Abstract
The modified lateral superficial musculoaponeurotic system (SMAS)-ectomy is an evolution of the technique described by Baker. This modification of the lateral SMASectomy improves and simplifies the procedure by addressing the SMAS and platysma in one surgical procedure. A rectangle of SMAS and platysma, parallel to the nasolabial fold (1 cm inferior to the zygomatic arch, 4 to 5 cm below the jaw line, and 3 cm wide), was marked. This plane was undermined anteriorly with blunt dissection, leaving the facial nerve deep to the deep cervical fascia. After excision of the rectangle, the defect was closed, leading to a correction of the neck, jowl, and nasolabial folds. Superolateral elevation of the inferior portion of the flap in particular addresses the problem of neck laxity and platysma redundancy. A total of 359 patients have undergone this procedure performed by the senior author (N.W.). This technique gives pleasing, durable results, with minimal morbidity.
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