Comparative Vector Analysis in Deep Plane Rhytidectomy: Evaluating Combined Horizontal and Oblique SMAS Fixation Strategies in Face and Neck Lifting.

BACKGROUND

Deep plane rhytidectomy provides effective rejuvenation by repositioning surgical superficial musculoaponeurotic system (SMAS). However, the optimal vector strategy for facial and cervical fixation remains unclear. This study aimed to compare the aesthetic outcomes of four combined SMAS fixation vector strategies-horizontal and oblique-in face and neck lifting using FACE-Q and WSRS analyses.

METHODS

A retrospective study was conducted on 80 patients who underwent deep plane rhytidectomy between September 2022 and April 2024. The patients were equally divided into four groups: facelift with horizontal and neck lift with horizontal fixation (Group A), facelift with horizontal and neck lift with oblique fixation (Group B), facelift with oblique and neck lift with oblique fixation (Group C), and facelift with oblique and neck lift with horizontal fixation (Group D). All procedures followed a standardized deep plane approach, and postoperative outcomes were evaluated at 6 months using the FACE-Q questionnaire and the Wrinkle Severity Rating Scale (WSRS). Statistical comparisons were performed with one-way ANOVA followed by Tukey's HSD post-hoc test, with a p value < 0.05 considered significant.

RESULTS

Group D (face-oblique + neck-horizontal) demonstrated significantly higher FACE-Q scores (88.4 ± 3.9) and greater WSRS improvement (mean reduction 2.4 ± 0.6 points) compared to Groups A, B, and C (p < 0.01). No significant differences were observed among Groups A-C for either FACE-Q or WSRS. No major complications occurred.

CONCLUSION

A differential vector approach-oblique fixation for the face and horizontal fixation for the neck-yields superior patient satisfaction and wrinkle severity reduction. Combining FACE-Q and WSRS outcomes confirms that tailored vector planning by anatomical region optimizes both subjective and objective results in deep plane rhytidectomy.

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