The subperiosteal approach for the correction of the deep nasolabial fold and the central third of the face.

The nasolabial fold is one of the most difficult problems to correct with the traditional skin-SMAS rhytidectomy. This article presents a technique for the correction of the deep nasolabial fold and the central third of the face. Key steps of the operation include (1) a wide subperiosteal dissection with extension under the intermediate temporal fascia and the fascia of the masseter muscle, (2) subperiosteal release of the lower margins of the malar and maxillary areas, and (3) upward lifting and fixation of the deep structures in an almost vertical orientation. These surgical principles can be applied to the open, pure endoscopic, or endoscopic-assisted biplanar facelift.