Background: Attaining a long-lasting result has always been a major goal of facial rejuvenation surgery. A major objective of this article is for the reader to understand which specific factors have been the keys to durability and consistency in facial rejuvenation. Methods: The authors describe the evolution and development of their current techniques for face lifting. The authors review reliable techniques and point to factors that in their experience increase longevity of facial rejuvenation. Results: The authors' experience spans 25 years and 1089 facial surgery patients. Long-term follow-up was difficult beyond 3 years in addition to a lack of uniform photography before the 1990s. Plication and superficial musculoaponeurotic system excision techniques have achieved consistent and reliable results with skin undermining based on an individualized component analysis. Neck techniques that involve wide skin undermining and midline plication help prevent recurrence and optimize shape. Conclusions: Patient selection is just as important as technical advances. Patients with better long-term results included younger, more attractive patients with fuller faces. Patients with fuller necks had a higher relapse rate. Opening and treating midline platysmal bands decreased recurrence of neck deformities. Skin resurfacing and the use of topical retinoids has improved our long-term results. Male and female patients had similar results and revision rates. Through trial and error and a wealth of experience, the authors have found techniques that can produce practical, durable, and consistent result in the paradigm of facial rejuvenation.
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