The Release Zone in Facelift Surgery

Goals/Purpose:  A surgical strategy for facial rejuvenation is described which maximizes the result and avoids the unsightly stigmata frequently seen from facelift surgery.

Methods/Techniques:  This advance in facelift surgery requires the surgeon to access the “facial release zone” by elevating the parotid fascia off from the parenchyma of the parotid gland in continuity with the platysma muscle, continuing beyond the anterior border of the parotid gland.  Multiple fine ligamentous attachments in this location (masseteric ligaments) are divided, and a point is reached where, on traction, a definite visible release will be seen to occur.  This release allows for greater advancement of the deep plane.  The release zone is invariably located beyond the anterior border of the parotid gland in the deep plane.  Facial nerve branches are at risk.  The release zone is also a danger zone.

Results/Complications:  By advancing and securing the parotid fascia and platysma in combination with advancement of the malar fat pad, the surgeon is able to achieve restoration of a more youthful and natural appearance in all areas of the face and neck.  The neck contour is restored.  Jowls are eliminated.  The amount of skin which can be advanced and removed in the cheek vector is doubled.  The procedure is predictable, and the patient can appear 20 years younger without looking tight, stretched, or strange.  In our series of over 800 cases, there have been no instances of permanent facial nerve branch palsy and only 3 instances of temporary paresis, all with complete recovery.

Conclusions:  The greater youthfulness the patient achieves, the longer the results will last.  The anatomy and surgical approach into the facial release zone will be demonstrated with emphasis on safety to the branches of the facial nerve.  The positive aspects are 1) maximum rejuvenation, 2) predictable results, 3) longer-lasting results, and 4) avoidance of facelift stigmata.   The drawbacks are length of surgery time and limited margin of error due to the proximity of facial nerve branches.