about the need of SMAS procedures in facial rejuvenation.
Methods/Technique: Instead of the traditional lateral vectors of
conventional facelift techniques which include SMAS manipulation, a
technique has been developed to elevate the skin, cheek fat and
subcutaneous fat superior to the SMAS, and the zygomaticus-orbicularis
musculature en bloc and effectively reposition this flap in a
superior-medial direction. This is not a subperiosteal dissection. A
septal reset is always incorporated under this flap. I have found that
by not elevating the SMAS, this facial flap moves unencumbered and when
it is elevated, the facial platysma shows little sign of redundancy,
particularly after a double layered corset procedure of the neck
actually recruits muscle away from the parotid. This cheeklift is done
with extraordinary tension which leaves a lessor amount of skin to be
excised near the tragus. Having utilized the SMAS since beginning with a
Skoog technique since 1973, and being for years an ardent advocate for a
SMAS inclusion in all of my facelifts, the results achieved when
deleting it have clearly justified its discontinued use and raises
questions about its usefulness. SMAS transpositions in the best hands
have frequently been responsible after months or years of a “lateral
sweep” or a surgerized appearance. The ultimate criteria of a
rejuvenated eyelid-cheek junction is when it almost ceases to exist
following a facelift.
Results/Complications: The results of this procedure are demonstrated in
these patient photographs. The complications of cheek-lifts are always
possible with lower eyelid malposition. Fortunately these occurrences
are readily corrected with a tarsal strip canthoplasty done as an office
procedure.
Conclusion: In spite of a universal devotion by most plastic surgeons to
SMAS procedures since 1976, this procedure that I have routinely used
since 2005 achieves a very impressive youthful eyelid and midface far
superior to results I have ever obtained or observed. Given the truly
significant advances in rhinoplasty, breast surgery, and body contouring
in the past few years, one would hope that after thirty six years of
SMAS facelifts giving suboptimal results, new thoughts can be
entertained and evaluated.