9.8 - High SMAS facelift: combined single flap lifting of the jawline, cheek, and midface

Abstract

The traditional “low” cheek and deep plane superficial musculo-aponeurotic system (SMAS) flaps elevated below the zygomatic arch all suffer the drawback that they cannot, by design, exert an effect on tissues of the midface and infra-orbital region. Low and deep plane designs target the lower cheek and jowl only and produce no improvement in the upper anterior cheek and “midface” area. Planning the flap “higher", along the zygomatic arch, and extending the dissection medially in an “extended SMAS” fashion to mobilize midface tissue, overcomes this problem and allows a combined, simultaneous single flap lifting of the jawline, cheek and midface. An improved outcome is obtained and no separate midface lift procedure is needed. If skin and SMAS are dissected as separate flaps in a “lamellar” fashion and advanced “bidirectionally” along independent vectors, additional improvement and a more natural appearance is achieved.