Different levels of undermining in face lift - experience of 141 consecutive cases

Context: The most revolutionary concept in rhytidectomy is the role of Sub Muscular Aponeurotic System (SMAS), even if many alternative approaches have been proposed. The main aim of face lift is to bring back the time, preventing the “lifted-face” appearance. Settings and Design: The authors present their personal experience with different levels of undermining, i.e. subperiosteal forehead lift, subcutaneous midface lift with SMAS plication and platysmal suspension, and discuss the anatomical and biomechanical elements of rhytidectomy. Results: Optimal aesthetic results were achieved by repositioning the neck, face and forehead tissues in a global and harmonious fashion, without distorting face characteristics and disguising surgery trails as much as possible. Conclusions: Different levels of undermining can give good and stable aesthetic results minimizing the risks and preventing face distortion.