How I Do It: Surgical Face and Neck Rejuvenation

BACKGROUND: Facelift and necklift remain the gold standard for surgical facial rejuvenation despite continued advances in nonsurgical aesthetic treatments. Modern facial rejuvenation has evolved beyond simple skin excision to restore youthful facial proportions through the repositioning of descended soft tissues and replacement of age-related volume loss. Contemporary facelift surgery encompasses a broad spectrum of techniques, including SMAS plication, SMASectomy, extended SMAS, and deep plane approaches, with no single procedure universally applicable. Successful outcomes depend on individualized treatment based on patient anatomy, aesthetic goals, and surgeon experience. METHODS: This article reviews contemporary concepts in facelift and necklift surgery, highlighting the current spectrum of operative techniques and their indications. Particular emphasis is placed on the authors' preferred approach, refined through more than 4 decades of high-volume surgical experience. The operative technique is described in detail, including an anatomy-based algorithm for neck rejuvenation, inverted "L" SMAS plication, and key surgical pearls. RESULTS: The senior author's technique has consistently produced durable restoration of facial and cervical contour with natural-appearing rejuvenation, improved jawline definition, and a well-defined cervicomental angle. The individualized approach allows the extent of cervical surgery to be tailored to each patient's pattern of aging while minimizing unnecessary dissection and morbidity. CONCLUSIONS: Contemporary facelift and necklift surgery should be guided by individualized assessment of facial and cervical anatomy rather than adherence to a single operative technique. An anatomy-based approach incorporating tailored neck rejuvenation, reproducible SMAS plication, and restoration of facial volume provides safe, reliable, and durable rejuvenation while preserving a natural appearance.