Abstract
Purse string sutures in superficial musculoaponeurotic system (SMAS) plication facelifts
may cause technique-related problems, such as soft tissue deformities, dimpling, and
bulkiness inside and between the independent sutures. Therefore, the authors have
developed a new approach named the multiple rhomboid vector (MRV) suture. A total
of 103 patients (89 female, 14 male patients; median age: 57 years) received a primary
rhytidectomy with the MRV SMAS plication suture in our clinic (2015–2017). Intraoperative
time to perform the suture per side was recorded. Postoperative complications and
dimpling and bulkiness of subcutaneous tissues were judged by three independent surgeons
from 1 (= none) to 4 (= extreme) after 1 week, 1, 3, 6, and 12 months. A standardized
survey, the FACE-Q questionnaire, was performed to evaluate postoperative patient
satisfaction. Mean time to perform the suture was 5:14 minutes per side (minimum:
3:20 minutes, maximum: 5:53 minutes; standard deviation: 0:51 minutes). During the
follow-up period, four complications were detected (two cases of temporary neurapraxia
of the marginal branch of the mandibular nerve {n = 2 [1.9%]} and two cases of retroauricular hematoma {n = 2 [1.9%]}). Postoperative dimpling or bulkiness of subcutaneous tissues was judged
as absent. Overall patient satisfaction rate, after the surgery was performed, was
measured as “very high.” The MRV suture offers a combined horizontal and vertical
suspension approach, which effectively addresses the different vectors of age-related
facial soft tissue descent with complication rates equal to other surgical lifting
techniques. Apart from that, it may help reduce the possibility of contour irregularities,
whereby it must be noted that a thorough preoperative assessment together with the
patient and surgical planning is crucial to ensure realistic expectations of the surgical
outcome.
Keywords
SMAS plication - facelift - rhytidectomy - interlocking rhombi - multiple rhomboid
vector suture
