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, 36 rhytidoplasties were performed by plicating the superficial musculoaponeurotic system (SMAS)-platysma complex. Also, additional procedures were performed to improve the aesthetic result. Patients were followed for 3 to 33 months (median, 13 months); their ages ranged from 42 to 72 years (median, 53 years). Because the facial soft tissues present specific anatomic particularities and the force-vector determinants for facial ptosis are many and varied, specific plications were combined to obtain the desired results during a rhytidoplasty. Combinations of six different types of plications are described; some of them are used individually by various authors to manage the SMAS-platysma complex. Major complications did not occur, despite extensive cutaneous undermining, and morbidity was similar to that of other techniques that handle the SMAS. The results were satisfactory for all patients, and clinical improvement was noted in all cases. On the basis of these results, using combined plication to manage the SMAS-platysma complex during a rhytidoplasty is recommended. The opposing vectors should be considered when planning the combination of plications.