Face lift, Part 4: Use of superficial musculoaponeurotic system suspending sutures.

We describe nonabsorbable sutures running from one or more sites in the superficial musculoaponeurotic system (SMAS), to other sites at a distance, or to fixed sites beyond or deep to SMAS for the purpose of pulling on or suspending the distal selected SMAS sites or changing contours between the suture ends. Our reasons for abandoning some sutures and continuing with others are stated. In face lifting, we still often employ sutures running from the anterior part of the platysma and SMAS back to the sternocleidomastoid fascia. These sutures help prevent platysma "cording" and are useful in the restoration and preservation of a more youthful profile in the neck. Examples and controls are demonstrated. These sutures and the long-term results of their use have never been shown before. Problems encountered in using suspending sutures are described.