Monobloc and Interrupted Sutures to Plicate the SMAS

Approaching the SMAS during a facelift has become very common, and different techniques have been described, some more demanding, like deep SMAS treatment, and some more easy achievable, like plication.

Each of these options have their advantages and disadvantages, but it is becoming more frequent to see surgeons opting for the plicature in a superficial SMAS dissection. The goal of different techniques, in these cases, is anchoring the movable SMAS to a fixed structure, using running or interrupted sutures.

Our approach is, in our opinion, a fast and safe way to suspend the SMAS, and using two practical tatics, we believe we have achieved a better long term result.

It is our option to do:

1- a monobloc suspension of the SMAS, anchoring it to the temporal fascia, a technique known as the Roundblock SMAS Treatment, with a polyamide 2-0 single suture; and

2- multiple interrupted polyamide 4-0 suture fixating the now redundant movable SMAS to the fixed parotid fascia.

We think this double suturing sustains the results for a longer period of time, compared to the previous described Roundblock SMAS Treatment, and the monobloc suspension takes away the tension sometimes found when just bringing together the SMAS and the parotid fascia.

We made the decision to use the interrupted suture in addition to the monobloc suspension as our standard technique two years ago and, since then, have less patient complaints, specially concerning residual or recurrent jowls and cervical laxity.

As other advantages associated with the use of both tatics, we have a smaller dissection and scars, less facial nerve transitory lesions, flap necrosis, and haematomas, compared to extended skin and/or SMAS dissection.