title: Esthetic outcome after soft tissue reconstruction of the face using deep dissection and composite facelift technique.
abstract: OBJECTIVE
  Large defects in the face resulting from the excision of malignant tumors, trauma, and congenital malformation pose a significant challenge to reconstructive surgeons. Achieving good esthetic and functional outcomes is often very demanding.
  
  
  METHODS
  A facelift technique was used in 47 patients (25 female, 22 male; age range, 17.5 to 82.3 years; mean age, 49.3 years) to replace lost tissue of the face from 2009 through 2012. The minimum defect size was 2 cm in diameter and the maximum was 8 cm. To achieve tension-free coverage with a reliable blood supply, a deep-plane dissection, including the skin and superficial musculoaponeurotic system (SMAS), was performed. The deep sub-SMAS dissection was extended into the neck and the contralateral part, as needed. A thick flap was created and composite lifting was performed.
  
  
  RESULTS
  No significant deformity concerning the lower eyelids, nose, and lip was registered. Most scars could be placed in hidden regions and became undetectable after a year. The facial nerve function remained intact in all patients.
  
  
  CONCLUSIONS
  Using these facelift techniques, including the incision, sub-SMAS dissection for volumetric positioning of the skin, and the SMAS flap, the closure of extensive facial defects with excellent functional and esthetic results is conceivable.
authors.affiliation: Department of Oral, Maxillofacial, and Plastic Facial Surgery, University Hospital RWTH-Aachen, Aachen, Germany. aghassemi@aachen.de
authors.forename: Alireza
authors.initials: A
authors.lastname: Ghassemi
authors.forename: Mandana
authors.initials: M
authors.lastname: Shamsinejad
authors.forename: Marcus
authors.initials: M
authors.lastname: Gerressen
authors.forename: Mohammad
authors.initials: M
authors.lastname: Talebzadeh
authors.forename: Albert
authors.initials: A
authors.lastname: Rüben
authors.forename: Ali
authors.initials: A
authors.lastname: Modabber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003238:Connective Tissue / Q000601:surgery; D004954:Esthetics; D005145:Face / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015361:Rhytidoplasty / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult