Received: 10 July 2022 | Revised: 14 October 2022 | Accepted: 23 October 2022

DOI: 10.1111/jocd.15496

ORIGINAL ARTICLE

Stab access fascia suspension lift: A facelift technique without

skin excision and visible scar

Xi Fu MD | Jia Qiao MD | Jianfeng Liu MD | Ying Chen MD | Qi Jin MD |

Shixing Xu MD | Bing Yu MD | Lai Gui MD | Feng Niu MD

The Craniofacial Center One, Plastic

Surgery Hospital, Chinese Academy of Abstract
Medical Sciences, Peking Union Medical
Background: Traditional middle and lower facelifts are not suitable for patients with
College, Beijing, China
mild skin laxity or who wish to avoid incision scars.
Correspondence
Objective: We present the stab access fascia suspension lift (SAFS-­lift) technique,
Feng Niu and Ying Chen, Department
of Craniomaxillofacial Surgery, Plastic which does not require regular skin incisions, as a reliable surgical facelift strategy for
Surgery Hospital, Chinese Academy of
the lower and middle face.
Medical Science, Peking Union Medical
College, No. 33, Ba-­Da-­Chu Road, Shi Jing Methods: From September 2020 to September 2021, 38 patients underwent SAFS-­lift.
Shan District, Beijing 100144, China.
SAFS-­lift involved (1) incomplete subcutaneous undermining with hydrodissection-­
Email: cmfniufeng@163.com and
cmfchenying@163.com assisted tunneling; (2) complete subcutaneous undermining with a dissecting cannula
in the zygomatic buccal groove area and hollow below zygomatic arch; and (3) maximal
Funding information
Natural Science Foundation of Beijing firm superficial musculoaponeurotic system suspension with polydioxanone barbed
Municipality, Grant/Award Number:
threads in loops. All patients evaluated the outcome according to the Global Aesthetic
7192180; Scientific Research Foundation
directly under the ministries and Improvement Scale. Four plastic surgeons evaluated postsurgery result with a five-­
commissions of the Central Government,
point Likert scale (5 = excellent, 4 = good, 3 = fair, 2 = no change, and 1 = worse).
Grant/Award Number: 3332020029;
The Clinical and Translational Medicine Results: Thirty-­six patients were successfully enrolled. The mean follow-­up period
Research Project, the Science and
was 14.72 ± 3.89 months. No patients showed visible scarring 6 months after surgery.
Technology Innovation Project of
Medicine and Health, the Chinese The minor complication rate was 19.4%. They all subsided within 1–­6 weeks with-
Academy of Medical Sciences, Grant/
out treatment. No infection, hematoma, seroma, or facial nerve injury was observed.
Award Number: 2020-­12M-­C T-­B-­078
Patients’ outcome ratings were 4.22 ± 0.58 (3 months), 4.69 ± 0.46 (6 months), and
4.69 ± 0.54 (1 year). Surgeons' outcome scoring was 3.98 ± 0.95.
Conclusions: Stab access fascia suspension-­lift is a predictable, effective, and safe
facelift technique that can be performed without making noticeable incisions and re-
secting the skin.

KEYWORDS
face lift, liposculpture, threading

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

J Cosmet Dermatol. 2023;22:897–906.  wileyonlinelibrary.com/journal/jocd | 897

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898 FU et al.

1 | I NTRO D U C TI O N The extent of undermining started at the highest point in the

Relatively young patients with noticeable jowl sagging but with-
out major skin laxity are frequently seen in the clinic in East Asia.
Encouraged by their demands, we have performed stab access fas-
cia suspension lift (SAFS-­lift) since September 2020. In this study,
we aimed to introduce SAFS-­lift as an innovative surgical face reju-
venation technique to effectively elevate the deep tissues and skin
without visible scarring.
With SAFS-­lift, flap dissection is accomplished by incomplete
subcutaneous undermining with hydrodissection-­assisted tunneling
through 2–­3-­mm access stabs and complete subcutaneous under-
mining with a dissecting cannula in the zygomatic buccal groove
area and hollow below zygomatic arch. Then, the superficial muscu-
loaponeurotic system (SMAS) and malar fat pad is suspended with
polydioxanone (PDO) bidirectional barbed threads that are firmly
anchored to the deep temporal fascia around the sideburn stabs
using the bury guidance technique.
Stab access fascia suspension-­lift undermines the lateral face,
places three vertical loops, two cheek loops and a malar loop purse-­
string sutures to lift the lower face and midface (Figure 1).
2 | M E TH O D S
temple area by the hairline and was directed toward the malar em-
inence, then curving downward (5–­6 cm in front of the ear) to the
lower mandibular margin. Seven stabs were marked around the
sideburn by the hairline as cannula exit ports. One vertical stab was
marked below the mandibular angle, and one stab was marked below
the mandibular margin in the parallel direction as cannula entry
ports. All stabs were 2–­3 mm in length. The hollow below zygomatic
arch, the zygomatic buccal groove, and the zygomatic buccal groove
area (which extended 1 cm on each side of the zygomatic buccal
groove) were marked. Three loops on the lateral face, two loops
on the cheek, and a malar loop were marked. The zygomatic buccal
groove, the zygomatic buccal groove area (which extended 1 cm on
each side of the zygomatic buccal groove) were marked (Figure 1).
SAFS-­lift was performed under sedation or local anesthesia.
2.1.2 | Subcutaneous incomplete undermining with
hydrodissection-­assisted tunneling
After local anesthesia using 0.5% lidocaine with 1:200 000 epineph-
rine in saline, seven stabs were made around the sideburn with a No.
11 blade. The whole marked dissection area was infiltrated in the

This study enrolled consecutive patients who underwent SAFS-­lift from

September 2020 to September 2021 at a single hospital. At the clinic,
a facial analysis of each patient was conducted to assess (1) skin lax-
ity; (2) facial tissue ptosis (jawline sagging, cheek sagging, and midface
sagging); (3) the nasolabial groove, orbital zygomatic groove, and mari-
onette line; and (4) fat accumulation in the lower face and neck region.
The inclusion criteria are: (1) jowl sagging which makes the lower third
face wider; (2) aggravating subzygomatic arch hollow; (3) noticeable
mid-­cheek groove, nasolabial groove, or mild marionette line; (4) mini-
mal or mild skin laxity. Patients with obvious skin laxity or minimal soft
tissue ptosis were excluded. Patients with major organ dysfunction,
cardiovascular disease, cerebrovascular disease, or any potential heal-
ing impairment were excluded. Ethics approval was obtained from the
institutional review board at our institution. Written informed consent
was obtained from the patients for the use and analysis of their data.

2.1 | SAFS-­lift technique

See Video S1 which demonstrates the surgical procedures of the

SAFS-­lift technique.

2.1.1 | Preoperative marking
While in a sitting position, patients were asked to lower the head to
show the double chin. The double chin area and the lower part of the
jowls with extra fat deposits were marked for liposuction.
F I G U R E 1 Stab access fascia suspension lift (SAFS-­lift). SAFS-­lift
undermines the lateral face, the malar region is included (red line).
Three vertical loop, two cheek loop, and a malar loop purse-­string
sutures are placed to lift the lower face (jowl lines and marionette
grooves) and the malar fat pad (nasolabial groove, zygomatic buccal
groove, and midface).

FU et al.
subcutaneous plane. The tumescent solution contained 0.1% lido-
caine with 1:1 000 000 epinephrine in saline. The tumescent solution
used for the middle and lower face was approximately 200–­300 ml
in volume. If lower-­face and submental liposuction were performed,
suitable tumescence was reached with 500–­700 ml of solution. The
solution was infiltrated with a high-­pressure (90 kPa) infiltration
mode to achieve hydrodissection of the skin flap (Video S2).
For patients with extra fat deposition in the lower face and neck
region, liposuction was performed. We used a 2.0-­G cannula with
two openings. The opening of the cannula was directed toward the
deep tissue to protect the skin flap. An extra stab incision was made
beneath the earlobe. Liposuction was performed in the subcutane-
ous plane with tactile guidance of the nondominant hand.
In the marked dissection area without planned liposuction, we
moved the cannula without a vacuum in a fan motion to form numer-
ous tunnels. A 2.0-­G cannula with three scraping holes in a row was
used (Figure 2A). The openings were directed laterally in accordance
with the forward direction to loosen the perpendicular attachments.
2.1.3 | Complete subcutaneous undermining
with the dissecting cannula
The hollow subzygomatic arch was undermined completely with a
dissecting cannula (Figure 2B) to release the zygomatic and masse-
ter ligaments (Video S3). The zygomatic skin ligament area (in which
an obvious zygomatic buccal groove may exist) was completely un-
dermined with a dissecting cannula to release the zygomatic skin
ligament. Caution was exercised to ensure the dissecting cannula
remained in the subcutaneous layer. The dissecting area was de-
signed to extend 1 cm on each side of the ligament–­skin attachment.
A small pocket was shaped in the hollow below zygomatic arch and
the zygomatic skin ligament area (Figure 1). A 25G blunt cannula can
be used to test if the pocket is shaped successfully.
F I G U R E 2 Instruments used with
the stab access fascia suspension lift
technique. (A) A blunt cannula with three
scraping holes. (B) A 12-­G syringe needle
is used as a dissecting cannula. (C) A sharp
cannula with one hole is used for thread
guidance.
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899
2.1.4 | Three U-­shaped loops on the lateral face and
two cheek loops
The sagging facial tissues were suspended using 2-­0 PDO bidirec-
tional barbed threads (Ethicon). Three U-­shaped loops on the lat-
eral face run in the SMAS. The cheek loops run in the SMAS below
the lower rim of the zygomatic arch and subcutaneously above it
(Figure 1). The process was accomplished using a cannula for thread
guidance (Figure 2C; Video S4). Skin resection is not necessary, for
only patients with minimal or mild skin laxity are selected. Skin flaps
are evenly pulled by the underlying perpendicular fibers, which ef-
fectively tightens the skin flap.
Loops with the bury guidance technique
Bidirectional barbed PDO (2-­0) was anchored to the deep temporal
fascia by taking the first pass at the apex of the loop, which was
formed by two sideburn stabs, and gently pulling the thread to the
middle of it (Figure 3A). Then, the cannula was inserted through
the vertical stab below the mandibular angle into the SMAS layer,
following one arc of the loop and exiting from the sideburn stab.
The needle that was connected to the thread was cut down, and
the thread was inserted into the cannula through the hole on it
(Figure 3B). The cannula was withdrawn to the bottom of the loop
(Figure 3C) and redirected to the other arc of the loop, exiting from
the adjacent temple stab (Figure 3D). The left thread in the cannula
was pulled out (Figure 3E). The process was performed under the
tactile guidance of the surgeon's nondominant hand. The end of
the thread was pulled to the maximum extent and anchored by tak-
ing one pass away from the apex and then one pass in the reverse
direction into the deep temporal fascia with a 1/2, 3 × 8 triangular
needle (Figure 3F). Other loops are made with the same methods
(Figure 3G). These loops were fixed under maximal tension. To pro-
tect the frontal branch of the facial nerve, the paths of the loops ran
subcutaneously above the zygomatic arch.
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900 FU et al.

F I G U R E 3 Loops with the bury guidance technique. (A) Bidirectional barbed PDO (2-­0) was anchored to the deep temporal fascia by
taking the first pass at the apex of the loop, which was formed by two sideburn stabs, and gently pulling the thread to the middle of it.
(B) The cannula was inserted through the vertical stab below the mandibular angle into the superficial musculoaponeurotic system layer,
following one arc of the loop and exiting from the sideburn stab. The needle that was connected to the thread was cut down, and the
thread was inserted into the cannula through the hole on it. (C) The cannula was withdrawn to the bottom of the loop. (D) The cannula was
redirected to the other arc of the loop, exiting from the adjacent temple stab. (E) The left thread in the cannula was pulled out. (F) The end
of the thread was pulled to the maximum extent and anchored by taking one pass away from the apex and then one pass in the reverse
direction into the deep temporal fascia with a 1/2, 3 × 8 triangular needle. (G) Other loops are made with the same methods.

F I G U R E 4 The malar loop. The cannula

was inserted through the intraoral stab
access, to the temporal stab. The malar
loop ran through the malar fat pad and
suborbicularis oculi fat pad (SOOF). The
distal end of the loop was anchored to the
zygomatic skin ligament. In the temple
region, the loop was right above the deep
temporal fascia to avoid the frontal branch
of the facial nerve.

FU et al.
2.1.5 | The malar loop
The malar loop was oriented obliquely to suspend the malar fat
pad and to better improve the nasolabial groove, zygomatic buccal
groove, and midface. This step can be omitted if the patient shows
little midface aging sign.
Loop with the bury guidance technique
The first pass was made at the apex of the loop, and the suture was
anchored to the deep temporal fascia. An stab incision was made
on buccal side 5 mm adjacent to the maxillary vestibular groove as
cannula entry port to avoid visible scar. The cannula was inserted
through the stab access, to the temporal stab. The malar loop ran
through the malar fat pad and suborbicularis oculi fat pad (SOOF).
The distal end of the loop was anchored to the zygomatic skin liga-
ment. In the temple region, the loop was right above the deep tem-
poral fascia to avoid the frontal branch of the facial nerve. The loop
was tied under maximal tension (Figure 4).
2.1.6 | Postoperative management and patient
follow-­up
Patients were permitted to leave the clinic after surgery. Oral pain
medication was administered for the first 3 days. Patients were en-
couraged to resume normal activity, as comfortable. Patients were
advised to avoid vigorous exercise for the first 7 days. Stab sutures
were removed on postoperative days 5–­6. Standardized photo-
graphs were taken before surgery for all patients. All patients were
contacted through WeChat or email 1, 3, 6, and 12 months after sur-
gery to rate the surgical outcomes according to the Global Aesthetic
Improvement Scale (5 = very much improved; 4 = much improved;
3 = improved; 2 = no change; 1 = worse) and to provide postop-
erative photographs. Four plastic surgeons evaluated postsurgery
result with a five-­point Likert scale, where 5 = excellent, 4 = good,
3 = fair, 2 = no change, and 1 = worse.
3 | R E S U LT S
Data from 38 consecutive patients (36 females and two males)
aged 26–­45 years who underwent the SAFS-­lift technique from
September 2020 to September 2021 were analyzed. Two patients
were lost to follow-­up; thus, 36 patients were successfully enrolled
and followed up. Twenty-­four patients underwent liposuction in the
lower third of the face and neck region. Eighteen patients under-
went titanium plate and screw removal after malarplasty. The aver-
age liposuction volume was 25.0 ± 13.8 ml (10–­50 ml). The operating
time was between 90 and 180 min, depending on additional ancillary
procedures.
The overall minor complication rate in the early postoperative
period was 19.4% (7 of 36 patients). Three patients (8.3%) had a
palpable thread in the temple area, and four patients (11.1%)
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901
experienced temporary local depression, which subsided within
1–­6 weeks without treatment. No infection, hematoma, seroma,
or facial nerve injury was observed. The long-­term scarring for li-
posuction and SAFS-­lift is inconspicuous. The scarring for titanium
plate and screw removal after malarplasty is in the oral cavity which
cannot be seen. No patients reported visible scarring.
Twenty patients provided postoperative photographs.
Four patients provided qualified postoperative photographs.
Representative cases are shown in Figures 5 and 6. Typical early
results are shown in Figure 7. The mean follow-­up period was
14.72 ± 3.89 months. Patients rated the surgical outcomes ac-
cording to the Global Aesthetic Improvement Scale at 1 month
(3.75 ± 0.83), 3 months (4.22 ± 0.58), 6 months (4.69 ± 0.46), and
1 year after surgery (4.69 ± 0.54) (Table 1). Surgeons' outcome
scoring was 3.98 ± 0.95.
4 | DISCUSSION
The SAFS-­lift technique was inspired by the demands of relatively
young patients in the clinic. Nowadays, young patients who resort to
facelift comprise a large proportion of facial rejuvenation patients.
Although many of these patients show noticeable jowl sagging,
they have no major skin laxity and wish to achieve durable volume
lift without noticeable scarring. Some of these patients could ben-
efit from a short-­scar facelift according to Baker's classification.1
However, short-­scar techniques actually leave long scars, which are
unacceptable for many.
Skin resection has been an indispensable step in facelift sur-
gery since the early 1890s. The early facelift merely cut a piece
of skin. Surgeons quickly became unsatisfied with the results and
began to perform extended subcutaneous undermining. 2,3 Skoog
operated on the deeper layer, which was later named SMAS by Mitz
and Peyronie.4,5 This technique has become the foundation of the
modern facelift. Less invasive facelifts, such as SMASectomy and
minimal access cranial suspension lift, are also widely used6–­8 be-
cause they are less technically challenging, safe, can be performed in
a short time, and produce long-­standing results.
Thread-­lifting is a widely used and noninvasive facial reju-
venation method. Although there are reports stating 3–­7 years
of long-­t erm results, there is no scientific objective research
supporting this outcome.9–­11 Often times, the results are short-­
lived and unpredictable.10–­13 Moreover, many surgeons believe
that it is hard to lift ptotic tissue using sutures without under-
mining. Sutures will inevitably cut through, and ptotic tissue will
descend back into its original place. Ptotic tissue needs to be
released and fixed in a higher position to achieve a consistent
long-­t erm result.
Here, we present SAFS-­lift as a reliable surgical strategy for
the lower and middle-­third of the face. The basic rationale of this
approach is to accomplish subcutaneous undermining and SMAS
imbrication through minimal incisions. With our technique, incom-
plete subcutaneous undermining is performed through stabs; there
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902
F I G U R E 5 Typical patient underwent stab access fascia suspension lift (SAFS-­lift). (A, C, E) Pretreatment views of a 28-­year-­old woman.
(B, D, F) Post-­treatment views 7 months after SAFS-­lift.
is no skin resection, and there is usually no visible scarring on the
skin. Loop suspension through stabs might resemble a thread-­lifting
procedure with loops.11 However, we propose incomplete subcu-
taneous undermining by creating numerous tunnels as an effective
method to fix the SMAS imbrication and achieve a consistent long-­
term result. The loops to imbricate the SMAS can be fixed under
maximum tension without skin dimples. The preserved perpendicu-
lar connections simultaneously lift the SMAS and the skin flap when
suspending the SMAS (Figure 8). The long-­term result is secured by
continuous subcutaneous beneficial scar formation and maximal
SMAS imbrication.
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FU et al.
The main feature of the SAFS-­lift is incomplete subcutaneous
undermining. The purpose of skin flap elevation is to gain access to
deeper structures, resect redundant skin and redrape the flap, and
form beneficial scars between the skin flap and the SMAS. In pa-
tients with mild to moderate skin laxity, little redundant skin is pres-
ent. Thus, the skin excision is unnecessary, and the surgical result
is mainly produced by undermining and SMAS manipulation, which
allow the SMAS to be fixed in a higher position by the beneficial
scarring.
Scissor-­free undermining with tunneling and hydrodissection
through small incisions has been reported to reduce bleeding and

FU et al.
F I G U R E 6 Typical patient underwent
stab access fascia suspension lift (SAFS-­
lift) without malar loop. (A) Pretreatment
view of a 28-­year-­old woman. (B) Post-­
treatment view 10 months after SAFS-­lift.
complications.14–­17 This technique uses tumescent hydrodissec-
tion to create numerous subcutaneous tunnels to prepare the skin
flap. Afterward, the flap can be completely undermined quickly and
safely.
With our technique, incomplete undermining is performed with
hydrodissection-­assisted tunneling through stab access. Tumescent
fluid (200–­300 ml) is placed on each side of the face, and after sub-
cutaneous hydrodissection-­assisted tunneling, the majority of the
flap is effectively elevated with a few remaining subcutaneous at-
tachments, which are perpendicular to the flap (Figure 8A). Those
connective fibrous tissues form a beneficial internal pull to the flap
when suspending the SMAS (Figure 8B). This process causes very
little bleeding.
Incomplete undermining with hydrodissection-­assisted tunnel-
ing creates enough mobility for most of the skin flap, except for the
ligament attachment regions. The remaining strong zygomatic liga-
ment and the masseter ligament in the hollow below zygomatic arch
and zygomatic skin ligament in the zygomatic buccal groove area
(Figure 1) are completely undermined with a dissecting cannula to
release the restriction and avoid local depression, followed by SMAS
and malar fat pad suspension (Figure 6).
With our technique, the perpendicular fibers that allow the flap
to slide on the SMAS are preserved. This is because the patients who
undergo this technique have minimal to mild skin laxity; thus, skin re-
section is not necessary. Moreover, after incomplete dissection with
hydrodissection-­assisted tunneling and complete dissection in the
ligament attachment region, there is enough space between the skin
flap and the SMAS for SMAS imbrication. In addition, the perpen-
dicular fibers form internal pulling on the skin flap, which effectively
tightens the skin flap. Furthermore, the perpendicular fibers do not
affect the beneficial scar formation between the flap and the SMAS.
At last, to avoid making long incisions which result in visible scar.
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903
We suspended the SMAS with bidirectional barbed sutures
under maximal tension. The SMAS layer was imbricated with the
tension evenly distributed, and no knot was required. Complications
associated with knots, such as knotting leakage or local alopecia,
were thus avoided.18 Suspension under maximal tension is key for
the long-­term result. The suture fixation loosens over time, and any
reserved pulling yields little aesthetic outcome. The suture is able to
hold the SMAS for the initial 2–­3 months, and the long-­term results
are retained by beneficial scar formation between the flap and the
SMAS.
The direction of the loop suspension was vertical at the man-
dibular angle and oblique at the malar fat pad in a fan shape. The
lateral U-­shaped loops suspend the SMAS-­platysma in the vertical
direction to make a clearer jawline and improve the hollow below
zygomatic arch. The paths of the lateral loop are within a safe zone
in which they avoid the frontal branch of the facial nerve. Two cheek
loops and one malar loop run in an oblique direction to better lift the
malar fat pad and improve the nasolabial fold (Figure 1). The cheek
loops run in the SMAS below the zygomatic arch and go shallow into
the subcutaneous layer above the lower rim of the zygomatic arch.
The malar loop runs in the malar fat pad, suborbicularis oculi fat pad,
and deep to the periosteum at the outer orbital rim. It then runs right
on the surface of the deep temporal fascia. The distal end of the
malar loop is anchored to the zygomatic skin ligament. Zygomatic
skin ligament is a reliable anchor structure. After subcutaneous un-
dermining, the skin attachment of zygomatic skin ligament is lifted
and reattached higher to the skin. The malar fat pad is thus lifted and
the zygomatic buccal groove are alleviated. Durable midface reju-
venation outcome is achieved. All sutures are anchored to the deep
temporal fascia under maximal tension by the hairline.
The advantage of our technique is that we can achieve stable
facial volume lifting without visible scarring. It is ideal for patients
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904 FU et al.

F I G U R E 7 Typical early results. (A,

B) Pretreatment views of a 28-­year-­old
woman. (C, D) Post-­treatment views
7 days after stab access fascia suspension
lift.

TA B L E 1 Surgical outcomes rated by patients. It is scored according to the Global Aesthetic Improvement Scale (5 = very much improved;
4 = much improved; 3 = improved; 2 = no change; 1 = worse)

Follow-­up time (patients Much improved Very much Average

number) Worse (1) No change (2) Improved (3) (4) improved (5) score

Postoperative 1 month (36) 0 1 15 12 8 3.75 ± 0.83

Postoperative 3 months (36) 0 0 3 22 11 4.22 ± 0.58
Postoperative 6 months (36) 0 0 0 11 25 4.69 ± 0.46
Postoperative 12 months 0 0 1 7 21 4.69 ± 0.54
(29)

seeking a lift of facial contour, but without noticeable excess skin.
Those patients are usually in their 30s to early 40s. They show mild
to moderate soft tissue ptosis in the jowl area. Their lower face be-
comes wider, and their face contour is usually not smooth. Some
may present fat accumulation in the lower face and submandibular
region. Some may have an obvious mid-­cheek groove, nasolabial
groove, and mild marionette line. They maintain good skin elasticity
and have minimal excess skin. The disadvantages of our technique
are that (1) closed suspension without surgical field exposure needs
to be done with an adequate understanding of the anatomy; (2)

FU et al.
F I G U R E 8 Hydrodissection-­
assisted tunneling and superficial
musculoaponeurotic system (SMAS)
suspension. (A) After subcutaneous
hydrodissection-­assisted tunneling, the
majority of the flap is effectively elevated
with a few remaining subcutaneous
attachments, which are perpendicular to
the flap. (B) The preserved perpendicular
connections simultaneously lift the skin
flap when suspending the SMAS.
some patients may experience perizygomatic arch widening, which
will subside within 2–­6 weeks; and (3) SAFS-­lift is not suitable for
patients with obvious excess skin.
4.1 | Limitations
Postoperative photos showed little long-­term improvement for the
nasolabial fold. Studies with longer follow-­up periods and more ob-
jective quantitative indices will better illustrate the usefulness and
outcomes of this technique. Moreover, comparison between SAFS-­
lift and short-­scar SMAS suspension rhytidectomy may be a good
proof of the efficacy of SAFS-­lift.
5 | CO N C LU S I O N S
In this study, SAFS-­lift achieved reliable and consistent facial con-
tour rejuvenation results 1 year after surgery. SAFS-­lift is a predict-
able, effective, and safe facelift technique that can be performed
without making noticeable incisions and resecting the skin, thereby
avoiding visible scarring.
AU T H O R C O N T R I B U T I O N S
Feng Niu and Ying Chen contributed equally to this work and
should be considered co-­corresponding authors. Xi Fu, Feng Niu,
|
14732165, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocd.15496 by Cochrane Colombia, Wiley Online Library on [12/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
905
and Ying Chen designed the study. Jia Qiao, Feng Niu, Ying Chen,
Jianfeng Liu, Qi Jin, Shixing Xu, Bing Yu, and Lai Gui recorded
and analyzed the data. Xi Fu, Ying Chen, and Feng Niu wrote the
manuscript. Xi Fu, Feng Niu, Ying Chen, Jia Qiao, Jianfeng Liu, Qi
Jin, Shixing Xu, Bing Yu, and Lai Gui made critical revision of the
manuscript. Feng Niu obtained funding. Xi Fu, Feng Niu, and Ying
Chen supervised the study. All authors have read and approved
the final manuscript.
AC K N OW L E D G M E N T S
The authors thank Emily Woodhouse, PhD, from Liwen Bianji (Edanz)
(www.liwen​bianji.cn) for editing the English text of a draft of this
manuscript. They also thank Hengyuan Ma, MD, Jia Qiao, MD for
the illustration.
F U N D I N G I N FO R M AT I O N
This study was supported by the Scientific Research Foundation
directly under the ministries and commissions of the Central
Government (3332020029), the Clinical and Translational Medicine
Research Project, the Science and Technology Innovation Project
of Medicine and Health, the Chinese Academy of Medical Sciences
(2020-­12M-­C T-­B-­078), and the Beijing Natural Science Foundation
Program (No. 7192180).
C O N FL I C T O F I N T E R E S T
None of the authors were declared.
 |

14732165, 2023, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jocd.15496 by Cochrane Colombia, Wiley Online Library on [12/10/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
906 FU et al.

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