“…In the composite rhytidectomy proposed by Hamra, the platysma muscle, the malar fat and orbicularis oculi muscle are repositioned (14) obtaining the desired effect. It is important to mention that in a 30 year Pitanguy's rhytidectomy experience, where he proposes SMAS plicature, round lift technique and points out the direction of SMAS and facial flap traction should have, he is able to obtain results comparable to the ones where the SMAS was elevated (15,16).…”