Facial Plast Surg
DOI: 10.1055/s-0041-1722907
Original Research

The Multiple Rhomboid Vector Suture—Our Experience of Two Years with a Modified Suspension Approach for SMAS Plication Facelifts

Kai Kaye
1  Centre for Plastic and Aesthetic Surgery, Ocean Clinic Marbella, Marbella, Spain
Felix Paprottka
1  Centre for Plastic and Aesthetic Surgery, Ocean Clinic Marbella, Marbella, Spain
Sonja Kaestner
1  Centre for Plastic and Aesthetic Surgery, Ocean Clinic Marbella, Marbella, Spain
2  Department for Otolaryngology, Head and Neck Surgery, Universitätsklinikum Tübingen, Tubingen, Germany
› Author Affiliations


Purse string sutures in superficial musculoaponeurotic system (SMAS) plication facelifts may cause technique-related problems, such as soft tissue deformities, dimpling, and bulkiness inside and between the independent sutures. Therefore, the authors have developed a new approach named the multiple rhomboid vector (MRV) suture. A total of 103 patients (89 female, 14 male patients; median age: 57 years) received a primary rhytidectomy with the MRV SMAS plication suture in our clinic (2015–2017). Intraoperative time to perform the suture per side was recorded. Postoperative complications and dimpling and bulkiness of subcutaneous tissues were judged by three independent surgeons from 1 (= none) to 4 (= extreme) after 1 week, 1, 3, 6, and 12 months. A standardized survey, the FACE-Q questionnaire, was performed to evaluate postoperative patient satisfaction. Mean time to perform the suture was 5:14 minutes per side (minimum: 3:20 minutes, maximum: 5:53 minutes; standard deviation: 0:51 minutes). During the follow-up period, four complications were detected (two cases of temporary neurapraxia of the marginal branch of the mandibular nerve {n = 2 [1.9%]} and two cases of retroauricular hematoma {n = 2 [1.9%]}). Postoperative dimpling or bulkiness of subcutaneous tissues was judged as absent. Overall patient satisfaction rate, after the surgery was performed, was measured as “very high.” The MRV suture offers a combined horizontal and vertical suspension approach, which effectively addresses the different vectors of age-related facial soft tissue descent with complication rates equal to other surgical lifting techniques. Apart from that, it may help reduce the possibility of contour irregularities, whereby it must be noted that a thorough preoperative assessment together with the patient and surgical planning is crucial to ensure realistic expectations of the surgical outcome.

Publication History

Publication Date:
03 March 2021 (online)

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