title: The S-Plus lift: a short-scar, long-flap rhytidectomy.
abstract: BACKGROUND
  As rhytidectomy is one of the most elective surgical procedures, there is a strong trend toward less aggressive operative techniques. The authors introduce the S-Plus lift, a 'long flap' superficial musculo-aponeurotic system (SMAS) imbrication technique that diminishes risks, decreases recovery time, and yields long-lasting results.
  
  
  METHODS
  This paper describes a novel approach to mid-facial rejuvenation that combines the limited incision of an S-lift with two SMASectomies, purse-string suture imbrication of the extended supraplatysmal plane (ESP) and SMAS, and malar soft tissue suspension. SMAS excisions are performed pre-auricularly, and in the region overlying the anterior edge of the parotid gland. Purse-string imbrication sutures are designed to close the SMAS defects, pull the soft tissues of the neck upward, pull the jowl and lower face posteriorly and superiorly, and tighten the platysma. Ancillary purse-string suture lifts the malar fat pad and cheek soft tissues vertically, which achieves mid-face fullness and lifting. Compared to S-lift, the technique extends its efficacy in those patients who have moderate-to-severe mid-facial laxity, prominent nasolabial folds, and platysma redundancy.
  
  
  RESULTS
  A review of 144 consecutive S-Plus lifts performed by a single surgeon (SBH), with at least 6 months of follow-up, was performed. Over a 3-year period, 130 (90.3%) females and 14 (9.7%) males underwent S-Plus lift. S-Plus lift as primary rhytidectomy was performed in 132 (91.7%) and as secondary in 12 (8.3%) cases. Complication rate was low and comparable with other techniques of rhytidectomy.
  
  
  CONCLUSIONS
  The S-Plus lift is a novel, hybrid technique with pleasing results, short down-time, and high patient satisfaction rate. The technique combines two SMASectomies with purse-string suture imbrication of the ESP and SMAS, and malar fat suture suspension.
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, The George Washington University, Washington, DC, USA; Center for Cosmetic Surgery & The Washington Hair Institute, Washington, DC, USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Hopping
authors.forename: Sasa
authors.initials: S
authors.lastname: Janjanin
authors.forename: Neil
authors.initials: N
authors.lastname: Tanna
authors.forename: Arjun S
authors.initials: AS
authors.lastname: Joshi
mesh_terms: D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D015361:Rhytidoplasty / Q000009:adverse effects / Q000379:methods*; D013524:Surgical Flaps; D013536:Suture Techniques