BACKGROUND: The primary goal of the facelift is to rejuvenate the face without changing its natural features. This involves working on the deeper layers to preserve the surface look while adjusting the fat pads beneath. Thus, we often use a modified High-SMAS facelift method, following this deep-layer approach. The study evaluates whether the high-SMAS facelift, focusing on optimal repositioning, can effectively reduce aging signs in the mid to lower face and neck.
METHODS: Conducted from 2018 to 2022, this retrospective cohort study included demographic data, relevant comorbidities, and operative details of patients undergoing lateral extended high-SMAS facial lifting, excluding revision cases. Complications were recorded, and a minimum one-year follow-up was ensured. The technique\'s effectiveness was assessed using pre- and one-year post-surgery images analyzed by three masked examiners with a validated scoring method by La Padula et al. RESULTS: The study included 325 patients, with no major complications reported. Significant improvements were noted in post-operative High-SMAS visual scores compared to pre-operative scores (p < 0.0001), particularly in cheek fullness, jawline, and cervical angle definition.
CONCLUSIONS: The High-SMAS facelift technique, evaluated using the Face- and Neck-Lift Objective Photo-Numerical Assessment Scale, demonstrated significant cosmetic enhancements. This technique, focusing on optimal flap draping vectors, effectively restores a youthful appearance by improving facial contours.
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   www.springer.com/00266 .

The main and more frequent problem in face lift is recurrence of neck bands. To improve face lift stability, a new aging analysis is proposed. The visible sign of face aging is skin excess. Superficial musculo aponeurotic system (SMAS) retraction is a much less visible sign. Nevertheless, botulinum toxin injections elongate muscles of the SMAS and rejuvenate the face. In the Face Recurve Concept, MRI studies prove the mimic muscles retraction that comes with aging. Face lift techniques include SMAS plication, traction or excision, which increases discrepancy between the envelope, the skin and the core, the SMAS. As skin excision is poorly efficient because performed posteriorly, far from the anterior skin excess located at the medial neck, the association to SMAS retraction exacerbates the gradient difference between envelop and core. This analysis shows that it is paramount to preserve the SMAS. (1) The sub-skin dissection has to be executed moving beyond the marionette fold and the paramedian neck bands; (2) no action is performed on the SMAS, only an horizontal section of the platysma at the hyoid height that will avoid platysma band recurrence. A botulinum toxin injection performed herein just after, blocks muscle regeneration; (3) the skin is pulled backward with a clear posterior transposition to the platysma. The skin at the cervico-mental angle and all along the cervico-mental crease is fixed to the deep cervical fascia, in the gap between the edges of the sectioned platysma, blocking muscle recreation. A resorbable barbed thread is used, with a first bite made at the cervico-mental angle through the deep cervical fascia then in the direction of the mastoid, with long bites through the deep cervical fascia versus short subcutaneous bites. Thanks to this strong shift, the cervico-mental crease is definitely recreated with no need of pre-auricular skin tension. Thirty-two patients have been operated with this technique on a one-year period. The results are a lot more stable and swelling is lowered down to the minimum.

Background: Characteristic aesthetic changes of the aging neck include skin laxity and rhytid formation, submental fat deposition, plastysmal banding, and ptosis of underlying structures that lead to the development of an obtuse cervicomental angle (CMA). Cervical rejuvenation techniques that aim to restore the CMA are widely discussed in the literature, and share variable outcomes. The aim of this study is to compare the restoration of the CMA in patients undergoing the addition of midline platysmal plication using a modified Giampapa stitch with absorbable PDS suture, to those patients undergoing standard deep plane lateral rhytidectomy alone. Methods: A retrospective cohort study was performed by a single surgeon in a private facial plastics practice. 264 patients undergoing rhytidectomy were included in the study. Pre and postoperative measurement differences in CMA degree and depth were compared in patients undergoing only traditional deep plane lateral rhytidectomy (TDPLR) in isolation, with those who also had modified suture suspension and platysma plication (MSSPP). The primary outcome in the study was the change in the degree of the CMA taken from standardized preoperative and postoperative surgical photos in the Frankfort profile view. Secondary outcomes include the change in the depth of the CMA as determined by the hyomental distance between study and control groups. Results: A total of 264 patients were identified who met the study criteria. A total of 134 (123 female; 11 male; average age, 62.66 ± 8.19) underwent TDPLR with MSSPP, and 130 (127 female; 3 male; average age, 63.09 ± 7.75) underwent TDPLR alone. All patients in the study underwent preoperative photographic evaluation in Frankfurt profile view and the same postoperative photographic evaluation at an average of 436.56 days (14.4 months) after surgery. Patients in the cohort study group were found to have a statistically significant increase in the depth of the CMA by an average of 13.9 degrees ± 6.26 and increase in the hyomental distance of 1.38 cm ± 0.87, compared to the control group who underwent traditional lateral rhytidectomy with an average CMA change of 6.87 degrees ± 6.7 (P = .00146) and hyomental distance increase of 0.75 ± 0.68 (P = .00031), respectively. Statistical significance was taken at P < .05. Conclusions: The results from this study indicate that the addition of a relatively minimally invasive approach to neck rejuvenation using a modified Giampapa stitch with absorbable PDS suture is helpful in restoring the CMA in an aging neck.
Contexte: Les modifications esthétiques caractéristiques du cou vieillissant sont notamment la laxité de la peau et la formation de rides, le dépôt sous-mentonnier de tissu adipeux, la formation de bandes du muscle platysma et la ptose des structures sous-jacentes qui mènent au développement d’un angle cervico-mentonnier (ACM) obtus. Les techniques de rajeunissement du cou visant à restaurer l’ACM font l’objet de nombreuses discussions dans les publications avec des résultats variables. Le but de cette étude était de comparer la restauration de l’ACM chez des patients subissant l’ajout d’un pli du platysma sur la ligne médiane au moyen d’une suture modifiée de Giampapa avec un fil résorbable en PDS par rapport à des patients bénéficiant d’une rhytidectomie latérale plane profonde standard seule. Méthodes: Une étude de cohorte rétrospective a été réalisée par un seul chirurgien dans un établissement privé de chirurgie plastique du visage. L’étude a inclus 264 patients subissant une rhytidectomie. Les différences de mesures de degrés et de profondeur pré et postopératoires de l’ACM ont été comparées entre les patients subissant une rhytidectomie latérale plane profonde traditionnelle (RLLPT) seule et les patients avec suspension de suture modifiée et un pli du platysma (SSMPP). Le critère d’évaluation principal de l’étude était la variation du nombre de degrés de l’ACM mesuré sur des photographies chirurgicales pré et postopératoires standardisées sur un profil de type Frankfort. Les critères de jugement secondaires étaient, notamment, la variation de profondeur de l’ACM mesurée par la distance hyomentale entre le groupe d’étude et le groupe contrôle. Résultats: Un total de 264 patients satisfaisant les critères de l’étude a été identifié: 134 patients [123 femmes, 11 hommes, d’âge moyen 62.66 ± 8.19] ont eu une RLLPT avec SSMPP et 130 patients [127 femmes, 3 hommes, d’âge moyen 63.09 ± 7.75] ont eu une RLLPT seule. Une évaluation photographique préopératoire avec vue de profil de type Francfort a été réalisée pour tous les patients de l’étude; la même évaluation photographique a été réalisée en postopératoire, en moyenne 436.56 jours (14.4 mois) après l’opération. Les patients du groupe d’étude de la cohorte avaient une augmentation statistiquement significative de la profondeur de l’ACM, en moyenne de 13.9 ± 6.26 degrés et une augmentation de la distance hyomentale de 1.38 ± 0.87 cm comparativement aux patients ayant subi une rhytidectomie latérale traditionnelle chez lesquels la variation d’ACM était de 6.87 ± 6.7 degrés [P = .00146] et l’augmentation de la distance hyomentale de 0.75 ± 0.68 cm [P = .00031]. La signification statistique était fixée à P < .05. Conclusions: Les résultats de cette étude indiquent que l’ajout d’une approche peu invasive à la technique de rajeunissement du cou usant une suture modifiée de Giampapa est utile pour restaurer l’ACM dans un cou vieillissant.

Facial aging changes due to increased skin laxity as well as soft tissue atrophy and decent lead to blunting and distortion of previously well-defined zones of the face and neck. A critical component of re-establishing a youthful appearance during facelift and neck lift surgery is restoring a well-defined mandibular contour. Key principles of jawline refinement include the addition of volume to deficient areas and removal of volume in areas of unwanted fullness to re-establish facial harmony in the lower face and neck. In this article, we describe a novel classification of jawline zones and discuss our stepwise surgical approach to aid in the systematic evaluation and surgical treatment of the jawline.

Face-lift surgery is the most crucial and constantly evolving technique of facial rejuvenation. Periodic reviews synthesizing the latest face-lift techniques may help surgeons sharpen their surgical procedures.
A literature search was conducted of the PubMed databases using the search term \"face lift\" and \"rhytidectomy.\" Articles reporting rhytidectomy of the forehead/brow, midface, lower face, and neck were included. Sixty-nine articles were selected after independent screening by three of the authors. The Oxford Centre for Evidence-based Medicine scale was used for evaluating evidence level.
Of the 69 candidate articles, 10 studies (15%) reported techniques of neck lifting; 10 studies (15%) introduced techniques of endoscopic brow lifting; 7 studies (10%) pertained to brow lifting without endoscopic techniques. The most frequently reported locations of rhytidectomy were the brow/forehead (20%), neck (19%), and face-neck (17%). Additionally, articles regarding Asian face-lifts (14%) have been increasing. The evidence level of the articles was generally low, with only 10 articles assessed as level 1-3 with 59 articles as level 4-5.
Face-lift articles with high-level evidence are still lacking. Prominently, forehead lifting and neck lifting have become upward trends of rhytidectomy in recent years, and the techniques of short-scar face-lift have been more valued.
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 www.springer.com/00266 .

Specialists seeking successful outcomes in male facial rejuvenation must be able to achieve adequate results in the neck and submental region to provide their patients with balanced and natural results. A thorough understanding of male jawline and neck surface aesthetics is described and its relevance to perceived age, attractiveness, and body mass index is presented. The neck lift technique described is based on the pursuit of 2 distinct objectives managed independently: (1) Volume contouring or reduction, which is mainly accomplished in the deep structures of the neck beneath the platysma and (2) superficial redraping, which consists of the management of the platysma itself and of the overlying subcutaneous fat and skin under minimal tension. A dual-plane approach to the neck is used, meaning 2 different dissection planes are carried out. In the area cranial to the submandibular-cervical junction line (ie, submandibular segment), a plane is developed both superficial and deep to the platysma, while in the area caudal to this line (ie, cervical segment), dissection is carried out only deep to the platysma, leaving the muscle attached to its overlying skin. A description of the technique is presented as well as its complications and indications for surgical neck enhancement.

Facial rejuvenation procedures have become more commonly performed due to an increasing elderly population and greater general public acceptance. As a result, patients are now increasingly undergoing secondary and tertiary rhytidectomies to treat natural aging and/or to correct complications from prior procedures. Revision face and neck lifts are more complex by nature of the procedure and require a comprehensive preoperative assessment for enhanced outcomes. In this review, we discuss the preoperative evaluation, surgical challenges encountered, primary face and neck lift deformities, and their surgical management for patients undergoing secondary face and neck lifts.

UNASSIGNED: There is an increased need for recontouring chin and submental areas for esthetic reasons. Reports of such surgeries across the world are present in the literature. India too has its share of chin and neck reconstruction needs. This study was carried out to document a single-center experience of authors\' approach in isolated submentoplasty.
UNASSIGNED: A retrospective analysis of case records of submentoplasty during 2012-2017 was collated. Cases fulfilling inclusion and exclusion criteria were selected for this study. A qualitative assessment of the outcomes was performed.
UNASSIGNED: Sixteen cases who had undergone isolated submental lipectomy with platysma plication formed the study group. The mean age was 44.38 ± 5.49, with a range of 37-54 years. There were 9 females and 7 males. The mean age of females was 42.89 ± 4.01, while for males, it was 46.29 ± 6.79 years. The mean follow-up ranged for 16.2 ± 3.4 months (14-20 months). None of the patients had major complications.
UNASSIGNED: The modified mini-neck lift approach for an isolated submental lipectomy and strap muscles of suprahyoid group with platysma plication is presented. Careful manipulation of the fat removal, plication of platysma, strap muscle and positioning of incision would help to a greater extent. The anatomical challenges for this variation are discussed.

BACKGROUND: Restoration of an esthetic neck contour is an integral component of facial rejuvenation. The corset platysmaplasty and the suture suspension neck lift were introduced by Feldman in 1990 and by Giampapa in 1995, respectively. Both techniques are routinely used in current practice with satisfactory and long-lasting results. However, some patients who have undergone the suture suspension platysmaplasty report long-term discomfort, excessive neck tightening, and recurrence of deformity.
OBJECTIVE: To achieve an improvement in the Cervicomental (CM) angle and other parameters in patients with a difficult neck and to reduce the probability of long-term discomfort, excessive neck tightening, and a recurrence of deformity. The author developed a new technique that includes a very wide suture suspension with no interlocking. We hereby present a revised suture suspension technique-The Wide Suture Suspension Platysmaplasty.
METHODS: Between the years 2015 and 2017, the senior author performed 286 face and neck rejuvenation surgeries with or without blepharoplasty. Of these cases, 35 patients with a heavy neck were chosen for the new Wide Suture Suspension Technique. This was a single surgeon retrospective cohort study. Patients were photographed in a lateral view preoperatively and 6 months postoperatively. Pre- and postoperative photographs were compared in four measured parameters: the cervicomental angle, the jowl angle, the horizontal distance between the mentum and the cervicomental angle and the vertical distance between the mentum and the cervicomental angle.
RESULTS: The Wide Suture Suspension Platysmaplasty resulted in pleasing esthetics, with minimal complications in patients with difficult necks. The cervicomental angle decreased by 42° (P < .0001), the jowl angle increased by 12° (P < .0001), the horizontal distance between the mentum and the cervicomental angle rose by 12.4% and the vertical distance between the mentum and the cervicomental angle was reduced by 34.5%.
CONCLUSIONS: The Wide Suture Suspension Platysmaplasty resulted in improved esthetics, as demonstrated by objective measurements. None of the patients in this series had any secondary intervention during the follow-up period. Particularly in the case of a difficult neck, surgeons should consider this technique.

Although the effect of normal aging on the appearance of the ear lobule is well known and defined, this often a neglected aspect of facial rejuvenation. Rhytidectomy offers a great opportunity to surgically enhance the aging earlobe. The objective of this study was to provide a step-by-step description of the execution of the three-triangle rotation flap technique for aesthetic ear lobule reduction.
The three-triangle rotation flap technique is described in a step-by-step fashion and illustrated by photographs and videos. All ear lobule reduction procedures that took place at our practice from December 2016 to February 2020 were retrospectively reviewed.
A total of 16 patients underwent bilateral ear lobule reduction during face lift, neck lift, or both, and 7 patients underwent bilateral lobule reduction in isolation. None of the patients experienced complications, and revisions were not performed or required.
The three-triangle rotation flap technique relies on simple principles that can be adjusted to address all shapes and degrees of true ear lobule ptosis, as well as patient desire. It is employed in isolation or synchronous with rhytidectomy. When performed during rhytidectomy, it provides lobule stability and fixation.
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 www.springer.com/00266 .