Combined SMAS Fixation Strategy Associated With Improved Deep Plane Facelift Outcomes
Key Takeaways
- A retrospective study of 80 patients undergoing deep plane rhytidectomy compared four combinations of horizontal and oblique SMAS fixation.
- Oblique facial fixation combined with horizontal neck fixation produced the highest FACE-Q scores (88.4 ± 3.9) and greatest WSRS improvement (2.4 ± 0.6 points).
- No major complications were reported, although retrospective design and 6-month follow-up limit conclusions.
A combination of oblique facial fixation and horizontal neck fixation was associated with higher patient satisfaction and greater wrinkle severity improvement following deep plane rhytidectomy, according to findings from a retrospective study published in Aesthetic Plastic Surgery.
The study, conducted by Fatih Cinar, evaluated 80 patients who underwent deep plane rhytidectomy between September 2022 and April 2024. Investigators compared four combinations of horizontal and oblique superficial musculoaponeurotic system (SMAS) fixation to assess differences in facial and cervical aesthetic outcomes.
Oblique Facial and Horizontal Neck Fixation Yielded Highest Scores
Patients were divided equally into four groups: horizontal fixation for both the face and neck (Group A), horizontal facial and oblique neck fixation (Group B), oblique fixation for both regions (Group C), and oblique facial with horizontal neck fixation (Group D).
All patients underwent a standardized deep plane surgical approach. Outcomes were assessed at 6 months using the FACE-Q patient-reported outcome questionnaire and the Wrinkle Severity Rating Scale (WSRS). Between-group comparisons were performed using one-way analysis of variance followed by Tukey’s honestly significant difference test.
Group D achieved the highest FACE-Q scores (88.4 ± 3.9) and greatest WSRS improvement, with a mean reduction of 2.4 ± 0.6 points. Both outcomes were significantly better than those observed in the other three groups (P < .01).
No statistically significant differences in FACE-Q or WSRS outcomes were identified among Groups A, B, and C. No major complications occurred.
“A differential vector approach—oblique fixation for the face and horizontal fixation for the neck—yields superior patient satisfaction and wrinkle severity reduction,” the author concluded. “Combining FACE-Q and WSRS outcomes confirms that tailored vector planning by anatomical region optimizes both subjective and objective results in deep plane rhytidectomy.”
1. Cinar F. Comparative vector analysis in deep plane rhytidectomy: evaluating combined horizontal and oblique SMAS fixation strategies in face and neck lifting. Aesthetic Plast Surg. Published online 2026. doi:10.1007/s00266-026-06377-y