Presto lift—a facelift that preserves the retaining ligaments and SMAS tethering

BACKGROUND: Producing youthful facial appearance by face-lifting often comes along with an undesired loss of patient’s individual phenotype. This may result from insufficient preservation of retaining ligaments, the “guardians of facial identify,” and from severance of the intersegmental connections of the superficial musculo-aponeurotic system (SMAS), which tether, structure, and compartmentalize facial soft tissue into defined, relevant anatomical zones. METHODS: The technique reported here preserves most retaining ligaments. They serve to fix the facial soft tissue mass in loco. With the possible exception of the zygomatic-cutaneous ligament, they are only carefully distended. The SMAS intersegmental connections and the zygomatic SMAS border are preserved to retain effective points of facial tissue fixture. Aging-associated thinning and lengthening of the lower eyelid are reduced by midfacial-submalar preparation (Aston 1996). Subplatysmal preparation and disconnection of the cranial-platysmal border permits optimal modeling of neck structure. RESULTS: The combination of preservation of retaining ligaments and SMAS tethering (“PRESTO facelift”) introduced here as a novel face-lifting technique conserves the individual esthetics of the patient by approaching her/his individual phenotype from decades ago. In addition, undesired outcomes of facelift surgery and common risks of facelift surgery are circumvented. CONCLUSIONS: The PRESTO facelift technique generates optimal esthetic results that conserve a patient’s personal facial identity, besides restoring a more youthful appearance and being rapid and safe.