Integrating SMAS plication and deep plane techniques in facial rejuvenation: A novel approach

In facial rejuvenation surgeries, deep plane facelift and superficial musculoaponeurotic system (SMAS) plication techniques have been applied with notable efficacy over an extended period, yielding aesthetically pleasing outcomes. Both methods have their own advantages and disadvantages depending on the individual circumstances. We endeavored to formulate an effective facelift method by integrating these approaches, aiming to harness the advantageous aspects of each method while addressing their respective drawbacks in a comprehensive manner.

Following the preparation of the subcutaneous plane overlying the fixed SMAS, the mobile SMAS was elevated from the deep plane, and a SMAS flap was fashioned. The SMAS flap in the prezygomatic and premasseteric areas was inwardly folded, and a plication procedure was applied using loop sutures from its most medial to lateral aspects. Subsequently, it was secured to the preauricular area with U stitches. The results were statistically evaluated preoperatively and postoperatively using the wrinkle severity rating scale (WSRS) scores.

A total of 40 patients underwent the operative procedures effectively performed by the senior author (F.C.). Preoperative WSRS scores were 4.2 ± 0.52. Postoperative WSRS scores at 3 months were significantly lower at 1.25 ± 0.44 (p < 0.05). The facelift procedure was effectively applied in all patients without the development of major complications.

This method combines deep plane facelift and surgical SMAS plication, using the advantages of both techniques to directly address the nasolabial folds and achieve gratifying outcomes in facial and neck rejuvenation.