title: Modified superficial musculoaponeurotic system face-lift: a review of 327 consecutive procedures and a patient satisfaction assessment.
abstract: BACKGROUND
  A conventional superficial musculoaponeurotic system (SMAS) face-lift is well established because it allows the skin envelope to be rotated in a bit more lateral direction than the cephalad redirection of the SMAS flap. This ensures an individualization of the treatment plan according to the needs of the patient and avoids a postoperative stretched look. However, this technique has some limitations with respect to its long-term effects on the sagging tissue, inadequate lifting of the malar fat pad, and flattening of the nasolabial fold.
  
  
  METHODS
  The procedure described by the authors consisted of a modified approach to conventional SMAS flap dissection for 327 patients with facial aging signs undergoing a face-lift. A pointing tongue-shaped flap of zygomaticotemporal fascia was dissected and preserved in the posterior half of the upper edge of the SMAS flap and anchored to the deep temporal fascia, enhancing the vertical support of the facial soft tissues. Outcomes were determined by case notes, clinical review, and a questionnaire.
  
  
  RESULTS
  The study investigated 327 consecutive modified SMAS face-lifting procedures. Few complications were observed. Only two patients experienced small hematomas needing evacuation. Some patients reported bearable pain in the temporal region and tension during mouth opening. Temporary weakness in the branches of the facial nerve experienced by two patients resolved completely within some months. Two patients presented with dehiscence of the scar, and one patient experienced punctual retroauricular skin necrosis, which healed uneventfully with conservative treatment. Two patients reported that the knot in the temporal region was palpable through the skin. One patient experienced retroauricular infection. Only two patients required additional procedures. One mild hypertrophic scar responding to steroid injection over the mastoid area was observed in the entire series. With the reported technique, the authors achieved pleasing, natural, durable results with minimal morbidity and an overall complication rate of 3.9%. All the patients were sent a satisfaction questionnaire or contacted for a telephone interview. A total of 235 patients replied. The patients reported high levels of satisfaction after treatment.
  
  
  CONCLUSIONS
  The authors believe that the rhytidectomy technique described in this report has several beneficial attributes. High vertical elevation of the SMAS flap delivers a long-lasting benefit and addresses the problem of neck laxity and platysma redundancy, leading to a correction of the neck contouring and jowls. Nasolabial folds appear to be smoothed, and malar flattening is restored by imbrications of the SMAS flap over the cut edge in the malar prominence. This investigation demonstrates that the rhytidectomy technique is safe and produces highly predictable results.
authors.affiliation: Divisione di Chirurgia Plastica e Ricostruttiva, Clinica Ars Medica, Rome, Italy. manuelfranciscocastello@gmail.com
authors.forename: Manuel Francisco
authors.initials: MF
authors.lastname: Castello
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Silvestri
authors.forename: Tommaso
authors.initials: T
authors.lastname: Agostini
authors.forename: Diego
authors.initials: D
authors.lastname: Gigliotti
authors.forename: Claudio
authors.initials: C
authors.lastname: Marcelli
authors.forename: Carlo
authors.initials: C
authors.lastname: D'Aniello
authors.forename: Marco
authors.initials: M
authors.lastname: Gasparotti
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D002610:Cheek / Q000601:surgery; D015331:Cohort Studies; D062109:Dermatologic Surgical Procedures; D004954:Esthetics; D005152:Facial Muscles / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000503:physiopathology; D012060:Rejuvenation / Q000502:physiology*; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D015595:Skin Aging; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology