Overview
Composite rhytidectomy added repositioning of the orbicularis oculi muscle to the deep plane face lift so that the eyelid area is lifted with the face. This paper describes a change in the midface dissection, called the zygorbicular dissection, and a change to the arcus marginalis release. The abstract reports no patient numbers.
Findings
- The orbicularis oculi is not separated from the zygomaticus minor.
- The dissection is extended under the medial portions of the zygomaticus major and minor muscles.
- A thin, nonrestrictive mesentery is left between the deep plane dissection and the zygorbicular dissection.
- This still allows vertical movement of the composite face lift flap without breaking the link between platysma, cheek fat and orbicularis oculi.
- The modification eliminates the occasional prolonged edema and the occasional temporary dystonia previously observed.
- The arcus marginalis release is kept, modified by resetting the septum orbitale over the orbital rim.
- The author states the two modifications give a more predictable result.
What it means for a patient
- This is a deep plane face lift variation that lifts the cheek and the lower eyelid area as one unit.
- The author reports that the change removed occasional long-lasting swelling and temporary muscle movement problems.
- The author presents eyelid-area rejuvenation as part of the face lift, and states it can prevent unfavorable results of a conventional face lift plus lower blepharoplasty.
- Limits: one surgeon's technique description with no numbers, comparisons or measured outcomes in the abstract.
Why this paper matters
It defines a midface dissection plane for composite rhytidectomy and presents periorbital rejuvenation as an integral part of facial rejuvenation. Cited 128 times (NIH iCite, 2026-09-25).
Terms
- Composite rhytidectomy: a deep plane face lift that also repositions the muscle around the eye.
- Deep plane face lift: a face lift that lifts skin and the deeper tissue layer together as one flap.
- Orbicularis oculi: the ring muscle around the eye that closes the eyelids.
- Zygomaticus major and minor: cheek muscles that lift the corner of the mouth and upper lip.
- Mesentery: here, a thin bridge of tissue left intact between two dissected areas.
- Arcus marginalis release: freeing the tissue attachment at the bony rim below the eye.
- Septum orbitale: the thin sheet that holds the eye socket fat in place.
- Dystonia: abnormal or poorly controlled muscle movement.