SMAS Flap Research Articles

Integrating SMAS plication and deep plane techniques in facial rejuvenation: A novel approach

IntroductionIn the realm of facial rejuvenation surgeries, deep plane facelift and SMAS plication techniques have been applied with notable efficacy over an extended period, yielding aesthetically pleasing outcomes.Both methods have their own advantages and disadvantages depending on individual circumstances.We endeavored to formulate an effective facelift method by integrating both approaches, aiming to harness the advantageous aspects of each method while addressing their respective drawbacks in a comprehensive manner. MethodsFollowing the preparation of the subcutaneous plane overlying the fixed SMAS, the mobile SMAS was elevated from the deep plane, and a SMAS flap was fashioned.The SMAS flap in the prezygomatic and premasseteric areas was inwardly folded, and a plication procedure was applied using loop sutures from its most medial to lateral aspects. Subsequently, it was secured to the preauricular area with U stitches. The results were statistically evaluated preoperatively and postoperatively using WSRS scores. ResultsA total of 40 patients underwent operative procedures effectively performed by the senior author(F.C.). Preoperative WSRS scores were measured at 4.2 ± 0.52. Postoperative WSRS scores at 3 months were significantly lower at 1.25 ± 0.44 (p<0.05). The facelift procedure was effectively applied in all patients without the development of major complications. ConclusionsThis method combines deep plane facelift and surgical SMAS plication, utilizing the advantages of both techniques to directly address nasolabial folds and achieve gratifying outcomes in facial and neck rejuvenation.

Clinical Practice Patterns in Facelift Surgery: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery.

This study evaluates change in practice patterns in facelift surgery based on a 15-year review of tracer data collected by the American Board of Plastic Surgery as part of the Continuous Certification process. Tracer data for facelift was reviewed from 2006 to 2021. The 15-year collection period was divided into an "early cohort (EC)" from 2006 to 2014 and a "recent cohort (RC)" from 2015 to 2021. Of 3400 facelifts (1710 EC/1690 RC) performed, 18% were done in hospital and 76% were done in an accredited office facility. Ninety one percent of patients were female with an average age of 61years. There was an increase in the number of secondary facelifts (4% EC vs 18% RC; p < 0.001) and an increased number of patients concerned about volume loss/deflation (25% EC vs 37% RC; p < 0.001). The surgical approach to the SMAS involved plication (40%), flaps (35%), SMASectomy (22%) and MACS lift (6%). One percent of facelifts were subperiosteal and 8% skin-only. Significantly more surgeons used the lateral SMAS flap (14% EC vs 18% RC, p < 0.005), while less used an extended SMAS flap (21% vs 18%; p = 0.001) and MACS lift (10% EC vs 6% RC; p = 0.021) techniques. The concomitant use of facial fat grafting is becoming more common (15% EC vs 24% RC, p = 0.0001). A 15-year review of ABPS tracer data provides an excellent venue for the objective assessment of the current status of facelift surgery, and key changes in practice patterns during that time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

FACELIFT TECHNIQUES: AN OVERVIEW.

Facelift techniques can be classified according to the depth and extent of the dissection applied. Imbrication and plication of the SMAS referred to as "SMAS lifts" or "classical facelifts" are the most commonly used techniques. Plication techniques involve in-folding of the SMAS and suture suspension without any SMAS incision whereas imbrication techniques involve a SMAS incision with a portion of the SMAS either removed or transposed with or without limited subSMAS dissection. Ageing changes in the lower face and neck can be successfully treated with SMAS lift techniques. However, there is no lifting effect at midface level or improvement of the nasolabial folds since the retaining (zygomatic cutaneous and masseteric cutaneous) ligaments that prevent the transmission of traction to the malar portion of the facelift dissection are not released. Extended facelift techniques involve surgical release of these ligaments, and produce combined, balanced and harmonious rejuvenation of the midface, cheek, and lower face without requiring a separate midface lift procedure. There are different techniques having similar extended midface dissections with some variations: The extended SMAS technique involves a long skin flap and a distinct SMAS flap dissected and pulled separately. The high SMAS technique has a similar dissection but involves a higher SMAS flap along the superior border of the zygomatic arch. The deep plane facelift involves undermining of skin-SMAS flap as a single unit following a more limited subcutaneous dissection. In the composite plane facelift, in addition to deep plane facelift dissection, the lower part of the orbicularis oculi muscle is also dissected and included in the flap. As they have a single unit, deep and composite flap facelifts allow excellent blood supply to the overlying skin. In this article, various facelift techniques are discussed in detail in line with the relevant surgical anatomy.

Subperiosteal Midface Lift with Sub–Superficial Musculoaponeurotic System Rhytidectomy

The subperiosteal midface lift is a powerful tool that allows the surgeon to reposition the SOOF and malar fat pad in a vertical direction. Additionally, it significantly softens deep nasolabial folds. Its effect, however, is minimal with regards to addressing the jowl, jawline, gonial angle and cervicomental angle. Combining the subperiosteal midface lift with an extended sub-SMAS rhytidectomy addresses the pre-jowl sulcus by releasing the mandibular ligament. The jawline and gonial angle become more defined with the transposition and suspension of the SMAS flap. The SMAS transposition flap along with the suspension of the platysma flap to the mastoid fascia support the submandibular glands and deepen the cervicomental angle. These two approaches are valuable additions to the surgeons armamentarium and can yield excellent results in carefully selected patients.

Developing the Aesthetic Postoperative Complication Score for Detecting Major Morbidity in Facial Aesthetic Surgery

INTRODUCTION: Facial aesthetic surgery encompasses a wide variety of procedures with a complication rate that is difficult to estimate. To explore this further, we sought to estimate major complication rates in patients undergoing facial aesthetic procedures and to develop a risk assessment tool to stratify risk. METHODS: We utilized the Tracking Operation and Outcomes for Plastic Surgeons database from 2003 to 2018. The database was evaluated to include major facial aesthetic procedures selected based on CPT codes. All infra-cervical procedures were excluded. Procedures included were blepharoplasty (upper and lower), rhytidectomy (forehead, neck with platysma tightening, glabellar, SMAS flap, cheek, chin, and neck), repair or brow ptosis, repair of blepharoptosis, canthopexy (lateral and medial), genioplasty, augmentation of mandibular body, primary rhinoplasty (minor and major), revision rhinoplasty (minor and major), subcutaneous injection/fat transfer, cervicoplasty, and otoplasty. Demographics, comorbidities, and procedures were analyzed with univariate analysis for initial selection. Clinically relevant cutoff points were used to dichotomize significant continuous variables for the model. A backward stepwise multivariate regression model was developed to determine the risk factors for prediction. Goodness-of-fit was assessed with Hosmer-Lemeshow test. Regression coefficients were multiplied by two and rounded up to the nearest integer, and then summed to create the total score. Area under receiver operating characteristic curves were used to measure performance and choose optimal predictive models. Lastly, sensitivity analysis was performed with a complete case analysis to evaluate robustness of the model. RESULTS: A total of 38,569 patients were identified to have had a facial aesthetic procedure. The major complication rate for this adult population undergoing at least one facial aesthetic procedure was 1.44% (460). From the available demographics and perioperative variables, those statistically significant in univariate analysis included current/former smoker, diabetes mellitus, body mass index, ASA classification, canthoplasty, blepharoptosis repair, rhytidectomy in forehead, rhytidectomy with platysma thickening, rhytidectomy with SMAS flap, rhytidectomy with check/chin/neck, cervicoplasty, subcutaneous injection of filler/fat graft, primary rhinoplasty, lower blepharoplasty, and over three procedures were performed at the same time. In the final stepwise backward regression model undergoing rhytidectomy with platysmal tightening, rhytidectomy of cheek/chin/neck, cervicoplasty, over three surgeries at the same time, BMI ≥ 25, and ASA class ≥ 2 were the variables fit for calculating the risk prediction score [n = 13,349; AUC: 0.70, SE: 0.02, (0.66–0.74)]. The sum of the calculated integers gives a total score of 7 with cervicoplasty counting for two points and the rest of the covariates each given one point. Sensitivity analysis from each level of our score (0–7) showed the cutoff point of ≥2 to best balance sensitivity and specificity, with 58% and 70%, respectively. At this cutoff point, 70% of cases were correctly classified as a major complication (n = 12,764). CONCLUSIONS: Despite low morbidity rates, we were able to develop an acceptable risk prediction score with a cutoff value of ≥2 correctly classifying approximately 70% of major morbidity in adult patients undergoing face and neck aesthetic surgery.

Prevention of Frey's Syndrome with the Use of Porcine Dermal Collagen Graft: Retrospective Analysis of 76 "Formal" Parotidectomies for Benign Pathologies.

Frey's syndrome is a well-known complication of parotid surgery; its prevention may be achieved by the use of an interpositional barrier between the overlying flaps and the exposed parenchymal bed of parotid gland. The aim of this study was to retrospectively evaluate clinical outcomes with and without the interpositional placement of a porcine dermal collagen graft (PDCG) for prevention of syndrome occurrence. We conducted a 20-year retrospective study including the patients who had undergone "formal" (superficial, total, or subtotal) parotidectomies for benign pathologies. The inclusion criteria also involved patients that were (i) regularly monitored about clinical symptoms related to syndrome, and (ii) examined with Minor starch-iodine test. The severity of the diagnosed syndrome was retrospectively evaluated according to the grading score system of Luna-Ortiz. To assess group differences in terms of the extent of dissection in operating sites, we estimated the tumor and histological specimen volumes using the available dimensions. We included 73 patients who had undergone 76 formal parotid surgeries. The surgical sites were divided into 2 groups: (1) Group A consisted of 44 sites that were reconstructed with a SMAS flap, and (2) Group B, comprised 32 sites where a PDCG was additionally applied as an artificial preventive barrier. At a mean follow-up of 26.3 months, a significantly lower incidence of clinically diagnosed Frey's syndrome was found after the use of dermal collagen interpositional barrier (P = .031). Specifically, subjective symptoms were reported at an incidence of 31.8% in Group A and 6.7% in Group B. Minor's test was positive at an incidence of 59.09% in Group A and 21.87% in Group B (P = .004, 95% CI). Severe Frey's syndrome was observed in 31.82% of the patients of Group A and in 3.12% of the patients of Group B (P = .002, 95% CI). Since there were no statistical significant differences between the volumes of the removed tumors and the excised histological specimens, the extent of dissection was not proved to influence the occurrence of Frey's syndrome in the compared groups. Porcine dermal collagen is a safe, practical, and useful means for parotid reconstruction, since it seems to contribute in prevention of Frey's syndrome when increased amount of glandular tissue has to be removed. Additional randomized controlled studies with bigger samples are required to better assess the PDCG use in parotid surgery.

The Inclusion of Orbicularis Oculi Muscle in the SMAS Flap in Asian Facelift: Anatomical Consideration of Orbicularis Muscle and Zygomaticus Major Muscle.

In the malar region, the SMAS flap can be thin and tear easily, making it difficult to securely fix it. And the surgical anatomy of the region may be unclear and confusing. The authors performed an anatomical study on the location of the lateral margin of the orbicularis oculi muscle (OOM) and the origin of the zygomaticus major muscle (ZMM) when using a high-SMAS facelift with finger-assisted spaces dissection technique, which included elevation of the SMAS flap with OOM. One hundred twenty-one Asian patients underwent this facelift procedure. Of those, the distances between the posterior margin of tragus and the lateral margin of the OOM and the center of the origin of the ZMM were measured in 20 patients. The mean age of the initial 121 patients was 50.9years. In all cases, improvement was seen in soft tissue sagging of the midface and lower face. There was no functional impairment of the OOM. In 20 patients of them, the lateral margin of the OOM and the center of the origin of the ZMM were located at mean distances of 50.6 (range 48-53mm) and 61.0mm (range 60-65mm) from the posterior margin of the tragus. The SMAS flap with the OOM is sufficiently strong enough so that it can maintain the pulling force and also helps to securely fix it. The authors hope that these anatomical findings would be useful when performing it and aid in the understanding of the relationship between the muscles in the malar area. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract 6. The Anatomic Implications of Utilizing Cannula Lipodissection and Avoiding Platysmaplasty in the Tumescent Facelift: A Clinical and Cadaveric Study

Purpose: The tumescent facelift utilizes Saldanha’s concept of cannula lipodissection, as opposed to wide undermining, to recruit soft tissue while preserving perforating neurovascular branches. The information herein is a clinical and cadaveric study examining the senior author’s technique for tumescent lipodissection in rhytidectomy. Methods: From 2005–2016, 1,000 consecutive patients underwent rhytidectomy by the senior author (LPB). In addition to implementing cannula lipodissection, the senior author avoids routine anterior platysmaplasty as it was observed to limit jowl excursion of the lower face. In an attempt to validate the abovementioned approach (developed from clinical observation), a cadaveric study was performed on five fresh tissue cadavers. Post-auricular skin excursion was measured following lipodissection (cannula only) and then measured again after traditional wide undermining. Next, SMAS flap and jowl excursion were measured with and without anterior platysmaplasty. A force gauge was utilized to ensure that equivalent force was applied during all comparisons of skin and SMAS excursion. Results: Cannula lipodissection resulted in a mean skin excursion of 41.9mm. There was no significant difference in skin excursion compared to wide undermining (41.9 versus 42.1mm; p=0.785). Jowl position, in reference to the mandibular border, was significantly lower following anterior plastysmaplasty (18.3 versus -3.4mm; p=0.005). Anterior platsymaplasty; however, did not adversely affect the excursion at the tip of the high lateral SMAS flap (39.3 versus 37.9mm; p=0.644) Conclusion: Cannula lipodissection results in equivalent skin recruitment in comparison to wide undermining. Routine anterior platysmaplasty may compromise results by inhibiting jowl excursion.

Use of the SMAS flap for reconstruction of the parotid lodge.

SUMMARYThe purpose of our study was to evaluate the benefits of the SMAS flap in patients with benign tumours of the parotid gland treated by superficial parotidectomy. We carried out a retrospective chart review on 123 patients suffering from benign tumours of the parotid gland admitted to our Institution between March 1997 and March 2010. A superficial parotidectomy was performed in all the cases reported. Our sample was divided in two groups basing SMAS flap reconstruction done (Group 2) or not (Group 1) after superficial parotidectomy. Reconstruction using SMAS flap was accomplished in 64 patients. Chi-square test was used to assess statistical difference between the two groups. The level of statistical significance was P < 0.05. No significant differences concerning hematoma, wound infection and facial paralysis were observed between the first and second group (3.38 vs 1.56% [P > 0.05], 8.47% vs 4.68% [P > 0.05], 5.08% vs 0.00% [P > 0.05]). Transient facial nerve weakness, fistula, dip skin and Frey's syndrome were significantly more frequent without SMAS flap reconstruction (10.16% vs 3.125% [P < 0.05], 13.55% vs 3.125% [P < 0.05], 13.55% vs 3.125% [P < 0.05], 20.33% vs 0% [P < 0.05] respectively). The use of the SMAS flap is able to reduce the cosmetic and functional complications that occur after the removal of a benign tumour of the parotid through the superficial parotidectomy technique, above all, it reduces the occurrence of Frey's syndrome.

Facial rejuvenation using a combination of lateral SMASectomy and thread-lifts

Original lateral SMASectomy has several advantages over conventional SMAS elevation. However, it was felt that lateral SMASectomy alone caused unsatisfactory results with regard to undercorrection of midface ptosis. Thread lifting was added to counteract the remaining aesthetic problem. The purpose of this study is to describe the combined surgical techniques adopted. The procedure was performed under local anaesthesia with intravenous sedation. When indicated, liposuction for free fat transfer to the malar area, nasolabial folds, is performed with a Coleman fat aspiration cannula. After access skin incision, dissection extends across the zygoma to release the zygomatic ligaments and masseteric cutaneous ligaments. Then the SMAS flap was designed. The superior border of the incision was approximately at the level of the zygomatic arch and the inferior border was ∼4–5 cm below the jaw line. After SMAS resection, closure is performed by elevating the inferomedial corner of the flap in a superolateral direction, fixed lateral portion suture to mobile anterior fascia. Then, thread lifting was performed to correct midface ptosis (medial side). The skin was marked preoperatively to determine the appropriate vector of the thread and its 2–3 end fixation points. The facelift sutures were inserted through the cannula from the midface to the dissected open wound. After that free fat graft was performed for volumetric support, when indicated. The overall surgical time was less than 90 minutes. This combination therapy would be ideal therapy with elderly patients with significant midface ptosis and prominent nasolabial folds.

The Canadian Society for Aesthetic Plastic Surgery 39th Annual Meeting

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.

The Canadian Society for Aesthetic Plastic Surgery 39th Annual Meeting

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.

SMAS flap and Frey's clinic and subclinic syndrome: incidence, quality of life and cosmetic results. 11 years of experience

SMAS flap and Frey's clinic and subclinic syndrome: incidence, quality of life and cosmetic results. 11 years of experience

SMAS Flap Rhytidectomy

SMAS Flap Rhytidectomy

SMAS Flap Rhytidectomy

Antunes, and Becker. Study supervision: Becker. Financial Disclosure: None reported. Previous Presentation: This study was presented as a poster presentation at the American Academy of Facial Plastic and Reconstructive Surgery fall meeting; September 23-26, 2010; Boston, Massachusetts. Additional Contributions: Alex Radin, PhD, and the University of Pennsylvania Mechanical Testing Central Facility helped with study setup and osteotome testing and assisted in the manufacturing of the osteotome, the suture holders, and the actual testing device. Also, Lolita Rotkina, PhD, at the University of Pennsylvania Regional Nanotechnology Facility helped with the high-powered optical microscopic photographs of the osteotome edge. REFERENCES

Facial Rejuvenation with SMASectomy and FAME Using Vertical Vectors

The quest for better results in the midface after a face lift has led to the repositioning of a structure called the malar fat pad. Finger-assisted malar elevation (FAME) consists of detaching the malar fat pad from the underlying SMAS, which allows for the elevation of this structure. Two hundred five patients (189 females and 16 males) from January 2002 to August 2007 underwent a facial rejuvenation procedure comprising short-scar rhytidoplasty, SMASectomy, and FAME, with or without a simultaneous endobrow, blepharoplasty, and lipofilling. The midface fixation technique consisted of a stitch from the malar fat pad and SMAS flap to the periosteum at the zygomatic arch which was performed in every case. Elevation of the midface and improvement of the nasolabial fold and the mandible contour were obtained in all cases. Facial aging should be evaluated as a global process instead of a segmented one. Aging occurs in every structure of the face in different ways, depending on the vector of descent, thereby treatment must be individualized. We have observed improvement of the midface when using the FAME procedure in a rhytidoplasty with SMASectomy with deep fixation.

Inferiorly Pedicled Tongue-Shaped SMAS Flap Transposed to the Mastoid to Improve the Nasolabial Fold and Jowls and Enhance Neck Contouring during Face-Lift Surgery

Inferiorly Pedicled Tongue-Shaped SMAS Flap Transposed to the Mastoid to Improve the Nasolabial Fold and Jowls and Enhance Neck Contouring during Face-Lift Surgery

Rhytidectomy and Parotidectomy Combined in the Same Patient

Until now, aesthetic goals in parotid surgery have seldom been addressed because oncologic concerns have largely overshadowed aesthetic issues for patients with parotid masses. Fortunately, the majority of parotid masses are benign pleomorphic adenomas that rarely recur, leaving a large group of patients healthy after their parotid surgery, with some desiring aesthetic improvement in their facial appearance. Traditional parotidectomy incisions leave a visible scar on the neck as well as a visible hollow in the retromandibular region, which can extend onto the cheek. A rhytidectomy approach to the parotid gland allows for a more concealed, aesthetically appealing scar while maintaining good visibility and access to the parotid gland. By performing bilateral sub-SMAS (superficial musculoaponeurotic system) rhytidectomy after a parotidectomy, facial symmetry and balance is enhanced, and these aesthetic deformities can be minimized. The SMAS flap can help to fill the hollow and form a tissue barrier over the resected gland to prevent gustatory sweating. Finally, the incision scarring is minimized with a rhytidectomy-type approach. Two cases are reported in which patients underwent both rhytidectomy and parotidectomy. In the one case, the procedures were performed in the same surgical setting. In the other case, they were performed in a delayed fashion. These cases exemplify the possibility of addressing facial aesthetic goals of rejuvenation in a patient requiring parotid resection.

Short scar face lift

Daniel C. Baker, MD Foad Nahai, MD Hamid Massiha, MD Patrick Tonnard, MD Dr. Baker: The first patient is a 48-year-old fashion consultant who wants to correct her neck and jowl laxity (Figure 1). Although her hair is quite short, she is planning to let it grow and wear it up off her face. Many of her friends and clients have undergone face lift surgery and have significant scars behind their ears; she would like to avoid this. Dr. Massiha, how would you treat this patient? Figure 1 This 48-year-old fashion consultant is requesting correction of her neck and jowl laxity. Dr. Massiha: She has some asymmetry, and the right side of her face is smaller than the left. The asymmetry may require another procedure, such as fat grafting. She has a type 1 or 2 deformity1 and would be an ideal candidate for a short scar face lift. Dr. Baker: Would you do a SMAS flap, plication, or some type of suspension technique? Dr. Massiha: I would dissect the SMAS and platysma as one unit and pull it up. Whatever SMAS is in excess, I would remove. I would treat the left side more aggressively than the right, and maybe that would improve the asymmetry. I like using a SMAS platysma unit, but if I could not dissect the cheek part of the SMAS because it was too thin or too thick, I would create a skin flap in the upper part of the face and blend it with the SMAS platysma flap of the lower face, namely below the level of the lips inferiorly. Dr. Baker: Dr. Nahai, the submental area seems a little full. How would you address that? Dr. Nahai: I agree with Dr. Massiha that this woman would be a good candidate for a short scar …

Omega incision face-lift approach and SMAS rotation advancement flap in parotidectomy for prevention of contour deficiency and conspicuous scars affecting the neck

To overcome the disadvantages after the surgical removal of tumours of the parotid gland, especially the depressed facial deformity and conspicuous cervical scar formation subsequent to parotid surgery, we have concentrated on omega face-lift incision in combination with an SMAS rotation advancement flap for the last several years using a lazy omega incision. Nine patients (3 male and 6 female) ranging in age from 43 to 68 years (mean age: 56.3 years) fulfilled the selection criterion of having a clinically benign discrete parotid lump with a benign preoperative fine needle cytology result. Parotidectomy was performed using the modified omega face-lift incision in conjunction with the rotation advancement SMAS flap. All patients underwent follow-up every 3 months in the first year. During the follow-up, the patients were specifically asked about their satisfaction with the post-operative appearance and whether they would consent to the operation again. The vascularized SMAS rotation advancement flap is clinically simple to perform and provides satisfactory cosmetic and functional results in patients undergoing conservative parotidectomy. There are no drawbacks in the use of modified face-lift incision to remove tumours of the parotid gland.