‘Optimum Mobility’ Facelift

Abstract

Dr Nabil Fanous presented a clear discussion of his theory of the intrinsic mobility of the face. The author noted that the mobility of the superficial musculoaponeurotic system (SMAS) layer is more dominant than the subskin layer. This is an astute observation and has inherent practical applications. The concept of calling this mobility ‘intrinsic’ is a good one. The author dramatically and pictorially described the technique for the preoperative markings. It would have been easier to follow had he used the same side of the face for his diagrams and photographs. The description and intraoperative presentation of his suturing technique was very clear. The author compared the various techniques currently used in achieving facelift surgery. He concluded that it is not always necessary to have an extensive dissection to achieve the end result. This of course is an axiom for all surgery – do no more dissection than required to achieve the end result, whether you are doing a facelift or a fasciectomy for Dupuytren’s contracture. Dr Fanous’ technique of SMAS plication is similar to the less invasive suturing plications of the SMAS that are being presented currently. The author documented the historical evolution of SMAS anatomy and utilization. One must not forget that, 45 years ago, Dr Gustof Aufricht was hauling up and suturing the SMAS – he called it the deep fascia. The pre- and postoperative photographs depicting the results were comparably clear; all of the patients presented had a loose integumentary system. The results were good and demonstrated that what could be achieved from plications of the SMAS only and lateral placation of the platysma only. The author did not show any patients with heavy integumentary systems or fat necks, which would require suction-assisted lipectomy and subplatysma removal of fat.