Sub-SMAS Reconstruction of Retaining Ligaments

Abstract

Abstract 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. Level of Evidence: 4