Rhytidectomy employing a two-layered closure: improved results with hidden scars.

The goal of a face-life procedure should be to obtain the maximal improvement with minimal morbidity. The author's technique is presented as an alternative technique to accomplish this goal. It is based on 427 face-lift patients from 1973 to 1979. The technique employs defatting of the superficial musculoaponeurotic system and platysma muscle (which is not dissected free) and use of multiple plication sutures to create a second-layer closure. This is in contrast to the standard face-lift procedure, which employs a single-layer closure whereby all the retraction tension is sustained by the skin flaps. With the author's technique, the complication rates are markedly reduced and satisfactory cosmetic results are obtained with "hidden" face-lift incisions.