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Page 2 of 6 Colombo et al. Plast Aesthet Res 2018;5:25 I http://dx.doi.org/10.20517/2347-9264.2018.29
[1]
tomical position, resisting the gravitational change. In 1976, Mitz and Peyronie described the superficial
musculoaponeurotic system (SMAS) and after this date multiple surgical procedures were improved. These
techniques produce excellent results, but require a thorough dissection and have the potential for greater
[2]
morbidity. The anatomical distribution of the facial nerve has been studied by various authors and dur-
ing the surgical dissection the most dangerous area of the face, the most worried one, must be considered.
The frontal branch is one of the most commonly damaged nerves in plastic surgery. The path of the frontal
[3]
branch can be drawn on the skin by two divergent lines that start from the region of the earlobe and go to
[4]
the lateral extremity of the eyebrow and to the highest front fold. To locate the frontal branches it is use-
ful to look for the superficial temporal artery. The branches of the buccal and zygomatic nerve have a deep
position and in the nasolabial fold there is an excess of skin and fat which provides greater protection to the
[5]
underlying nerve. The mandibular branch is located above the lower margin of the mandible in 80% of the
cases, in the remaining 20% it forms an arch under the lower edge of this bone and always flows inside or
in depth of the muscle fibers of the platysma so in this area there is almost no danger of injuring the nerve.
In this study, the authors, Colombo and Ruvolo, describe a new simple and safe face lifting technique, the
KORU technique, designed for their patients and to guide the young surgeons in a first approach to this sur-
gical procedure.

METHODS
Between October 2010 and October 2012, 31 patients were operated using the facial lifting surgical tech-
nique, called KOru, conceived by the authors Colombo and Ruvolo. There were 25 women and 6 men. The
age of the patients ranged between 35 and 64 years. All patients underwent the primary facelift.

TECHNICAL DESCRIPTION
The skin incision is performed along the temporal hairline and extends into the conventional position of the
facelift in the postural auricular groove, posteriorly extending on the mastoid following an external audi-
tory canal line. The skin flap is elevated in a subcutaneous plane and the dissection extends up to 2 cm from
the labial commissure to respect the buccal branches of the facial nerve. Inferiorly the dissection is carried
out to expose the neck and the mandibular edge, externally extending up to the orbital edge and beyond the
upper edge of the zygoma. The authors suggest that the dissection is safer and it’s less difficult to find the
right dissection plan if the surgeon started from the temporal region. All face-lift procedures were associated
[7]
[6]
with a blepharoplasty using the technique of Adamson et al. and Mendelson . The SMAS plications are
performed on four vectors: the first vector passes from the external cantus to the tragus and gives a vertical
direction; the second vector goes from Darwin to the tragus and gives a vertical/oblique direction; the third
vector goes from the angle of the jaw to the Lore band; the fourth vector that goes from the back/subauric
platisma to the mastoid. The last two vectors give a vertical direction and an angle definition of the jaw that
draws a U around the earlobe [Figures 1-3].

The choice of these traction points was according to the area of the face where the branches of the facial
nerve are deeper to work safely. A plication suture performed between cantus and tragus was made to create
a spindle to restore the cheek volume [Figure 4]. The suture [Figures 5 and 6] takes less tissue on the mar-
ginal area in the direction of cantus and tragus and takes more tissue in the central zone of placation, in this
way the author restores the loss of volume at a point of greater projection of the face and gives an all-round
look 3D topography that is delineated by series of arcs and convexities [8-18] [Figure 2].

RESULTS
The authors performed 31 interventions, using the KORU technique, from October 2010 to October 2012. In
no case there were infections, there was minimal tension on the suture line. There is minimal postoperative