Craniofacial Suspension and Superficial Musculoaponeurotic System Plication Using a Diffuse Superficial Musculoaponeurotic System Weave: A Bulletproof Adjunct to Long or Short Scar Facelifts.

The plethora of facelift techniques described in literature suggests that no single method addresses all age-related changes in facial anatomy. To reduce the limitations of a single approach, a multimodal technique is recommended. Craniofacial suspension and superficial musculoaponeurotic system plication using a diffuse total superficial musculoaponeurotic system (SMAS) weave is an effective and satisfactory method of dealing with the superficial musculoaponeurotic system. It utilizes a continuous barbed polydioxanone suture that is woven throughout the lower superficial musculoaponeurotic system. This technique preserves facial volume while achieving the symmetrical tightening of the superficial musculoaponeurotic system. In this article, the authors describe over 10 years of experience of applying this procedure with success to different patients, including elderly ones and those with a previous facelift history. It can be integrated into the classic minimal access cranial suspension (MACS) lift or used with more extensive facelifts. It is a safe, easy, and powerful tool that should have a wide application in facial rejuvenation procedures.