2017-18 HSC Section 4 Green Book

Jacono et al

Figure 1. Deep plane dissection of the cheek during rhytidectomy in this 58-year-old woman. (A) Sharp entry into the deep plane along a line from the lateral canthus to the angle of the mandible. (B) Blunt vertical facelift spreading dissection raising the skin and super fi cial musculoaponeurotic system (SMAS) as 1 unit in the inferior cheek. (C) After dissection over the superior cheek super fi cial to the orbicularis and zygomaticus musculature, the zygomatic ligament is released sharply. (D) Deep-plane cheek fl ap dissection completed.

Figure 2. (A) Deep plane dissection in this 56-year-old female patient who underwent deep-plane rhytidectomy. The deep plane cheek fl ap is suspended with 3 PDS sutures from the deep plane entry point to the zygomatic arch periosteum in an interrupted fashion, spaced equidistant along a line from the angle of the mandible to the lateral canthus. (B) Medical illustration demonstrat- ing suspension of composite deep plane fl ap of skin and SMAS after release of the zygomatic osseocutaneous ligaments at an angle of approximately 60 degrees. Note the suspension sutures are anchored in the posterior one-third of the zygomatic arch periosteum to avoid injury to the frontal branch of the facial nerve.

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