The mechanism creating the strong vertical uplift of the Refresher Lift is based on an obliquely directed (lateral canthus to base of earlobe) inverted C, elliptically shaped smasectomy, starting with a pie shaped excision of the lateral periorbital orbicularis and finishing with a similar excisional wedge of the superolateral platysma in the sub-tragal area. The strong quasi vertical uplift of the malar pad is achieved with a near/far slipped auto-locking knot running suture. Prior to this step, a gathering auto-locking purse string suture is used to elevate the superolateral platysma and the lower smas in a fanlike fashion, and secure them to the rigid pretragal smas (this suture may extend in the neck when needed, toward the supraglottic area tightening the mid platysma).

In some cases, when a substantial superolateral malar uplift is needed, and only a minimal fat pad laxity is present, a subperiosteal malar undermining accompanied by a strong transfixing suspension suture anchored to the temporal fascia is added to the smasectomy.

Closure of the orbicularis resection consistently improves lower lid posture. The small lateral canthal dog ear created by the vertical uplift is reduced by syringe liposuction of the subcutaneous malar pad. Squinting lines are reduced by a punch avulsion of the lateral periorbital orbicularis. Enhancement of the medial sub orbital fill hollow is achieved at the end of the procedure with 4 to 5 cc micro fat grafting placed below orbital rim and under the periorbital orbicularis.

A receding hairline belies all rejuvenating efforts. The Refresher Lift maintains a youthful temporal hairline because the hairs are never displaced behind or above the superior ear sulcus. This is achieved by using a sharply beveled, wavy, intra, or retro trichial incision, designed to minimize the displacement of the temporal hairline or sideburns. The post-tragal incision is refined by a one sided Z-plasty.

When no anteroposterior neck tightening is needed, the post auricular sulcus absorbs the dog ear resulting from the superolateral cheek skin transfer. When a more substantial lateral neck skin redraping is needed, a beveled, wavy intra and/or retro trichial incision is designed following obliquely, the nape of the neck.

The most common ancillary procedures performed in conjunction with the Refresher Lift are intraconjunctival lower blepharoplasties with a 35% TCA peel, corset platysmaraphy to correct prominent band, pre or sub platysmal fat excision, and repair the platysmal sling with a strong slipped knot, auto locking suture. Our dual plane brow lift is commonly performed to restore an elegant and dynamic framing of the eyes.