Modified approach to the subperiosteal rhytidectomy.

Our technique modifications include a systematic preauricular approach to the zygomatic arch and preservation of the temporal fat pad, which is left undisturbed. The preauricular extension permits greater access along the zygomatic arch, which may additionally reduce the risk of injury to the frontal branch of the facial nerve. Leaving the temporal fat pad undisturbed may help prevent a recently described late complication of temporal region depression that may be due to temporal fat atrophy from surgical trauma. By following the aforementioned steps, this technique can be performed efficiently and safely even if it is used infrequently.