Overview
The author states that facial aging reflects the downward movement of three deep structures: the platysma muscle, cheek fat and the orbicularis oculi muscle. These structures keep their close relationship to each other as they descend. The paper describes a facelift designed to move all three back up as one unit with the skin, and reports the author's case count.
Findings
- Signs of facial aging reflect changes in position of three deep elements: platysma muscle, cheek fat, orbicularis oculi muscle.
- These elements sag progressively while keeping their close relationship with each other.
- Conventional facelifts separate the skin from these elements and so disrupt that relationship.
- SMAS techniques reposition only the platysma, not the cheek fat or orbicularis muscle.
- Composite rhytidectomy raises one musculocutaneous flap containing all three elements and the skin, keeping them attached.
- 167 composite rhytidectomies performed; the author reports "impressive results and minimal complications."
- The abstract gives no complication rates or measured outcomes.
What it means for a patient
- In a composite facelift, the skin, cheek fat, platysma and the muscle around the eye are lifted together as one layer.
- The author's view is that lifting skin alone, or the SMAS alone, does not move the cheek fat and the muscle around the eye back into place.
- Ask your surgeon which layers they lift and whether the cheek fat is included.
- Results are the author's own description of 167 cases. The abstract gives no numbers on complications or how long results last.
Why this paper matters
It described the composite rhytidectomy and the view that facial aging is a descent of platysma, cheek fat and orbicularis oculi together. It argued that these should be repositioned as one unit with the skin. Cited 325 times (NIH iCite, 2026-09-25).
Terms
- Rhytidectomy: the medical name for a facelift.
- Composite flap: a single layer of tissue lifted together, here skin, fat and muscle.
- Musculocutaneous flap: a flap that contains both muscle and skin.
- Platysma: the thin muscle over the neck and lower face.
- Orbicularis oculi: the ring-shaped muscle around the eye.
- Ptosis: sagging or drooping of tissue.
- SMAS: the layer of muscle and fibrous tissue under the facial skin and fat.