Face lift, Part 3: Plication of the superficial musculoaponeurotic system

It is thought that plicating or folding the superficial musculoaponeurotic system (SMAS) upon itself near the ear with permanent sutures will improve and help maintain the results of cheek-neck lifting of the skin layer alone. Getting proof of this conjecture with controlled studies is difficult in the existing medicolegal climate. However, many years ago, we did carry out a limited study in a few patients in whom plication was performed on one side only. We found that plication does have some relatively long-lasting effects, particularly in improvement of platysma cording and in elevation and deepening of the cervical angle. Plication is not a substitute for adequate skin and/or fat resection. Because the early improvement in cases with platysma cording was so marked in contrast to the unplicated side, we had to limit the series stringently. As time went by, the differences on the two sides lessened.