Modified Composite-Flap Facelift Combined With Finger-Assisted Malar Elevation (FAME): A Cadaver Study

Area of Science:

• Plastic Surgery
• Anatomy
• Facial Rejuvenation

Background:

• Inadequate release of retaining ligaments during facelift surgery can result in an unnatural appearance.
• Surgeons often avoid transecting these ligaments due to the risk of facial nerve injury.

Purpose of the Study:

• To evaluate the anatomical basis and safety of the finger-assisted malar elevation (FAME) technique for modified composite flap rhytidectomy.
• To assess the safe release of zygomatic cutaneous ligaments through the prezygomatic space under direct vision.

Main Methods:

• The FAME technique was performed on 22 fresh cadaver hemi-faces for modified composite-flap facelift.
• Detailed dissection of facial nerve subbranches was conducted to evaluate surgical safety.
• Investigated the anatomical relationships between the facial nerve, ligaments, orbicularis oculi muscle, and malar fat pad.

Main Results:

• Finger dissection within the prezygomatic space enables safe release of zygomatic cutaneous ligaments.
• Provides direct visualization for accessing a surgical plane above the zygomatici muscles.
• Preserves the malar fat pad and overlying structures, avoiding a transblepharoplasty approach.

Conclusions:

• Modified composite-flap facelift using the FAME technique is a safe and effective procedure.
• Allows for adequate and en-bloc repositioning of the composite flap for balanced facial rejuvenation.
• Eliminates the need for a separate midface lift, offering comprehensive lower and midface enhancement.