Serial plication facelift.

In over 3,700 facelifts in the last 40 years, the author has evolved a simple technique with a natural look. All cases were done with conscious sedation and local anesthesia. Patients are ambulatory immediately following surgery and have a rapid recovery with little edema or ecchymosis. Nerve injuries are avoided, and the temple hairline and earlobe clefts are preserved. There are no ridges, dimples, or "joker lines." The superficial musculocutaneous system (SMAS) is tenuous or absent in older patients and one has difficulty in elevating heavy jowls and outer canthal tissues with the usual SMAS technique. Therefore, a serial plication starting low in the jowl and extending up the cheek, spaced 12-15 mm apart, laces the face up just like lacing a shoe, making the entire face firm and youthful. Neck plication pulls the tissues up behind the ear and a platysmal sling keeps the earlobe up in its normal position (Figs. 1-2). The deep tissues are tightened in the temple, the temple hair flap can actually be pushed forward and preserved. This adapts well with ancillary procedures and most patients return to work in 7-10 days.