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. 2023 Dec 28;44(7):671–692. doi: 10.1093/asj/sjad382

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© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society.

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Figure 7. — Suture tying sequence. After completion of the anterior platysma corset the following suture placement algorithm is extremely important to maximize vertical rotational tissue displacement. (1) We begin with the superior zygomatic arch sutures to the temporal fascia, usually 2 to 3 laterally in the “safe lane.” The exact positioning is determined by the relationship of the medial and lateral zygomatic lateral neurovascular bundles. (2) Next, we place 2 or 3 cheek sutures lifting the cheek fat pads toward the temple area. (3, 4) The next level of suturing connects the bitemporal (anterior wound edge) and paramedian (posterior wound edge) incisions to perform the brow rotation. (5) As a next step we place stiches that grab the TPF island on its distal cut edge and tie them to the temporal fascia. (6) The proximal edge of the TPF island flap is sutured to the temporal incision wound edge and fascia. (7) Finally, the posterior platysma corset is completed. Importantly, the assistant lifts the face vertically during the entire suture tying sequence, with hooks deploying tension from the paramedian incisions. TPF, temporoparietal fascia.