title: Cervicofacial rhytidoplasty: more does not mean better.
abstract: BACKGROUND
  Aesthetic correction of cervicofacial flaccidity has undergone numerous modifications over time, including extent and depth of dissection. We present our experience with this type of surgery, passing through different stages and procedures to achieve optimal and highly satisfactory results.
  
  
  METHODS
  From January 1995 to December 2009, 576 patients (498 females and 78 males, age range = 34-78 years, mean = 47) underwent cervicofacial rhytidoplasty. During the first 6 years of the study period, cervicofacial tissue was managed with six different types of plications, according to the needs of each patient, requiring extensive supra-SMAS undermining. During the last 9 years, undermining was significantly limited and only three of the six plications were used, adding different surgical procedures to achieve the surgical objectives.
  
  
  RESULTS
  During the first period, 220 patients were operated on and 164 patients required additional procedures (74%). Seventy-nine patients (36%) needed 6 plications, 90 patients (41%) required 5 plications, and 51 patients (23%) only 4 plications. During the second period, 356 patients were operated on, needing only 3 plications, but 336 (94%) required additional procedures. The percentage of complications during the first period was 2.2% hematomas, 2.7% superficial necrosis, and 0.45% deep necrosis compared with 0.84, 0.56, and 0%, respectively, in the second period. A greater disability rate than expected from edema and/or prolonged ecchymosis occurred in 25 and 12% of the patients in the first and second periods, respectively. A similar degree of patient satisfaction was obtained in both periods, 93 and 92%, respectively.
  
  
  CONCLUSIONS
  Our approach to cervicofacial rhytidoplasty has varied substantially by limiting undermining, which has produced a lower complication rate and has accelerated the recovery process. However, to acquire similar results, we have had to implement additional procedures, with which we have obtained the same degree of satisfaction but with a lower rate of postsurgical morbidity.
authors.affiliation: Centro Médico Puerta de Hierro, Boulevard Puerta De Hierro 5150, Edificio C Int. 403, Zapopan, Jalisco, Mexico. drlazaro@drlazaocardenas.com
authors.forename: Lázaro
authors.initials: L
authors.lastname: Cárdenas-Camarena
authors.forename: Joel
authors.initials: J
authors.lastname: Encinas-Brambila
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Guerrero
mesh_terms: D000328:Adult; D000368:Aged; D005145:Face / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D015361:Rhytidoplasty