title: The purse-string reinforced SMASectomy short scar facelift.
abstract: BACKGROUND
  Over the last two decades, short scar facelifts, often referred to as "mini" facelifts, have gained popularity. We use a purse-string reinforced (PRS) superficial musculoaponeurotic system rhytidectomy (SMASectomy) shortscar facelift that combines a SMASectomy in the vertical direction and suspension sutures in order to improve structural facial support. In the case of visible platysma bands and/or local fat deposition, liposuction (frequently followed by an anterior plastysmaplasty procedure) was added to correct features that are not consistently correctable using only a short scar facelift.
  
  
  OBJECTIVE
  This study retrospectively analyzes our experience with a new type of short scar facelift technique that combines both a superficial musculoaponeurotic system rhytidectomy (SMAS-ectomy) and suspension sutures with a thorough approach to the anterior surface of the neck.
  
  
  METHODS
  Over a period of three years, the PRS short scar facelift was performed in 137 patients with a mean age of 55 years (range 23-79 years). In almost half of the patients, the PRS short scar facelift was preceded by a separate treatment of the anterior neck contour by liposuction (67/137 patients; 49%). In two-thirds of these patients (42/67 patients), this liposuction was followed by an anterior plastymaplasty.
  
  
  RESULTS
  Most patients (129/137; 94%) were satisfied or very satisfied with their results at the end of the follow-up period. Eight patients were not satisfied: five because of higher expectations, two because of insufficient improvement of the plastysma bands (which had not been treated by a plastysmaplasty procedure), and one because of the improper recognition of midface sagging (which had not been treated and was not properly discussed preoperatively). In the case of plastysma bands, platysmaplasty (n = 42) did improve the presence of these bands. There were no major complications in this series: 1 case had temporary neuropraxia of a buccal branch, which resolved after two months; two cases had hematoma, requiring evacuation on the outpatient clinic after one week; two cases with traction dimpling in the neck over the sternocleidomastoid region required late surgical revision; and one case had hypertrophic scarring in the preauricular area.
  
  
  CONCLUSIONS
  The PRS technique is a short scar facelift technique that is both simple and safe. Complications are uncommon and usually minor. However, in the presence of platysma bands and/or local fat deposition, an anterior neck procedure-liposuction and/or anterior platysmaplasty-should be incorporated in order to optimize the results.
authors.affiliation: Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. b.van.der.lei@plchir.umcg.nl
authors.forename: Berend
authors.initials: B
authors.lastname: van der Lei
authors.forename: Michel
authors.initials: M
authors.lastname: Cromheecke
authors.forename: Stefan O P
authors.initials: SO
authors.lastname: Hofer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015187:Lipectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000009:adverse effects / Q000379:methods*; D013518:Surgery, Plastic / Q000009:adverse effects / Q000379:methods; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult