Resumo

RAMIREZ, O. M.; NOVO TORRES, A.  e  VOLPE, Ch. R.. "Double ogee" facial rejuvenation. Cir. plást. iberolatinoam. [online]. 2007, vol.33, n.1, pp.01-14. ISSN 1989-2055.

Subperiosteal techniques describes by Tessier have revolutionized the treatment of the aging face advocating this approach to treat early signs of aging in young and middleage patients. Psillakis refines the technique further and Ramirez describes a safer and more effective method of subperiosteal lifting, so that this technique could be applied across the full spectrum of facial aging. The introduction of the endoscope in the treatment of facial rejuvenation ushered in a new era in Aesthetic Surgery. Today, endoscopically assisted subperiosteal undermining of the upper, middle and lower face can provide a means for repositioning the sagging facial soft tissues in addition to augmentation of the craniofacial skeleton, with a reduced preoperative facial edema, minimal injury to the facial nerve branches and improved aesthetic correction of the sagging cheek structures. This approach, refined over the past decade, has come to be known as the "Double Ogee" rhytidectomy technique. The ogee arch is well-known in architecture from the antiquity and is characterized for being a harmonic line convex curve and later curved concave. The youthful face, when viewed at an oblique angle, maintains a characteristic distribution of tissues, previously described in the midface by an architectural ogee or single S-shaped curve. However, on more precise examination, the entire contour the youthful face generates follows a "double ogee" or double sigma when analyzed in three-quarter view. To view this reciprocal multi-curvilinear line of beauty, the face must be viewed in an oblique position that allows visualization of both medial canthi. In this position, the youthful face demonstrates a characteristic convexity of the tail of the brow that flows into a concavity of the lateral orbital wall (the upper ogee). This is joined by the convexity of the upper midface that flows into the concavity of the lower midface (the lower ogee). Patients with considerable aging and ptosis of the central facial structures can benefit most from our endoscopic approach. The eyebrows, eyelid commisures, nasoglabellar soft tissues, nose, nasolabial folds, cheeks, angle of the mouth and jowls are effectively treated with this approach. Tear through deformities, as well as deep infraorbital hollows can be corrected too. Additionally is quite effective for patients undergoing secondary or tertiary facelift procedures, those requiring immediate skin resurfacing, and those requiring soft tissue augmentation. Patients who demostrate skeletal and soft tissue desproportion can benefit from endoscopic lifting techniques. The exposed bony structures can be augmented or reduced as needed. The authors recommend this approach in patients with alloplastic facial implants that require removal or exchange. The endoscopic forehead and midface procedures allow recreation of the "Double Ogee" that is associated with a youthful appearance.

Palavras-chave : Subperiosteal facelift; Endoscope; Facial rejuvenation.

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