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Long-Term Results in Face Lifting: Observational Results and Evolution of Technique

Rohrich, Rod J., M.D.; Narasimhan, Kailash, M.D.

Plastic and Reconstructive Surgery: July 2016 - Volume 138 - Issue 1 - p 97-108
doi: 10.1097/PRS.0000000000002318
Cosmetic: Special Topics
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Background: Attaining a long-lasting result has always been a major goal of facial rejuvenation surgery. A major objective of this article is for the reader to understand which specific factors have been the keys to durability and consistency in facial rejuvenation.

Methods: The authors describe the evolution and development of their current techniques for face lifting. The authors review reliable techniques and point to factors that in their experience increase longevity of facial rejuvenation.

Results: The authors’ experience spans 25 years and 1089 facial surgery patients. Long-term follow-up was difficult beyond 3 years in addition to a lack of uniform photography before the 1990s. Plication and superficial musculoaponeurotic system excision techniques have achieved consistent and reliable results with skin undermining based on an individualized component analysis. Neck techniques that involve wide skin undermining and midline plication help prevent recurrence and optimize shape.

Conclusions: Patient selection is just as important as technical advances. Patients with better long-term results included younger, more attractive patients with fuller faces. Patients with fuller necks had a higher relapse rate. Opening and treating midline platysmal bands decreased recurrence of neck deformities. Skin resurfacing and the use of topical retinoids has improved our long-term results. Male and female patients had similar results and revision rates. Through trial and error and a wealth of experience, the authors have found techniques that can produce practical, durable, and consistent result in the paradigm of facial rejuvenation.


Dallas and Sherman, Texas

From the Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the Sherman Surgery Center.

Received for publication November 1, 2015; accepted March 1, 2016.

Disclosure:Dr. Rohrich is a volunteer member of the Allergan Alliance for the Future of Aesthetics and receives instrument royalties from Eriem Surgical, Inc., and book royalties from Taylor and Francis Publishing. No funding was received for this article.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Videos” tab to watch. On the iPad, tap on the Hot Topics icon.

Kailash Narasimhan, M.D., Sherman Surgery Center, 1111 Sara Swamy Drive, Sherman, Texas 75090,

Copyright © 2016 by the American Society of Plastic Surgeons