A paradigm shift for plastic surgeons: No longer focusing on excising skin excess

Methods of dealing with the parenchyma now seem to be much more important than was the case previously. The skin is considered secondarily. This is evident in the plethora of new techniques for rhytidectomy. These newer techniques all manipulate the deeper tissue in different ways. The large number of different techniques described indicates just how many ways the deep tissue can be manipulated. In addition, there are other methods to effect change in the surface topography, for example, by altering the balance of muscle vectors. These factors have altered the way plastic surgeons assess and manage clinical problems, and in many instances this has led to improved results.