Introduction: To highlight the use of the double-layered, running, locking (DRL) stitch technique for superficial musculoaponeurotic system (SMAS) plication in short-scar rhytidectomy, comparing its efficacy and safety to other commonly used techniques. Materials and Methods: Short-scar rhytidectomy using the DRL SMAS plication technique was performed in 2300 patients over 84 months. Charts were reviewed for postoperative complications after 6 months. Complication rates were compared to those from a previous cohort of 1000 short-scar rhytidectomies in which SMAS plications were accomplished with several other techniques. Results: In the first 6 months, 537 patients (23.3%) experienced suture extrusions. Other complications included hematoma formation (0.7%), postauricular nodules (0.65%), hypertrophic scarring (0.39%), hyperpigmentation (0.17%), infection (0.04%), and the need for touch-up liposuction (0.78%). Revision rhytidectomy was required in 7 patients (0.3%). Both skin and subcutaneous suture extrusion rates were significantly higher in the group undergoing DRL SMAS plication (P < .001). Other complication rates were not significantly different between groups. Conclusions: Use of the DRL stitch technique for SMAS plication in short-scar rhytidectomy may be associated with a very low revision rate after 6 months. However, this rate does not appear to differ significantly from the revision rhytidectomy rates after short-scar procedures that utilize other SMAS plication suture techniques.
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