Full facelift through an endoscopic approach has been indicated for young individuals without significant skin excess but with mild laxity of the midface. It also has been indicated in secondary rhytidoplasty. Wide undermining of the face and neck is performed. Liposuction at submental and submandibular areas provides noticeable improvement for the neck and mandibular contour. Plication of the SMAS and platysma muscle is used to replace tissues and to regain a youthful appearance. Improved results become evident when plication is performed over the deformity. The unlikely course for the SMAS and platysma plication is to provide an aesthetic balance for the face and neck. Extracorporeal knotting is used to hold the folded muscle in position. In addition, scars are minimal and occur in areas where they cannot be seen. However, selection criteria must be followed to achieve excellent results with this procedure.