facelift facelift facelift facelift facelift

Lower eyelid blepharoplasty Lower eyelid blepharoplasty

neck lift neck lift neck lift

The modified composite-flap facelift with the FAME technique incorporates the orbicularis muscle, allowing safe release of the zygomatic cutaneous ligament and precise entry into the correct plane, while preserving all malar fat pads attached to the skin. This approach creates a stronger en-bloc composite flap that more effectively repositions the ptotic malar fat and reduces the upper nasolabial folds. Overall, it provides combined, balanced, and harmonious rejuvenation of the midface, cheek, lower face, and neck without requiring an additional midface lift procedure.

Traditional surgical approaches often address only subcutaneous fat and, occasionally, the platysma muscle, while neglecting subplatysmal structures. This limited focus may produce suboptimal outcomes or even worsen existing issues, resulting in contour irregularities that are difficult to correct. In many cases, additional factors deep to the platysma—such as subplatysmal fat, the anterior bellies of the digastric muscles, perihyoid fascia, and the submandibular glands—contribute to obtuse neck contours. For these patients, a submental incision provides access for precise management of these deep structures. Achieving natural and durable neck contours requires detailed anatomical knowledge, targeted modification of subplatysmal elements, platysma tightening, and judicious preservation or removal of subcutaneous fat. Despite concerns about potential risks, deep neck contouring consistently yields long-term, natural results with low complication rates.

filler complications round table discussions

Subciliary lower eyelid blepharoplasty has evolved to achieve a more harmonious, natural appearance with a fuller, unoperated look, while minimizing complications. Whereas lower eyelid malposition was once common, its incidence has been markedly reduced through careful preoperative evaluation, meticulous surgical planning, precise technique, and attentive postoperative care. Prophylactic maneuvers that maintain or reinforce lower lid support include preservation of the pretarsal orbicularis oculi muscle, conservative skin and muscle resection, and suspension of the orbicularis oculi muscle and/or tarsus to the periosteum of the lateral orbital rim. Releasing the orbicularis retaining ligament and transposing orbital fat over the rim, rather than excising it, smooths the lid–cheek junction, corrects the tear trough deformity, and reduces the appearance of lower eyelid fat prolapse. This presentation outlines a comprehensive approach to achieving a smooth lid–cheek transition while preserving or restoring lower lid support and provides detailed postoperative guidelines to optimize recovery.