Adequate undermining of the SMAS layer, excision of redundant SMAS, and repositioning with permanent sutures to fascia in a more superior area has afforded better results without untoward risks. Plication of the lateral edge of the platysma to the mastoid fascia with the same 3/0 permanent suture is usually sufficient, although strong mid-neck banding must be treated with a submental incision, excision of the medial platysma borders which are then sutured together with the same permanent sutures. My series represents more than fifteen hundred cases performed in this manner. I recently did a secondary facelift sixteen years later and found these sutures still holding very well. In these days of many facelift techniques, it would be interesting to compare your comments and suggestions.
