{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T02:33:49Z","timestamp":1790044429546,"version":"4.0.1"},"reference-count":17,"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>Deep-plane rhytidectomy, first described by Skoog, has had a resurgence in popularity and is in high demand today. We describe anatomical findings that establish the presence of a true deep fascia in the midface, we named as Chiara's fascia, like the first author's first name, which helps to form the facial ligaments and is contiguous with the superficial layer of the deep temporal fascia. This fascia inserts on the periosteum of the inferior orbital rim at the arcus marginalis and separates the suborbicularis oculi fat (SOOF) from the preperiosteal fat. This distinct fascial layer lies under the superficial fascia or superficial musculoaponeurotic system (SMAS) and represents the floor of what is commonly termed the \u201cdeep plane.\u201d When this fascial highway is identified intraoperatively, blunt dissection immediately superficial to this layer will protect facial nerve branches overlying the muscles lifting the upper lip such as the zygomaticus. Subsequent dissection over the middle and lower face can usually be performed bluntly. Over a 10-year period, a total of 100 hemifaces were dissected with a 100% success rate of identifying this fascia in all specimens. This work was further validated by examining histologic specimens that clearly demonstrate this unique fibrofatty fascial layer. These dissections and new anatomical findings were then correlated to over 300 intraoperative deep-plane facelift cases by the primary and senior authors. We term this operative technique as the suprafibromuscular facelift. Dissection in this plane allows for safe release of facial retaining ligaments with protection of facial nerve branches.<\/jats:p>","DOI":"10.1055\/s-0042-1756456","type":"journal-article","created":{"date-parts":[[2022,10,19]],"date-time":"2022-10-19T23:15:01Z","timestamp":1666221301000},"page":"623-629","source":"Crossref","is-referenced-by-count":6,"title":["The Deep Fascia of the Infraorbital Region, Deep Plane, and Suprafibromuscular Facelift: New Anatomy for Safer Facelifting"],"prefix":"10.1055","volume":"38","author":[{"given":"Chiara","family":"Andretto Amodeo","sequence":"additional","affiliation":[{"name":"Ecole Doctorale Sorbonne Paris Cit\u00e9\u2013M\u00e9dicament, Toxicologie, Chimie, Imagerie (MTCI), Universite Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Eggerstedt","sequence":"additional","affiliation":[{"name":"Department of Facial Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene A.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishad","family":"Nabili","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory S.","family":"Keller","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,10,19]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1001\/jamafacial.2013.53","article-title":"The SOOF and the fascial planes: has everything already been explained?","volume":"16","author":"C Andretto Amodeo","year":"2014","journal-title":"JAMA Facial Plast 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"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1001\/archfacial.2007.16","article-title":"Surgical anatomy of the face: implications for modern face-lift techniques","volume":"10","author":"H G Gassner","year":"2008","journal-title":"Arch Facial Plast Surg"},{"issue":"04","key":"ref4","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. Tightening the net","volume":"122","author":"G S Keller","year":"1996","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"01","key":"ref6","first-page":"913","article-title":"A deep fascia exists in the midface: the missing plane coming from the temporal region","volume":"28","author":"C Andretto Amodeo","year":"2014","journal-title":"FASEB J"},{"issue":"01","key":"ref8","first-page":"542","article-title":"The midface deep fascia: the missing plane of the infraorbital region that changes the concept of fascia superficialis of the face","volume":"29","author":"C Andretto Amodeo","year":"2015","journal-title":"FASEB J"},{"issue":"01","key":"ref10","first-page":"1046","article-title":"The facial nerve: the path of its branches to the muscles of the infraorbital region that lift the upper lip in relation to the deep fascia of the midface","volume":"30","author":"C Andretto Amodeo","year":"2016","journal-title":"FASEB J"},{"key":"ref11","first-page":"1046.15","article-title":"The relationship between the parotid fascia and the deep fascia of the infraorbital region: a new concept in descriptive and applied anatomy","volume":"30","author":"C Andretto Amodeo","year":"2016","journal-title":"FASEB J"},{"issue":"01","key":"ref14","first-page":"913","article-title":"The relationship between the facial vessels and the deep fascia of the infraorbital region: a new concept","volume":"28","author":"C Andretto Amodeo","year":"2017","journal-title":"FASEB J"},{"key":"ref16","first-page":"901.2","article-title":"The relationship between the MC Gregor ligament, the masseteric ligaments and the deep fascia of the infraorbital region","volume":"31","author":"C Andretto Amodeo","year":"2017","journal-title":"FASEB J"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1055\/s-0038-1675634","article-title":"Deep plane facelift: an evaluation of the high-SMAS versus standard incision points","volume":"34","author":"J P Sand","year":"2018","journal-title":"Facial Plast Surg"},{"key":"ref18","first-page":"300","volume-title":"Plastic Surgery New Methods and Refinements","author":"T Skoog","year":"1974"},{"key":"ref19","first-page":"51","volume-title":"Aesthetic Facial Surgery","author":"J Owsley","year":"1994"},{"key":"ref20","first-page":"77","volume-title":"Color Atlas of SMAS Rhytidectomy","author":"M L Lemmon","year":"1993"},{"key":"ref21","volume-title":"The \u201cF.A.M.E.\u201d facelift: Finger-assisted malar elevation","author":"S J Aston","year":"1998"},{"issue":"01","key":"ref22","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"},{"key":"ref23","first-page":"996","volume-title":"In Farhadieh RD: Plastic and Reconstructive Surgery Approaches and Techniques","author":"B C Mendelson","year":"2015"}],"container-title":["Facial Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1756456.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T01:16:10Z","timestamp":1671844570000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0042-1756456"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,19]]},"references-count":17,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2022,12,23]]},"published-print":{"date-parts":[[2022,12]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1756456","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0736-6825","1098-8793"],"issn-type":[{"value":"0736-6825","type":"print"},{"value":"1098-8793","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,19]]}}}