Modification of Rhytidectomy: Stepped Lift of the Superficial Musculoaponeurotic System.

Rhytidectomy is a complicated surgery. Less experienced surgeons are often confronted with technical challenges. To simplify the procedure and achieve long-lasting effects, the authors propose a modified rhytidectomy method, reorder surgical sequences and suggest a stepped lift of the superficial musculoaponeurotic system.A total of 54 patients underwent this surgical procedure. Superficial musculoaponeurotic layers of the temple, face, and neck were dissected sequentially and suspended to lift the ptosis tissue. They scored the frontalis and excised the corrugator after raising the flap in the subgaleal plane. The operation time, complication events, drainage volume, and hospital days were compared with conventional surgical technique. Patient-reported outcomes were described using a modified Face-Q questionnaire. Three laypersons evaluated pre- and postoperative pictures.In the current technique, the average operation time was 265 minutes. The total complication rate was 7.40%; only 1 patient with hematoma needed extra treatment. Compared with previous technique, the operating time of current technique shortened, and the drainage volume decreased. Three-year follow-up showed all patients were satisfied with the surgical outcomes and thought they looked 8.3 years younger than their actual age. The areas with greatest satisfaction were midface, temple, and nasolabial folds. Significant improvements were seen comparing pre- and postoperative photos.Follow-up indicated that modified facelift procedure and stepped superficial musculoaponeurotic layer lift technique worked well for elderly patients who have severe facial wrinkles and ptosis, and provide a long-lasting natural and youthful appearance.Level of Evidence: Level IV, therapeutic study.