The S-Lift Rhytidectomy

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The S-Lift Rhytidectomy


Steven B. Hopping and Ziya Saylan


The wish of many patients seeking facial rejuvenation is for a limited procedure, devoid of complications, with a natural, nonoperated result and a rapid return to regular activities. Patients will often demonstrate their aesthetic desires by lifting the skin of their face with their fingers from the angle of the mandible vertically upward toward the tragus of the ear, a maneuver many of them have repeated endless times in the mirror prior to presenting for consultation (Fig. 13-1). It is important to remember that there is no surgical procedure more elective than facelift surgery. Consequently, cosmetic surgeons must continually strive to maximize results while, at the same time, minimizing complications and postoperative recovery. Patients’ wishes, as just outlined, may not always be shared by cosmetic surgeons, many of whom often prefer a more aggressive surgical facial rejuvenation program. The S-lift procedure as described by Saylan1 can in the properly selected patient achieve many of our patients’ wishes for facial rejuvenation, providing a limited operation with minimal risks and a short recovery period.


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Figure 13-1 Patient demonstrating the results she would like to achieve from facelifting. Note the primarily vertical vector of this mock rejuvenation.


The S-Lift facelift, as popularized by Dr. Ziya Saylan, has received much attention around the world. The S-Lift is a conceptually new approach to facelifting and is particularly applicable to younger patients and patients requiring secondary facelifts. It is important to note that the S-Lift is not a simple “mini-lift” skin excision, but is rather an advanced superficial musculoaponeurotic system (SMAS) multiplane rhytidectomy. In this chapter, we also describe what is referred to as the S-Plus Lift. This procedure combines aspects of the technique of lateral SMASectomy described by Baker2,3 and malar fat pad suspension utilizing a purse-string suture, suspending the ptotic malar fat pad from the temporalis fascia (M-suture), described by Tonnard et al.4 The S-Plus Lift extends the efficacy of S-Lift in those patients who have significant midfacial ptosis. The S-Lift is generally a “short flap” facelift procedure, whereas the S-Plus with its midface extension is a “long flap” rhytidectomy.


Image Advantages of the S-Lift



Image Disadvantages of the S-Lift



  • Image Limited access to the neck
  • Image Posterior dog ear that can last 1 to 3 months and can often require revision surgery
  • Image Pain over the zygomatic arch secondary to the “O” and “U” suture
  • Image Limited improvement on severely ptotic necks
  • Image Limited improvement in patients with ptotic midface

Image Key Technical Points



  • Image Retrotragal incision, both in men and women, except for smokers in whom a pretragal incision is recommended (Fig. 13-2)
  • Image Preexcision of a limited skin ellipse (always be conservative, especially in secondary facelift cases). Skin only. Stay superficial.
  • Image A #15 blade to create thick flaps and demarcate the dissection plane just superficial to the parotid fascia
  • Image Complete flap elevation under direct vision with facelift scissors
  • Image Extent of undermining determined by extent of mid-face laxity (the greater the midfacial laxity, the greater the undermining)
  • Image Closed and open liposuction only after elevation of flap to maximize flap viability

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Figure 13-2 S-Lift incision demonstrating three key vectors: A to A1, B to B1, and C to C1.


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Figure 13-3 Diagramatic depiction of U suture, O suture, and M suture.


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Mar 16, 2016 | Posted by in Craniofacial surgery | Comments Off on The S-Lift Rhytidectomy

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