[Role of deep temporal lift in the surgical treatment of face aging]

This is a new technique which is completely different from superficial temporal facelift also referred to as the mannequin facelift, which is associated with well known failures and sequelae. The principle of the deep temporal facelift is to approach the deep surface of the musculoaponeurotic plane by remaining in contact with the bone and to attach the ascension of this plane by means of sutures anchored to the temporalis mucsle and fibrin glue. This operation is technically possible due to the use of the dissectable space described by Rouvière between the galea and the temporalis muscle. This virtual, detachable space can only be easily defined by the use of hydrodissection. It is an avascular space with the exception of an unnamed vein located at the external agnle of the orbit. There is no resection of the scalp, no modification of the hairline and no modification of the sideburns. The frontal branch of the facial nerve constitutes the anatomical danger. It is situated anterior to the superficial temporoparietal aponeurosis which prolongs the galea. The two danger zones are the zygomatic arch which is crossed by the frontal nerve trunk and a quadrilateral area between the hairline and the tail of the eyebrow and a vertical line 1.5 cm lateral to the lateral canthus of the eye. The frontal nerve does not constitute any risk during deep temporal facelift, as this procedure remains about 1.5 cm away from the zygomatic arch. The nerve is obviously more superficial in the quadrilateral area. To avoid damaging it, the dissection must be performed under direct vision using a cold light, remaining in contact with the temporalis aponeurosis and avoiding any untimely instrumental manoeuvre between a subaponeurotic metallic instrument and the stretched skin. This technique causes minimal discomfort to the patient. It can be performed under local or general anaesthesia. The hospital stay is brief and the postoperative course is extremely straightforward with a very limited risk of bruising. The deep temporal facelift can be combined with the subpalpebral facelift in order to act on the upper 2/3 of the face. Its essential indications are: drooping of the tail of the eyebrow, drooping of the external canthus of the eye, erows feet.