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Objective: Through the anatomy study of the premasseter space, further improved the anatomic knowledge of the premasseter space and explored its application in rhytidectomy, in order to reduce the risk of facial nerve injury. To further improve the anatomic knowledge of the premasseter space and to determine its application in rhytidectomy., Methods: The anatomy of the premasseter region was investigated in 12 fresh cadaver (24 hemi-faces) dissections;810 patients of SMAS rhytidectomy procedures were observed., Results: ①There were several soft tissue spaces superficial to the masseter muscle, and the boundaries were strengthened by retaining ligaments. Adjacent spaces were separated by numerous weak fiber membranes connecting the SMAS and masseter fascia.② The space was further divided into two parts; one part was located under the platysma and another part was under the aponeurosis of SMAS. The former part was easier to identify and dissect. ③ The relaxation, expansion, and sliding of the space is an important reason in the face sags with aging, which is referred to as the layered ptosis theory., Conclusions: The soft tissue space superficial to the masseter muscle have two different characteristics. The different nature of the two parts of the space can easily mislead dissection to the wrong layer, which is the important anatomical factors for the risk of facial nerve damage in rhytidectomy. The layered ptosis theory seem to better explain the process of aging. The primary treatment of aged face was facial space dissection and tighten.

Objective: To observe the effect of the outer orbicularis muscle partial resection combined with orbital fat flap or orbicularis muscle flap transfer to block orbicularis muscle for improvement of crow's feet., Methods: From October 2010 to May 2015,82 cases of females (aged from 27 to 54 years old) with crow's feet were treated with new method(n =41) and traditional method(control, n =41).The new method included partial resection and orbital fat flap or orbicularis muscle flap transfer to block orbicularis muscle. The traditional method was performed to lift the skin and orbicularis oculi muscle to improve the crow's feet. The operation time, the postoperative recovery time, eyes closing function and hematoma, nerve injury and other complications were recorded.1,3,6 and 12 months after operation, the effect was assessed by one cosmetic surgeon who is unkown the groups. Completely correction was assed as 5 points and no improvement or even worse as 0 point.12 months after operation, the patients satisfactory rate was recorded., Results: 75 cases were followed up, including 39 in new method group and 36 in control group. The operative time and postoperative recovery time were (50 ± 5) min,(58 ± 4) min and (5 ±1) d,(6.0±1.5) d in the new method group and control group respectively (P＜0.05).The two groups both had good eyes closing function, no eyes closing fatigue or difficult or other serious complications such as hematoma, nerve injury. Visual analog scale were 3.2 ± 0.6,3.5 ± 0.5,4.2 ± 0.8,4.3 ±0.8 and 3.1 ±0.6,3.4 ±0.9,3.0 ±0.6,2.8 ±0.5 in the new method group and control group at 1,3,6,12 months after surgery respectively. Obviously, the effect in new method group was much better than that in control group after 6 and 12 months with statistical significance (P ＜ 0.05).12 months after surgery, the satisfaction surveys showed satisfactory in 33 cases; fairly satisfactory in 4 cases; dissatisfactory in 2 cases in new method group, and satisfactory in 10 cases; fairly satisfactory in 15 cases; dissatisfactory in 11 cases in the control group, showing significant difference between the 2 groups (P ＜0.05)., Conclusions: The outer orbital orbicularis muscle partial resection combined with orbital fat flap or orbicularis muscle flap is reasonable and reliable to correct crow's feet with short recovery and less complication. It is a worthy new method for recommendation.

Objective: To discuss the rhytidectomy technical improvements and clinical efficacy and safety, using the purse-string imbrication suture in midface and lower face lift., Methods: The absorbable purse-string suture was used in a pure antigravitational direction for correction of the aging middle and lower parts of the face. The volume of cheeks and jowls was repositioned in a cranial direction with a first, slightly oblique purse-string suture on SMAS. To correct the nasolabial fold, the face-lift was performed by adding a second malar vertical purse-string suture between the paracantbal area and the malar fat pad., Results: From July 2009 to May 2014,52 patients underwent this technique for facial rejuvenation with obvious effect and high satisfactory rate. There was only two minor complication of hematoma., Conclusions: The Purse-string imbrication suture in the rhytidectomy produces a natural face lifting through a better correction of the sagging tissue and restoration of the volume of the face. This is a simple technique with good results, short down-time, and high patient satisfactory rate.

Objective: To investigate a simple, minimally invasive and effective operative method for the facial rejuvenation in the upper eyelid and midface region., Methods: Blepharoplasty was combined with suspending orbicularis oculi muscle flap and fixing it on the periosteum underneath the eyebrow through eyebrow incision. Meanwhile, for midface rejuvenation, inferior palpebral margin incision was performed and prezygomatic interspace was separated completely under the orbicularis oculi muscle. The under-eye puffiness and tear trough deformity were corrected through releasing orbital fat, reposition and fastening orbital septum, and transposition of orbicularis oculi muscle flap. And the deep sulci nasolabialis and cheek anetoderma were relieved by dual lifting of malar fat pad and orbicularis oculi muscle flap. Follow-up was taken at the 1 week,3 months,6 months,1 year,2years and 3 years after operation. Each case was evaluated with postoperative effect, reprocessing time and postoperative complications and underwent photography., Results: From Feb.2010 to Oct.2014,190 patients (9 male,181 female, an average age of 49.03 ± 5.67 years) underwent this operation. Obvious improvement on the upper eyelid and midface region was achieved in all the patients after operation without serious or irreversible complication, Conclusions: Combining eyebrow and inferior palpebral margin incision, through suspending the malar fat pad and orbicularis oculi muscle flap at the same time, as a simple, minimally invasive and reliable method, can strengthen the effect of the facial rejuvenation in the upper eyelid and midface region markedly.

Objective: To evaluate the modified rhytidectomy incision in superficial parotidectomy., Method: Thirty-five patients with superficial parotid tumor were included in this study. A modified rhytidectomy incision often used in facial plastic surgery was used for superficial parotidectomy and subtotal superficial parotidectomy with preservation of facial nerve and great auricular nerve. The follow-up study included the exposed region, the cosmetic effect of this approach and the rate of complication., Result: All patients healed without salivary fistula, and were satisfied with this modified approach. Temporary paralysis of the marginal mandibular branch of facial nerve were found in five patients, and six patients felt insensible around earlobe after operation. They all recovered in 1 to 3 months after surgery, no recurrence was happened during follow-up in 36 to 60 months (median follow-up period was 48 months)., Conclusion: The modified rhytidectomy incision provided good exposure, had less complication and better cosmetic outcome.

Objective: To explore an ideal procedure with more lasting aesthetic results by covering the orbicularis oculi muscles with the superficial temporal fascia flap in rhytidectomy, which can help to correct the crow's feet successfully., Methods: During rhytidectomy, dissection was performed subcutaneously and also under pericranium and superficial temporal fascia at temporal area. Then the superficial temporal fascia flap was formed by cutting between pericranium and superficial temporal fascia. The fascia flap was reversed to cover the lateral orbicularis oculi muscle with fixation., Results: From May 2004 to May 2010, 18 cases were treated with a follow-up period of 6-12 months. The crow's feet was corrected better with long lasting results, compared with conventional rhytidectomy. No complication happened., Conclusions: The crow's feet can be corrected markedly with long lasting results by covering the orbicularis oculi muscles with the superficial temporal fascia flap in rhytidectomy.

Objective: To assess the safety and efficacy of hyaluronic acid-based gel of non-animal origin (NASHA gel [Restylane]; Q-Med AB, Uppsala, Sweden)for correcting nasolabial folds in Chinese., Methods: Patients with moderate or severe nasolabial fold (Wrinkle Severity Rating Scale, WSRS) were recruited to receive NASHA gel injection ( < 1.5 ml). The patients were followed up for 6 months. The efficacy was assessed by physicians and patients, respectively. Adverse events (AEs) were recorded and laboratory tests were performed before and after operation., Results: 86 patients were treated. 6 months after injection, improved esthetic results was assessed by patients and physicians independently. 52 AEs happened in 32 cases (37.2%). Most of them were local injection reaction and minor, which were recovered spontaneously. No systemic reaction was found., Conclusions: NASHA gel can improve the nasolabial folds. It is very safe and tolerated.

Objective: To investigate the method and the curative effect of postauricular muscular fasciae-periosteal flap and modified unwrinkle incision in parotidectomy., Methods: From January 2006 to August 2008, 28 patients with benign lesions of parotid gland were treated. There were 17 males and 11 females aged 19 to 79 years old (average 50 years old), including 20 cases of mixed tumor, 5 cases of adenolymphoma, 1 case of branchial cleft cyst, 1 case of eosinophilic hyperplastic lymphogranuloma, and 1 case of myoepithelioma. Tumor masses were all prominent, with the diameter of 2.4-3.8 cm and partial-tough texture. The course of disease was 3-18 months (average 9.5 months). Parotid gland and tumor mass were resected with postauricular incision hidden within the hairline, introcession defect (3.0 cm x 2.0 cm x 1.0 cm-3.5 cm x 2.5 cm x 1.5 cm) were repaired with simultaneously adopting postauricular muscular fasciae-periosteal flap (4.0 cm x 3.0 cm x 1.0 cm-5.0 cm x 4.0 cm x 1.5 cm) by turning the pedicle flap 180 degrees., Results: All incision healed by first intention and no necrosis of postauricular muscular fasciae-periosteal flap occurred. All patients were followed up for 6-24 months (average 12 months). The incision was hidden within postauricular hairline and shape of parotid realm was good. No salivary fistula, facial paralysis, and earlobe numbness occurred. No Frey syndrome were found by local iodine-starch tests., Conclusion: Because of hidden incision, good repair effect of region introcession deformity, and fewer postoperative complications, the modified parotidectomy with postauricular muscular fasciae-periosteal flap and modified unwrinkle incision is a better method in parotidectomy.

Objective: To investigate a modified midface lift for baggy deformity of low eyelid, zygomatic laxity, periorbital wrinkle and deep nasolabial groove., Methods: Through the incision at palpebral margin for baggy eyelid, the dissection was performed under the periosteum of midface. The orbicularis oculi and zygomatic major muscles were suspended to lift the midface through the incision at temporal area., Results: During the recent 5 years, 42 cases were treated with satisfactory results., Conclusions: The modified midface lift is easily performed with low morbidity and good safety. It is one of the best choices for mini-invasive midface rejuvenation.

Objective: To investigate the technique of lower face and neck lifting with parotid fascia-SMAS-platysma flap., Methods: To improve the lifting strength of SMAS and the cosmetic result, the traditional SMAS-platysma flap was modified as parotid fascia-SMAS-platysma flap. The modified flap was folded and suspended step by step to lift the lower face and neck., Results: From Oct. 2004 to Oct. 2008, 78 patients were treated with this method. The patients' age ranged from 40 to 65 years old. There were 2 cases of male and 76 cases of female. All the patients were followed up for 6 months to 4 year with satisfactory results., Conclusions: Folding and suspension of the parotid fascia-SMAS-platysma flap step by step can effectively lift the saggy tissue of lower face and neck.

Objective: To evaluate the effect of autologous free fat particle grafting combined with-bFGF to repair facial depression., Methods: From April 2004 to May 2006, 41 patients with facial depression were randomized into two groups (groups A and B). In group A, 12 cases were admitted from April 2004 to December 2004. There were 5 males and 7 females, aging 16-49 years (mean, 31 years). The pathological causes were congenital facial depression in 2 patients, hemifacial atrophy in 2, traumatic cicatrix in 5 and benign tumor removal in 3. The course of disease was 2-19 years. The concave regions were low (0.52 +/- 0.13) cm compared to surrounding normal skin, concave area (16.0 +/- 5.3) cm2. In group B, 29 cases were admitted from January 2005 to May 2006. There were 14 males and 15 females, aging 18-52 years (mean, 37 years). The pathological causes were: congenital facial depression in 3 patients, hemifacial atrophy in 4, traumatic cicatrix in 15 and benign tumor removal in 7. The course of disease was 2-20 years. The concave regions were low (0.58 +/- 0.15) cm compared to surrounding normal skin, concave area (18.0 +/- 6.2) cm2. Cases in group A were treated with pure autologous free fat particle injection; cases in group B were treated with autologous free fat particle injection combined with bFGF (4,200 IU/10 mL). The clinical outcome were comparatively analyzed between two groups after operation., Results: The follow-up time was 6 to 24 months (mean, 12.5 months) in group A and 6 to 24 months (mean, 13 months) in group B. In group A, 6 patients achieved satisfactory clinical effect after one injection of fat particle, the satisfactory rate of one therapy being 50%; other 6 cases were required reinjection of fat particle 6-12 months postoperatively, of which two-time injections in 3 cases, three-time injections in 3 cases. In group B, 24 patients achieved satisfactory clinical effect after one injection of fat particle, the satisfactory rate of one therapy being 82.8%; only 5 cases were required reinjection one year postoperatively. There was statistically significant difference in the satisfactory rate of one injection between two groups (P < 0.05)., Conclusion: Autologous free fat particle grafting combined with bFGF to treat facial depression can acquire satisfactory clinical effect, which is a safe and effective method.

Objective: To evaluate an improved treatment of an autologous fat injection for hemifacial atrophy to increase the survival rate of the fat graft and decrease complications including colliquation, necrosis, and absorption of the graft fat., Methods: From March 1999 to October 2004, 31 patients with hemifacial atrophy underwent an improved treatment by an autologous fat injection for their diseases. There were 12 males and 19 females aged 19-28 years (average, 23.5 years). The patients were divided into the following 3 groups according to the atrophy extent: the mild group (n=9), the moderate group (n=19), and the severe group (n=3). Based on the previous researches on the fat transplantation techniques, the improved treatment combined the following strategies that were simply called "3L3M": low position for the fat donation, low pressure for the fat harvesting, and low-speed centrifugation for purification of the fat; multi-point, multi-tunnel, and multi-plane for injections of the fat graft. The preoperative and the postoperative photos were taken and the findings were compared to make clear whether the hard and firm masses and cysts existed; then, the decision was made about whether the patients needed another operation according to whether the patients had a natural facial expression and whether the patients had comfortable feelings as well as the X-ray findings., Results: All the patients had a satisfactory symmetrical face after 1 injection of the fat in 15 patients, 2 injections in 13 patients, and 3 injections in 3 patients. The effect of the 3rd injection was better than that of the 2nd injection; the effect of the 2nd injection was better than that of the 1st injection; the fat volume for the injection could be gradually decreased. The fat volumes for injections were as follows: 8-14 ml (average, 11 ml) in the submaxillary region, 15-25 ml (average, 20 ml) in the buccal region, 5-10 ml (average, 7.5 ml) in the zygomatic region, and 18-20 ml (average, 19 ml) in the forehead region. The follow-up for 3-5 years revealed that there was no infection, hard and firm mass, cyst or other complications. The pigmentation in the affected face was significantly improved., Conclusion: Compared with the traditional treatments, the improved treatment of an autologous fat injection for hemifacial atrophy can achieve a satisfactory symmetry of the face with no injury to the donor site or complications in the recipient site. This improved method is an ideal treatment for hemifacial atrophy.

Objective: Facial contour remodeling is an important part of plastic surgery. Some skeletal abnormalities, such as mandible protrude, maxillary retrusion, induce the facial asymmetry (including arrowe direction or/and coronary direction), malocclusion, etc. These abnormalities are seen commonly in the lower one third of the face. Evaluation and preoperative design is very important for the treatment of these abnormalities. The purpose of this item is to summarize our experience in the preoperative design during the treatment., Methods and Results: Observation of the facial feature of the patient, cephalometric tracing, face-bow transfer and model reconstruction were necessary for the preoperative design. Three-dimensional direction was included in the bone movement for operation and soft tissue should be taken into account simultaneously. All the factors mentioned above were summarized, and outcomes were gathered., Conclusions: Determination of facial midline was very important, especially for asymmetry patient. The bone was moved in three-dimensional direction. The same site of osteotectomy may produce different effects by different movements.

Objective: To evaluate the effect of vacuum suction on facial shaping and cervicofacial rejuvenating., Methods: Based on injection of swelling solution, vacuum suction was used in totally 327 cases, including local fat deposit in face or neck., Results: Since 1993, we have carried out 327 case, satisfactory rate was up to 98%., Conclusions: This is an adaptable method for facial shaping and cervicofacial Rejuvenating, very good results can be achieved.

Objective: To explore the reliability of humping the forehead and temple by en block frontal temporal silicone ., Methods: Make wax mold by piling up wax slices layer by layer according to the rang of depressing of the forehead and temple, the section being humped and the hight need to be projected. Order the silicone block according to the dimension of the wax mold. Make the implant from the silicon block. Under local anaesthesia dissection under the superficial temporal fascia and galea through forehead and two temporal incisions. Implant the silicon through the middle incision., Results: Total 18 cases in this group were followed up for 3-12 months. Wound healed primarily without infection. I case with early blood effusion cured after aspiration. l case with later clear effusion cured after aspiration ad injection of prednisone in to the capsular. The frontal temporal contours were satisfactory . No outline of the implant was seen., Conclusion: It is safety and satisfied to hump the forehead and temple by en block frontal temporal silicone.

Objective: To introduce a safe and simple method to improve the effect of face lifting., Methods: During face lifting three anatomic dissection was applied. All the cases were performed with transferring the SMAS flap from the anterior ear to the posterior and fixing platysma flap with deep fascia of mastoid region, then removed fixed and sutured skin flap., Results: 12 cases with satisfying effect were followed up for 6 - 12 months. No complications were found such as facial nerve injuring., Conclusion: The application of pedicle SMAS flap and platysma flap in face lifting is simple and safe.

Objective: To evaluate a facial rhytidectomy technique to reduce the complications of temporal alopecia and incisional scar hyperplasia., Methods: The 82 aged patients were divided into 2 groups in random way: group A in 46 with the use of the three-point relief-tension suspension technique and group B in 36 as control. In group A, the two point of every relief-tension suture was located respectively in the subcutis of the hairline and fascia under the incision. The parallel three sutures formed a mechanical plane to make the relief suture more strong and permanent. The temporal alopecia and incisional scar was observed with the follow-ups after the operation., Results: With the 82 cases of facial rhytidoplasty, the complications of the temporal alopecia and incisional scars in group A were much less than in group B., Conclusions: This technique could decrease the complications such as temporal alopecia and incisional scars, and get a good and long term effect of temporal lifting simultaneously.

Objective: To evaluate the aesthetic outcome after application of rectangle periosteous flap to cover corrugator., Methods: On the basis of regular rhytidectomy, a inter-eyebrow periosteous flap is applied to cover the fascia flap of corrugator by means of turnover. This manipulation helps to separate the skin from the muscle and prevent the re-adherence between the skin and muscle., Results: The approach was applied on 15 cases. The follow-up ranged from 6 months to 1 year. The results were satisfactory., Conclusions: The method is effective in elimination of inter-eyebrow crease.

Objective: To study the effect of the fixation on skull and thorough mobilization of the brow area on the results of the endoscopically assisted subperiosteal forehead lift., Methods: The operation procedure included adequate subperiosteal dissection, especially at the frontotemporal transition area; complete mobilization of the brow area and fixation of the incised scalp to the skull through a cortical tunnel without tension. 19 patients received the operation., Results: Long-term follow-up showed that all the 19 patients were satisfied with the surgical results. A transient frontal branch paresis happened in one case, which resolved in 3 months spontaneously without sequelae., Conclusions: Cortical tunnel fixation well keeps the brows at a lifted position and achieves persistent rejuvenation of the forehead.

Objective: To utilize multiplane, subcutaneous and subperiosteal, dissection through small incisions in scalp to rejuvenate aging signs of forehead/temple., Methods: Forehead: We make four small incisions in scalp, widely separate tissues between subperiosteum skin and frontal muscle to form galea frontal muscle-periosteum flap, the flap is tightened and sutured with the galea at the posterior border of the incision. This method avoid to excise scalp. Temple: there are two small incisions in the scalp of temple at each side. Superficial temple fascia and orbicularis oculi muscle as well is dissected from deep temporal fascia and skin respectively, then tightened and sutured with the superficial part of deep temporal fascia, excising scalp is not necessary., Results: Twenty patients have received this treatment, the effects are satisfying., Conclusions: Multiplane dissection through small incisions can remove wrinkles of skin, correct the prolapse of eyebrow and avoid the complications of coronary incision. This approach brings more rapid recovery of patients, it is safe and affective.

Objective: To introduce a safe, effective and lasting rhytidectomy technique without destroying the configuration of sideburn., Methods: The operation is performed through the coronal incision, the temporal incision that is paralleled to the nasolabial sulcus, and the preauricular incision in the sideburn. Multi-layer dissection of facial tissue is made., Results: 46 patients with aging face have been treated using this technique since 2002. All patients obtained good curative effects without any severe complications., Conclusions: This operation technique may maintain the natural configuration of the preauricular area and sideburn, result obscure incision scar and avoid harming important nerves or vessels. Multi-layer dissection accords with anatomical principles and produces a lasting curative effect.

Objective: To find a procedure for facial rejuvenation which is simple, safe with lasting aesthetic results based on facial anatomic study., Methods: Anatomy study was performed on 12 sides from 6 head specimens. Observe the range and thickness of fat lateral to the nasolabial grooves. Observed the location of the skin retaining ligaments and reappraised their functions combining with clinical observations., Results: Skin and subcutis and SMAS (including mimic muscles) become slackening with aging, but the loosening degrees are different, especially in the region lateral to the nasolabial groove. So they should be handled respectively. The fat lateral to the nasolabial groove is thick and is mobile with aging . So the subcutaneous detachment need not beyond the anterior border of the masseter. In the past two years, we performed rhytidectomy on 100 patients by limited subcutaneous detachment and SMAS double-plication. Satisfactory results were obtained. There are no serious complications observed., Conclusions: Rhytidectomy by limited subcutaneous detachment and SMAS double-plication is a simple and safe procedure with lasting aesthetic results.

Objective: To improve the outcome of the face-lift with a craniofacial contouring procedure., Methods: Thirty-seven patients aged 29-53 years (31 in female, 6 in male) were treated through a bicoronal incision. The facial tissue was lifted through a subperiosteal procedure and the facial skeleton was remodeled in three dimensions by osteotomies., Results: The results were satisfactory after the 3-12 months of the follow-ups., Conclusions: The Face-lift combined with the facial aesthetic sculpturing may be more effective for the aging-face rejuvenating.

Objective: To introduce a new method for correction of deep nasolabial fold., Methods: From May 1998 to May 2002, 20 patients (aging 32-48 years, female) with deep nasolabial fold were treated with the buried guiding suture appliance and method through oral incision., Results: All patients recovered without complications, the scar is minimal. Six patients were followed up 6 to 12 months, stable and permanent result was achieved., Conclusion: This method is simple and reliable for correction of nasolabial fold.

Objective: To investigate the anatomical distribution of the zygomatic branch of the facial nerve and discuss its clinical significance in the rhytidectomy., Methods: The distribution of the zygomatic branch of the facial nerve was observed on 30 halves of the fifteen candaveric specimens (10 antiseptic cadaveric specimens and 5 fresh cadavers)., Results: The zygomatic branch made its way through the upper or the anterior border of the parotid gland, giving rise to 2 or 3 rami, which could be divided into the superior and the inferior rami. The superior rami, which were thin and superficial, crossed the zygomatic arch at its inner one-third or ran along the inferior margin of the zygomatic arch, and then entered beneath the zygomatic ligaments. The inferior rami were comparatively thick and deep, lying 1.0+/-0.3 cm inferior to the superior rami. The inferior and superior rami joined each other on the surface and deep side of the zygomatic major muscle., Conclusion: In the prevention of the zygomatic branch damage in rhytidectomy, the areas where caution should taken were the anterior border of the zygomatic major muscle in sub-SMAS dissection and the zygomatic arch in the subperiosteal dissection. The sharp dissection and excess tension should be avoided to reduce the nerve injury.

Objective: To reposit all the elements of the aging midface more adequately., Methods: We have performed combined facelift on 100 patients using extended subperiosteal dissection or sub-SMAS and subcutaneous dissection. In particular, the zygomatic arch subperiosteal dissect releases the attachment of the zygomatic ligament., Results: In this group of 100 patients, postoperative follow-up showed that this technique can restore the initiate anatomical relationship of multiple tissue layers of the face, provides the patient with both an excellent nasolabial fold and jawline contour without damage of the frontal branch of the facial nerve., Conclusion: This technique is most suitable for the patients about 40 years old.

Objective: The study is to correct all the deformities of the lower eyelid. There is a regressive keletonization of the orbit as the soft-tissue covering of the lower eyelid skin and orbicularis oculi descend downward due to loss of tone, and the orbital fat herniates through a weakened septum orbital, resulting in an infraorbital crease., Methods: We suspend the orbicularis oculi muscle and fix the orbital septum in blepharoplasty., Results: This method has been used in 32 patients with satisfactory results in recent years., Conclusion: The technique can improve all the deformities of the baggy eyelids and achieve long-lasting youthful countenance.

Objective: A technique is introduced to improve the operative result of rhytidectomy of the nasolabial fold., Methods: Regional anatomy was studied on 10 adult cadavers together with histological examinations of tissue sections to investigate the formation mechanism of the nasolabial fold. 13 patients were operated on using a new technique of nasolabial fold rhytidectomy., Results: Prolonged and repeated movements of the facial mimetic muscles produce a shearing force between the skin-subcutaneous tissue and the SMAS-mimetic muscles, causing relative motion of adjacent tissues with different structure at the site of the nasolabial fold, thus producing the nasolabial fold. In clinical application of the finding, the nasolabial folds of 13 patients were corrected with remarkable early and long-term results postoperatively., Conclusion: The operation should be performed between SMAS and the subcutaneous tissue. SMAS should be incised along the zygomatic major muscle. The fibro-fatty zygomatic pad should be replaced anatomically and the zygomatic ligament be reconstructed.

Objective: This is to introduce the experience in the treatment of lower eyelid pouches by orbital fat preservation and orbicularis oculi muscle flap suspension techniques., Methods: From Sept. 1996 to May 1997, thirty patients with lower eyelid pouches were treated using Hamra's procedure. During the operation, the arcus marginalis was incised. The orbital fat was released and advanced beyond the infraorbital rim and sutured. A lateral-based orbicularis oculi muscle flap was created, and its pedicle was repositioned to the periosteum of the upper lateral orbital rim in a superiomedial direction., Results: A total of 26 patients were available for postoperative follow-up for 3 to 8 months (mean 5.6 months). Of them one patient developed unilateral lower eyelid ectropion due to flabby reposition of the orbicularis oculi muscle flap. The rest obtained excellent cosmetic results without complications., Conclusion: This new method has following advantages: 1. The lower eyelid pouches and the infraorbital rim show that may be corrected simultaneously: 2. Sunken eyelids and scleral show that may follow fat removal in conventional lower blepharoplasty can be effectively avoided. 3. "Cheek lift" and a youthful eyelid-cheek complex contour can be obtained.

Objective: To further understand the distribution and course of the frontal branch of the facial nerve in the temporal and zygomatic areas., Methods: Facial dissection was performed on 9 cadaver heads(18 sides)., Results: It was found that the frontal of the facial nerve had 3 to 7 divisions (average 5) instead of one. The divisions of the frontal branch showed no constant course and distributed nearly all over the zygomatic arch. We divided the zygomatic arch into 3 equal parts and found that the middle third had the highest density of the branch distribution, accounting for 44.44% of the total divisions; the anterior third and the lateral third possessed 38.89% and 16.66% of the total divisions respectively. These divisions entered deeply into the temporoparietal fascia(the superficial temporal fascia). The divisions in the anterior third of the zygomatic arch innervate the lower and lateral orbicularis oculi muscle; the divisions in the middle third innervate the lateral orbicularis oculi muscle and the frontal muscle; the divisions in the lateral third innervate the frontal muscle and the anterior auricularis., Conclusion: We recommend discriminating the layers of the soft tissue over the zygomatic arch, not limiting the dissection range of the zygomatic arch to avoid damaging the nerve divisions while doing subperiosteal dissection of the zygomatic arch in facelifting.

Objective: To investigate the relationship between the SMAS and the facial nerve divisions in the cheek area., Method: We dissected 12 cadaver heads(24 sides)., Results: 1. SMAS distributed over the middle face. It became thinner as it extended forward and there was a small aperture lateral to the mouth. The branches of facial nerve lay directly beneath the parotidomassetric fascia after emerging from the parotid gland. 2. The frontal branch penetrated the deep fascia to the SMAS at about 0.5 cm below the zygomatic arch. 3. Some buccal branches went through the cheek fat pad while the others lay on its surface directly under the thin SMAS. 4. There was constantly a zygomatic ramus went into the upper one third of the zygomaticus. It innervated the lower and lateral orbicularis oculi muscle in 9 of 24 sides (37.5%) of the cadaver heads, zygomaticus major and minor and orbicularis oculi muscle in 8 of 24 sides (33.3%), and the zygomaticus major and minor in 7 of 24 sides (29.2%)., Conclusion: During facelifting, wide dissection of the SMAS should be done directly above the parotidomassetric fascia and 0.5 cm below the zygomatic arch. While approaching the middle face, the dissection should be limited to the lower two third of the zygomaticus, followed by elevating the zygomatic fat. The authors dissect the nasolabial fold through the lower eyelid incision, then the dissection should go downwards, under the orbicularis oculi muscle, to the nasolabial area. In a clinical situation, care must be taken not to damage the facial nerve trunk, and dissection of the upper one third of the zygomaticus should be avoided.

Objective: The multiple-layer composite rhytidectomy is presented in this paper for correction of the facial aging., Methods: The operative procedures include multiple-layer dissection, suspension reconstruction of the zygomatic ligament, and thinning of the zygoma., Results: The method has produced a good result in 28 patients since 1993., Conclusion: Study of clinical cases and cadaver dissections had led to better understanding of the aging face. With advancing age, all tissues of the face lose their balanced relationship. These changes occur in their volume shape, position, and consistency. With the multiple-layer dissection and suspension, the soft tissues of the check, forehead, nasolabial fold, lateral canthus and eyebrow can be lifted to reestablish their previously youthful relationship with the underlying skeleton.

Objective: This anatomic study was carried out in a bid to decrease damage of the temporal branch of the face nerve in endoscopic temporal lifting., Methods: We dissected the frontal-temporal region and located the temporal branch on 36 sides of adult head specimens., Results: It was found that the temporal branch is deep to the temporoparietal fascia and frontal muscle. The temporal branch has one to four branches in general. The first one is 8.1 +/- 2.1 mm anterior to articular tubercle and 33.8 +/- 4.9 mm superior to the bony lateral canthus. The temporal branches locate below a line drawn from the articular tubercle to 40 mm above the bony lateral canthus., Conclusion: It is suggested that the operation incisions in the temporal region be selected above this line.

Based on the character of degeneration and change of the aging skin, reconstruction and repair of the skin structure are performed with a method of subdermal incision in order to increase the content of collagen protein and replace the degenerates collagen in the dermis. The animal experiment shows that the treated skin contracts by nearly thirty percent (P < 0.01) at 15 days after surgery. The epidermis becomes thicker and the dermis contains more fiberoblasts and collagen than that of preoperation. Seven patients were treated with the method. Afterwards their crow's feet deformity and the wrinkles of the nasolabial groove almost disappeared.

It is just recently that video endoscopic techniques began to be applied to facial rejuvenation in China. Since July 1995, the authors have performed 15 operations of subperiosteal rejuvenation under the video endoscope, combined with liposuction of the sub-mandible region and the nasolabial fold. The operation uses small incisions, produces satisfactory results with less edema, less numbness and without alopecia. The indications, instrumentation, surgical technique and results and presented and discussed. According to our clinical experience, the best candidates for this operation are those aged from 40 to 55. For the patients about sixty years old, a mini multiplane facelift should be carried out in the cheek and neck region following the subperiosteal facelift. The more elderly patients are not candidates for this operation. We emphasize that the dissected scalp flap should be uplifted to the maximum and anchored on the cranial bone to ensure a satisfactory result.

The use of endoscopic techniques in facelifts has had a significant effect in recent two years. To reduce operation complications and trauma, the authors performed 31 endoscopic forehead rejuvenation procedures with corrugator-procerus resection and eyebrow elevation at a desired level in Chirurgie Esthetique Europeenne in Strasbourg, France from January to November 1995. Three to six months' follow-up revealed satisfactory operation results. Subperiosteal endoscopic forehead facelifting using resection and elevation of the muscle of the eyebrow is one of the best operations for facelifting.

A variation of the SMAS technique is introduced. During the operation, the SMAS was treated in two parts. The fixed part that is closely attached to the preparotid fascia is on the pre-auricle area. The movable part of the SMAS is from the lower part of the parotid gland to the platysma. The movable part of the SMAS was mobilized, elevated and fixed upwards to the fixed area. From January to November of 1995 at Chirurgie Esthetique Europeenne in Strasbourg, the authors did rhytidectomy on 31 cases using this technique with impressive results and minimal complications.

The endoscopic techniques were just recently applied to aesthetic surgery. The paper reports 22 cases of video endoscopic facelift that have been performed since April 1994. The operative results were satisfactory. Clinical experience with forehead plasty, resection of corrugator and procerus muscle and other cosmetic procedures using endoscopic technique is presented.