{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T10:29:48Z","timestamp":1778840988478,"version":"3.51.4"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Facial Plast Surg"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The attenuation of retaining ligaments with aging leads to downward displacement of facial fat compartments and is responsible for many of the stigmata that occur with aging. The zygomatic cutaneous and masseteric cutaneous ligaments prevent the transmission of adequate traction to the malar portion of the dissection during traditional low superficial muscular aponeurotic system (SMAS) facelift techniques which involve plication or imbrication of the exposed surface of the SMAS because they do not include surgical release of these ligaments. Inadequate release of these ligaments, especially the zygomatic cutaneous ligament may lead to an unbalanced, unnatural appearance with unopposed nasolabial folds. In contrast, extended facelift techniques (extended SMAS, high SMAS, deep plane facelift, and composite plane facelift) involving the release of these ligaments and can reposition the ptotic malar fat and diminish the nasolabial folds. Additionally, the composite and modified composite plane facelifts include orbicularis oculi muscle elevation and can achieve a more harmonious rejuvenation. However, due to facial nerve injury risk, many facelift surgeons either inadequately release these ligamentous attachments or prefer less-invasive techniques. Modified composite plane facelift allows safe release of the zygomatic cutaneous ligament, and safe entry into the right plane leaving all malar fat pad attached to the skin. Modified composite plane facelift technique also produces combined, balanced, and harmonious rejuvenation of the midface, cheek, lower face, and neck without requiring a separate midface lift procedure or a transblepharoplasty approach. Extending the sub-SMAS\/subplatysmal dissection inferior to the angle of mandible, releasing of the cervical retaining ligaments, and adding a horizontal platysma myotomy below the angle of the mandible significantly improve the cervical contouring and enhances the jawline rejuvenation. This study explains modified composite-flap facelift with extended neck dissection in a step-by-step manner and highlights anatomical details to perform a safe, effective, and successful extended face and neck lift surgery.<\/jats:p>","DOI":"10.1055\/a-1862-9024","type":"journal-article","created":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T22:37:41Z","timestamp":1653604661000},"page":"584-592","source":"Crossref","is-referenced-by-count":6,"title":["Modified Composite Plane Facelift with Extended Neck Dissection"],"prefix":"10.1055","volume":"38","author":[{"given":"Ozcan","family":"Cakmak","sequence":"additional","affiliation":[{"name":"FACEISTANBUL, Facial Plastic Surgery, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ismet","family":"Emre","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Acibadem University, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,12,23]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/00006534-198901000-00003","article-title":"The retaining ligaments of the cheek","volume":"83","author":"D W Furnas","year":"1989","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1097\/00006534-200209010-00026","article-title":"Surgical anatomy of the midcheek and malar mounds","volume":"110","author":"B C Mendelson","year":"2002","journal-title":"Plast Reconstr Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.prs.0000294656.92618.2b","article-title":"MOC-PSSM CME article: face lifting","volume":"121","author":"J M Stuzin","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"245e","DOI":"10.1097\/PRS.0b013e3182789c5c","article-title":"Relationship of the zygomatic facial nerve to the retaining ligaments of the face: the Sub-SMAS danger zone","volume":"131","author":"M Alghoul","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1055\/s-0040-1712472","article-title":"Surgical anatomy for extended facelift techniques","volume":"36","author":"O Cakmak","year":"2020","journal-title":"Facial Plast Surg"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1097\/00006534-199203000-00007","article-title":"The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging","volume":"89","author":"J M Stuzin","year":"1992","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1097\/00006534-200105000-00039","article-title":"Surgery of the superficial musculoaponeurotic system: principles of release, vectors, and fixation","volume":"107","author":"B C Mendelson","year":"2001","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/PRS.0000000000002310","article-title":"Building the composite face lift: a personal odyssey","volume":"138","author":"S T Hamra","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1055\/s-0037-1615283","article-title":"Surgical approach to the thick nasolabial folds, jowls and heavy neck-how to approach and suspend the facial ligaments","volume":"34","author":"O Cakmak","year":"2018","journal-title":"Facial Plast Surg"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/S0094-1298(20)30969-X","article-title":"Extended SMAS dissection as an approach to midface rejuvenation","volume":"22","author":"J M Stuzin","year":"1995","journal-title":"Clin Plast Surg"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1067\/maj.2002.128628","article-title":"The \u201chigh SMAS\u201d face lift technique","volume":"22","author":"F E Barton Jr","year":"2002","journal-title":"Aesthet Surg J"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/00006534-199007000-00008","article-title":"The deep-plane rhytidectomy","volume":"86","author":"S T Hamra","year":"1990","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00006534-199207000-00001","article-title":"Composite rhytidectomy","volume":"90","author":"S T Hamra","year":"1992","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1001\/archotol.1996.01890160019004","article-title":"Suprafibromuscular facelifting with periosteal suspension of the superficial musculoaponeurotic system and fat pad of Bichat rotation. 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