Multiple, combined plications of the SMAS-platysma complex: Breaking down the face-aging vectors

After analyzing how facial tissues are affected during the aging process, 3 6 rhytidoplasties were performed by plicating the superficial musculoaponeu rotic system (SMAS)-platysma complex. Also, additional procedures were perf ormed to improve the aesthetic result. Patients were followed for 3 to 33 m onths (median, 13 months); their ages ranged from 42 to 72 years (median, 5 3 years). Because the facial soft tissues present specific anatomic particu larities and the force-vector determinants for facial ptosis are many and v aried, specific plications were combined to obtain the desired results duri ng a rhytidoplasty. Combinations of six different types of plications are d escribed; some of them are used individually by various authors to manage t he SMAS-platysma complex. Major complications did not occur, despite extens ive cutaneous undermining, and morbidity was similar to that of other techn iques that handle the SMAS. The results were satisfactory for all patients, and clinical improvement was noted in all cases. On the basis of these res ults, using combined plication to manage the SMAS-platysma complex during a rhytidoplasty is recommended. The opposing vectors should be considered wh en planning the combination of plications.