BACKGROUND:
Since the advent of facelift surgery or rhytidectomy, there has been a progressive evolution in technique. Various methods have developed, however, there is still no consensus on the best technique for facelift.
The facelift procedure has increased its popularity among Asians in the past decades, while a satisfactory aesthetic outcome requires considerations over specific characteristics of the skin thickness and tightness and skeletal anatomy of Asian patients and the distinctive ethnic and cultural differences1.
Extensive literature regarding different techniques for Westerners have been published. Herein, the author reviews various facelift procedures, describes the evolution and development of his current techniques in facelift for Asians based on 30 years of clinical experience and introduces the innovative combination of bone contouring.

METHODS:
The author shares his modifications in techniques for facelift:
1 Extensive facial skin undermining as needed.
2 Shifts to vertical lift
3 Medial epicanthoplasty is needed in some cases
4 Correction of forehead wrinkle, glabella wrinkle and eyebrow asymmetry
5 SMAS plication and/or SMASectomy instead of extended SMAS dissection2;
6 Increased role of forehead-lift and correction of lateral hooding;
7 Neck liposuction routinely in Asians’ double chin ,open treatment of the neck, in rare elderly cases
8 Increased role of fat augmentation
9 Simultaneity with bone contouring3-5.
RESULTS:
The author’s experience spans 30 years. Plication or superficial musculoaponeurotic system excision techniques have achieved consistent and satisfactory results. The mean operative time for total facelift is 4 hours. 86 patients received facelift simultaneously with multiple bone contouring in recent 6 years. The follow-up period ranged from 6 months to 8 years. Although rare, complications from our experiences have included skin edge necrosis resulted in scar, depression at zygomatic area. Patients were all satisfied with surgical outcomes. Significant improvements were seen comparing pre- and postoperative photos (Figure 1,2).
CONCLUSION:
A successful facelift for Asians must take ethnic and anatomical differences into consideration. The modified subcutaneous dissection with SMAS plication or SMASectomy suits Asians, is practical and meanwhile can provide desirable and consistent aesthetic outcome in facial rejuvenation. The importance of forehead-lift should also be emphasized in Asians. In addition, for patients with wider and rounder face or higher eyebrow, the simultaneity of facelift and multiple bone contouring should be taken into practice and has been observed to be a feasible, safe and accurate new approach in author’s experience.