Modified Lateral SMASectomy

Abstract

Sir: Recently, advances on facial anatomy have been significantly achieved by Rohrich and Pessa1 and Mendelson et al.2 For this reason, various face-lift techniques have evolved and been introduced into clinical practice.3,4 Although limited-incision face lifts are popular, conventional face lifts have their own indications for treatment of aging face with severe skin laxity. Recently, face lifts with lateral superficial musculoaponeurotic system (SMAS)-ectomy technique have gained prominence among plastic surgeons. The theoretical benefits of lateral SMASectomy for facial rejuvenation are a short recovery time, relatively simple operation, low incidence of complications such as tearing of the SMAS and potential facial nerve injury, vertical elevation and strong fixation of the SMAS, comparable outcome with extended SMAS technique, and a short scar because of limited incision. Because of these advantages, we think the original technique is a good option with regard to overall improvement of skin tightness and effacement of fine wrinkles. However, we are somewhat suspicious of the effect on midface ptosis. Thus, following the original lateral SMASectomy described by Daniel Baker in 1992, various modified techniques have been introduced.5 We also adopted our own modified lateral SMASectomy design. The procedure was performed under local anesthesia with intravenous sedation. After access skin incision, dissection extends across the zygoma to release the zygomatic ligaments and masseteric cutaneous ligaments. We do not dissect further anteriorly. Then, we designed a trapezoid SMAS flap. The superior border of the incision was approximately at the level of the zygomatic arch and the inferior border was approximately 4 to 5 cm below the jaw line. A representative design is shown in Figure 1.Fig. 1: Intraoperative design of the modified lateral flap.Over a 2-year period, the patients underwent modified lateral SMASectomy. The treatment outcomes were evaluated both subjectively and objectively. All but four patients [33 of 37 (89.1 percent)] were satisfied with the outcomes after the surgical procedure. Consensus ratings by the two independent plastic surgeons found that objective outcomes were divided among excellent, good, and fair. None of the outcomes was rated as no change or worse. The postoperative course was uneventful, with the exception of five patients (13.5 percent) who presented with skin slough, hypertrophic scar, and hematoma. We think that our modified technique can be considered as another option that yields a better effect on midface ptosis, jowl, and jaw line and more powerful effacement of nasolabial folds. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Tae Hwan Park, M.D. Jin Hyuk Park, M.D. Kwi Whan Whang, M.D., Ph.D. Research Department Miz Aesthetic Surgery Clinic Seoul, Republic of Korea