabial fold and complete correction of the jowl. No facial nerve injury or hematomas were observed.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Baker
mesh_terms: D000556:Ambulatory Surgical Procedures; D005260:Female; D006801:Humans; D008875:Middle Aged; D015361:Rhytidoplasty / Q000379:methods*