title: Triple-anchoring sub-SMAS face-lift.
abstract: BACKGROUND
  This article presents the senior author's (ARB) 10-year experience with a rhytidectomy technique that incorporates concepts of modern facial shaping and contour using a sub-SMAS repositioning of volumetric units with partial sub-SMAS elevation (tunnel dissection), periosteal anchoring of SMAS and volumetric units, and limited skin undermining.
  
  
  METHODS
  The cases of triple-anchoring sub-SMAS face-lift performed from January 2000 to January 2010 were analyzed retrospectively. Primary and secondary cases were included. All case data and photography were analyzed. Data regarding patient age, sex, and operative time were gathered. Complication rates were also calculated.
  
  
  RESULTS
  A total of 626 patients had a face-lift using the author's technique in this period. A total of 484 patients had a primary face-lift and 142 had secondary surgery. Experience with 626 rhytidectomies performed over a 10-year period indicates that this operation can be completed safely with satisfactory results and a low incidence of complications. To alter effectively the facial contour, a system that reliably elevates the facial volumetric units is needed. After adequate release of the retaining ligaments, the thick SMAS is used as a load-bearing layer. All the tension is transferred from the SMAS to a fixed periosteal anchor point. Each volumetric unit of the face (mala, lateral, and cervical) should be independently mobilized and fixed.
  
  
  CONCLUSIONS
  The author's technique was shown to be effective in repositioning facial volumes. It was a predictable and reliable technique with few complications over the years.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at http://www.springer.com/00266.
authors.affiliation: Plastic Surgery Department, Basile Medical Center, Av. Prof Joao Fiusa 2300, Ribeirao Preto, Sao Paulo, 14024-230, Brazil. fibasile@gmail.com
authors.forename: Filipe Volpe
authors.initials: FV
authors.lastname: Basile
authors.forename: Antonio Roberto
authors.initials: AR
authors.lastname: Basile
authors.forename: Vinicius Volpe
authors.initials: VV
authors.lastname: Basile
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D040521:Subcutaneous Tissue / Q000601:surgery