Embracing the High SMAS for Facial Rejuvenation

Abstract

Operations centered on the superficial musculo-aponeurotic system (SMAS) have been the mainstay of facial rejuvenation procedures for nearly three decades. Since its initial description by Mitz and Peyronie in 1976 [6], the SMAS has been successfully used by plastic surgeons as the foundation for different face-lift techniques. Whether a SMAS lift or plication is performed, the basic principle of utilizing the SMAS to restore facial youth has withstood the test of time and has become a reliable technique to achieve facial rejuvenation. Despite the successful use of the SMAS, most plastic surgeons limit their dissection of the SMAS inferior to the zygomatic arch. These operations have not traditionally addressed the changes associated with mid-facial aging. The changes associated with mid-facial aging include: deepening of the nasolabial fold, descent of the malar fat pad with loss of malar prominence, descent of the lower eyelid skin below the orbital rim and deepening of the tear trough. These changes cannot be adequately addressed with an infra-zygomatic operation.