Increasing Superficial Musculoaponeurotic System Durability and Retention in Facelift Surgery

Facelift surgery remains the gold standard for facial rejuvenation, yet limitations such as suture pull-through failure, superficial musculoaponeurotic system (SMAS) laxity, and the need for secondary procedures persist. Although novel facelift techniques have emerged, none have effectively addressed the inherent biomechanical challenges. Photochemical tissue passivation (PTP) is a promising method to enhance tissue durability and improve facelift longevity by modifying the biomechanical properties of the SMAS itself.

In this study, the authors investigated whether PTP enhances the biomechanical properties of SMAS, strengthens tissue integrity, and improves suture retention strength, thereby reducing the likelihood of recurrent laxity and the need for revision facelifts.

SMAS tissue was harvested from facelift patients (n = 7) and Lewis rats (n = 16). The harvested SMAS underwent treatment with PTP. After treatment, the biomechanical properties, including modulus of elasticity, maximum load, and suture pull-through resistance, were assessed. Additionally, an in vivo rat SMAS plication model was established, and tissue laxity was evaluated at 4 and 12 weeks postoperatively.

PTP-treated human SMAS demonstrated a 229% increase in suture pull-through resistance (P = .21) and significantly higher modulus of elasticity in both human and animal specimens (P = .011 and P = .013, respectively). In the in vivo rat model, the laxity of SMAS plication was significantly lower by 58% at 4 weeks (P = .005) and 54% at 12 weeks (P < .0001) compared with untreated controls.

PTP significantly enhances the biomechanical strength of the SMAS, reduces postoperative laxity in a rat model, and improves suture retention capacity in human SMAS tissue. These effects indicate that PTP has the potential to substantially increase the durability of facelifts and reduce revision rates, positioning it as a valuable adjunct technique in facial rejuvenation surgery. Additional clinical studies are needed to confirm these findings. Level of Evidence: 5 (Therapeutic).