Background: Super-high superficial musculoaponeurotic system (SMAS) suspension and tailor tack plication are powerful facelift tools used in cases of primary facial rhytidectomy.
Technique: Thorough pre-operative patient screening and counseling are completed in an outpatient cosmetic surgery center. A super-high SMAS flap is developed by undermining and incising along a line extending from the tragus to lateral canthus and dissecting the SMAS sufficiently to induce movement of the lateral nose and the oral commissure with traction on the SMAS. The SMAS is suspended from the deep temporal fascia using 4-0 Mersilene sutures. Tailor tack sutures are placed strategically in the SMAS caudal to the malar bone to eliminate any residual laxity in the SMAS close to the oral commissures and the cheek area. This is repeated until the laxity of the SMAS is completely eliminated. The orbicularis muscle is conservatively suspended laterally from the deep temporal fascia, facial volume is restored with fat grafting, the neck is contoured, if necessary, and the vest-over-pants platysma overlap technique is commonly utilized. Concomitant forehead rejuvenation, blepharoplasty, and laser resurfacing are extremely common.
Results: Of the 72 cases of primary rhytidectomy performed by the senior author on consecutive patients included in the study, there were 64 (89%) female and 8 (11%) male patients. The average age of the patient at the time of primary facelift was 58 years old. Fifteen out of 72 (21%) patients received one dose of desmopressin (DDAVP) injection during the surgery, and one patient received DDAVP the day after surgery to maintain hemostasis. There was no incidence of facial nerve injury. Of those 72 cases, 3 (4%) developed minor hematomas that were resolved by aspiration. There were no expanding hematomas that required surgery. Of the 26 patients whose satisfaction was documented, 24 were very satisfied. Two patients expressed their dissatisfaction with the results, and one of these patients underwent a revision operation by the senior author. The other patient was mainly not pleased with the recovery duration.
Conclusion: An alteration in the SMAS elevation and suspension is described with strategic submalar plication, providing a powerful technique for primary facial rhytidectomy that offers reliable and significant malar lift, orbicularis suspension, improvement in jowls, and repositioning of the oral commissure. The technical details are demonstrated through complete video segments along with many nuances that make delivery of optimal and natural outcomes possible, while maintaining the normal anatomy.
Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Keywords: Facelift technique; Rhytidectomy; Tailor tack plication.