The Double “C” Plication Technique: A Reliable Technique for Lower Facial Rejuvenation: Review of 1500 Cases

Introduction: Facial rejuvenation procedures have evolved signiÞ cantly since they were Þ rst performed at the beginning of the 20th century. Modern SMAS lifting techniques focus on providing natural facial rejuvenation, durable results, fewer complications, and reduced morbidity. Many techniques exist, each proposing different methods to attain a common goal, resuspension of the SMAS. A simple new technique for SMAS plication of lower face and neck is introduced, called double “C” plication. This technique is reproducible and simple, creating lasting results for a natural look with a low complication rate. Materials and Methods: In over 1500 face-lifts in the last 4 years, the author has evolved a simple technique with a natural look. All cases were done with oral sedation and local anesthesia. Patients were ambulatory immediately following surgery and had a rapid recovery with little edema or ecchymosis. Nerve injuries were avoided, and the temple hairline and earlobe clefts were preserved. There are no ridges, dimples, or ‘‘joker lines.’’ Revision rate was less than 0.7%. This technique utilizes double running plication sutures in a “C” shape pattern for SMAS suspension, which can be placed via traditional or short-scar face-lift incisions. This technique provides an evenly distributed multi vector radial traction on the SMAS and lateral platysma, allowing for a more uniform suspension compared to traditional single plication and purse string sutures, which provide point speciÞ c tension. This SMAS plication technique tightens up the face just like lacing a shoe, making the entire lower face Þ rm and youthful. The neck plication pulls the platysma up behind the ear to maintain the earlobe up in its normal anatomical position. Results: Over a 4-year period, 1532 procedures were performed utilizing the aforementioned double “C” lift technique with average follow-up of 18 months. This is a retrospective chart review of a single surgeon’s rhytidectomy practice. Of the 1532 patients, 110 had undergone previous rhytidectomy by a different surgeon. Complications included in the evaluation process were major hematoma 1.3%, minor hematoma 5%, infection 0.5%, facial nerve injury 0%, greater auricular nerve injury 0.1%, post auricular skin necrosis (>2 cm) 0.8%, and revision rate 0.7%. Conclusions: The double “C” plication technique is a reliable, simple, and reproducible technique with natural results and low complications. This technique involves a double running plication suturing of SMAS and lateral platysma in a “C” shape pattern.