Sub-SMAS Reconstruction of Retaining Ligaments.

[BACKGROUND] Retaining ligaments must be fully released for effective soft-tissue mobilization during sub-superficial musculoaponeurotic system (SMAS) facelifts. Standard deep temporal fascia and lateral SMAS fixation techniques may fail earlier than anticipated, which may cause a relapse of facial aging signs. Reconstruction of retaining ligaments was previously proposed to enhance facelift fixation.

[OBJECTIVES] The author sought to assess the effect of their ligament reconstruction technique on early relapse rates and complication rates.

[METHODS] This study was a comparative analysis of 188 consecutive facelift cases where retaining ligaments were reconstructed employing the described techniques. A total 104 patients with standard fixation were analyzed in the control group. A novel set of criteria was established for the diagnosis of early relapse after facelift surgery based on the validated Merz scale.

[RESULTS] Early relapse rate was significantly lower (0.53% vs 5.76%) in the ligament reconstruction group compared with the control group. Ligament reconstruction was associated with an increased rate of temporary nerve paralysis (8.5%).

[CONCLUSIONS] Sub-SMAS reconstruction of retaining ligaments enhances facelift fixation and reduces the rate of early relapse. Increased risk of temporary neuropraxia is a reasonable trade-off.