The "R.A.R.E." technique (reverse and repositioning effect): the renaissance of the aging face and neck.

Considering the fixed points of the face (Fig. 1), and in light of the fact that gravity is one of the main factors involved in aging, a new alternative concept in cosmetic surgery is discussed in this paper. In our approach, rejuvenation of the face and neck involves two completely separate procedures. The whole face must be treated " homothetically", with an upward (vertical) and deep (subperiosteal) approach, to preserve facial proportions and distances, thus preserving the original facial identity. The facial portion of our rejuvenation surgery becomes a single " en bloc" and "closed" procedure, correcting the sagging tissue in the lateral sector, between the fixed zones which must be preserved. The Malaris portion of the Orbicularis Oculi Muscle, (through its strong connections with the skin and the malar fat) has become the "key tool" of the rejuvenation of the whole face. Then, neck surgery becomes a completely distinct procedure, and is to be performed in an oblique/horizontal direction. We now seek to preserve the very firmly attached neck zones, which are the attachment of the posterior border of the fibrous platysma onto the S.C.M. (Sterno-Cleido-Mastoidien muscle). This will permit a more conservative and less aggressive neck surgery, without any sub-platysmal dissection. Over 200 RARE procedures have been performed during almost four years. Improvement in terms of facial rejuvenation is dramatic and the technique is quite safe and predictable. The only possible difficulty involves the patient's temporary initial concern about early postoperative appearance.