The Canadian Society for Aesthetic Plastic Surgery 39th Annual Meeting

Abstract

Understanding the anatomy of the superficial fascia and its relation to the deep fascia, retaining ligaments and facial nerve is critical to safe sub-SMAS surgery. Facial surgery is an exercise in understanding three-dimensional nuances of complex face and neck anatomy. While the topographic anatomy of the face and neck is straightforward, the anatomy superficial-to-deep is complex and less easily mastered. With clear understanding of the complex three-dimensional anatomy, grasp of facial proportions and understanding the means of biomechanically addressing facial aging, surgery becomes easier. In the first part of this presentation, the platysma-SMAS complex spatial relations will be described and the relationship of ligaments, facial nerve branches and muscles of facial expression will be outlined. These structures relate to one another consistently in three-dimensional fashion and once these relationships are mastered facelift operations become easier. Three prototype subSMAS procedures will be described and outlined: Extended (separate skin-SMAS) SMAS flap, deep-plane facelift and subperiosteal lift, illumination of benefits and the drawbacks and similarities of the three procedures. Surgical correction does not necessarily require extended release at the sub-SMAS level. SMASplication, lateral SMASectomy and minimal access cranial suspension procedures have their place in facial rejuvenation. The concepts behind the efficacy of these operations will be outlined. Finally, the neck will receive special attention as this is often the most difficult part of the facelift. The author’s preference for medial platysmaplasty, superficial deep-fat removal and muscle modification will be described and the biomechanical benefits elucidated. Other authors’ preferences regarding the posterior approach will also be described.