In patients with a large amount of fat overlying the parotid fascia, open liposuction or direct defatting to the level of the parotid fascia is performed to avoid excess bulk in the preauricular area. The first imbrication suture is placed from the angle of the mandible to the inferior preauricular area. The SMAS flap then is imbricated superiorly in a similar direction until the flap is entirely repositioned under considerable tension. The posterior edge of the platysma in the neck then is plicated to the fascia overlying the sternocleidomastoid muscle. Absorbable sutures then are placed between the permanent stitches to help reinforce and smooth the suture line.
Absolute hemostasis is obtained.
Drains may be placed, or platelet gel may be used without drains. The skin then is redraped gently and closed as in a standard facelift. Great care is taken to avoid excessive skin removal, which would create tension on the wounds and may lead to wide or unsightly scarring. If used, the drains usually are removed on postoperative day 1. Patients are dressed with a standard light-pressure facelift dressing that consists of ointment over the wounds, a nonadherent dressing, and fluffed gauze or cotton secured with a light wrap.