eMedicine Specialties > Plastic Surgery > Rhytidectomy

Facelift, Extended SMAS: Multimedia

Author: Andrew Jacono, MD, Chief, Section of Facial Plastic and Reconstructive Surgery, The North Shore University Hospital at Manhasset; Assistant Professor, Division of Facial Plastic Surgery, The New York Eye and Ear Infirmary, New York Medical College; Assistant Professor, Department of Head and Neck Surgery, Albert Einstein College of Medicine; Director, The New York Center for Facial Plastic and Laser Surgery
Coauthor(s): David W Furnas, MD, Clinical Professor Emeritus, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California at Irvine
Contributor Information and Disclosures

Updated: Aug 22, 2008

Multimedia

Extended superficial musculoaponeurotic system (S...Media file 1: Extended superficial musculoaponeurotic system (SMAS) facelift. Superficial musculoaponeurotic plane (SMAP) and SMAP flap. SMAP flap dissection complete. Note extended SMAP with continuity between frontalis, SMAS, cervical platysma, and sternocleidomastoid. With help of retractor, submental fat is visible.
Extended superficial musculoaponeurotic system (S...

Extended superficial musculoaponeurotic system (SMAS) facelift. Superficial musculoaponeurotic plane (SMAP) and SMAP flap. SMAP flap dissection complete. Note extended SMAP with continuity between frontalis, SMAS, cervical platysma, and sternocleidomastoid. With help of retractor, submental fat is visible.

Extended superficial musculoaponeurotic system (S...Media file 2: Extended superficial musculoaponeurotic system (SMAS) facelift. Superficial musculoaponeurotic plane (SMAP) flap in place. Dissection area includes zygomaticus major (ZMM), mandibular ligament (ML), and zygomatic ligament (ZL). Dissection area outlined by gentian violet limit line. A peninsula is left attached to capture vasculature in the buccal area. Excision lines, incision lines, and chords have been scored as guides for excision and closure.
Extended superficial musculoaponeurotic system (S...

Extended superficial musculoaponeurotic system (SMAS) facelift. Superficial musculoaponeurotic plane (SMAP) flap in place. Dissection area includes zygomaticus major (ZMM), mandibular ligament (ML), and zygomatic ligament (ZL). Dissection area outlined by gentian violet limit line. A peninsula is left attached to capture vasculature in the buccal area. Excision lines, incision lines, and chords have been scored as guides for excision and closure.

Extended superficial musculoaponeurotic system (S...Media file 3: Extended superficial musculoaponeurotic system (SMAS) facelift. Aponeurotic component and muscular component of SMAS. The SMAS is exposed and marked with gentian violet. Musc = muscular component; Apon = aponeurotic component.
Extended superficial musculoaponeurotic system (S...

Extended superficial musculoaponeurotic system (SMAS) facelift. Aponeurotic component and muscular component of SMAS. The SMAS is exposed and marked with gentian violet. Musc = muscular component; Apon = aponeurotic component.

Extended superficial musculoaponeurotic system (S...Media file 4: Extended superficial musculoaponeurotic system (SMAS) facelift. Telae subcutanea and platysma-auricular fascia (PAF). Scissors are tunneled beneath the telae subcutanea in preparation for transecting them. They hold the skin to the underlying PAF. The PAF is visible as a shiny white structure between the tips of the scissors blades. The PAF also forms part of the aponeurotic area of the SMAS.
Extended superficial musculoaponeurotic system (S...

Extended superficial musculoaponeurotic system (SMAS) facelift. Telae subcutanea and platysma-auricular fascia (PAF). Scissors are tunneled beneath the telae subcutanea in preparation for transecting them. They hold the skin to the underlying PAF. The PAF is visible as a shiny white structure between the tips of the scissors blades. The PAF also forms part of the aponeurotic area of the SMAS.

Extended superficial musculoaponeurotic system (S...Media file 5: Extended superficial musculoaponeurotic system (SMAS) facelift. Muscular component of SMAS. The delicacy and pliability of the muscular SMAS is demonstrated by picking it up and folding it with Castroviejo forceps. The muscle is so thin that fibers of the masseter and branches of the facial nerve can be visualized through its semitranslucency.
Extended superficial musculoaponeurotic system (S...

Extended superficial musculoaponeurotic system (SMAS) facelift. Muscular component of SMAS. The delicacy and pliability of the muscular SMAS is demonstrated by picking it up and folding it with Castroviejo forceps. The muscle is so thin that fibers of the masseter and branches of the facial nerve can be visualized through its semitranslucency.

Extended superficial musculoaponeurotic system (S...Media file 6: Extended superficial musculoaponeurotic system (SMAS) facelift. Left: Markings for extended SMAS face/forehead lift. Right: Postoperative lateral view.
Extended superficial musculoaponeurotic system (S...

Extended superficial musculoaponeurotic system (SMAS) facelift. Left: Markings for extended SMAS face/forehead lift. Right: Postoperative lateral view.

Before extended sub-SMAS face lift. Photograph de...Media file 7: Before extended sub-SMAS face lift. Photograph demonstrates SMAS redundancy resulting in jowling and neck platysmal weakening.
Before extended sub-SMAS face lift. Photograph de...

Before extended sub-SMAS face lift. Photograph demonstrates SMAS redundancy resulting in jowling and neck platysmal weakening.

Result after extended SMAS face lift with correct...Media file 8: Result after extended SMAS face lift with correction of cervicofacial ptosis. This patient also underwent an upper and lower blepharoplasty and endoscopic midface and browlift.
Result after extended SMAS face lift with correct...

Result after extended SMAS face lift with correction of cervicofacial ptosis. This patient also underwent an upper and lower blepharoplasty and endoscopic midface and browlift.

More on Facelift, Extended SMAS

Overview: Facelift, Extended SMAS
Treatment: Facelift, Extended SMAS
Follow-up: Facelift, Extended SMAS
Multimedia: Facelift, Extended SMAS
References

References

  1. Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg. Jul 1976;58(1):80-8. [Medline].

  2. Adamson PA, Dahiya R, Litner J. Midface effects of the deep-plane vs the superficial musculoaponeurotic system plication face-lift. Arch Facial Plast Surg. Jan-Feb 2007;9(1):9-11. [Medline].

  3. Barton FE Jr. The SMAS and the nasolabial fold. Plast Reconstr Surg. Jun 1992;89(6):1054-7; discussion 1058-9. [Medline].

  4. Becker FF, Bassichis BA. Deep-plane face-lift vs superficial musculoaponeurotic system plication face-lift: a comparative study. Arch Facial Plast Surg. Jan-Feb 2004;6(1):8-13. [Medline][Full Text].

  5. Bosse JP, Papillon J. Surgical anatomy of the SMAS at the malar region. Transactions of the 9th International Congress of Plastic & Reconstructive Surgery. 1987;348-49.

  6. Cardenas-Camarena L, Gonzalez LE. Multiple, combined plications of the SMAS-platysma complex: breaking down the face-aging vectors. Plast Reconstr Surg. Sep 1999;104(4):1093-100; discussion 1101-2. [Medline].

  7. de Castro CC. Superficial musculoaponeurotic system-platysma: a continuous study. Ann Plast Surg. Mar 1991;26(3):203-11. [Medline].

  8. Furnas DW. Anthropometric landmarks for precision planning in rhytidectomy. Clin Plast Surg. Oct 1987;14(4):639-61. [Medline].

  9. Furnas DW. The superficial musculoaponeurotic plane and the retaining ligaments of the face. In: Deep Face-Lifting Techniques. 1st. Thieme Medical Publishers; 1994:205-16.

  10. Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg. Jan 1989;83(1):11-6. [Medline].

  11. Gosain AK, Yousif NJ, Madiedo G, et al. Surgical anatomy of the SMAS: a reinvestigation. Plast Reconstr Surg. Dec 1993;92(7):1254-63; discussion 1264-5. [Medline].

  12. Hamra ST. Composite rhytidectomy. Plast Reconstr Surg. Jul 1992;90(1):1-13. [Medline].

  13. Har-Shai Y, Bodner SR, Egozy-Golan D, et al. Mechanical properties and microstructure of the superficial musculoaponeurotic system. Plast Reconstr Surg. Jul 1996;98(1):59-70; discussion 71-3. [Medline].

  14. Har-Shai Y, Bodner SR, Egozy-Golan D, et al. Viscoelastic properties of the superficial musculoaponeurotic system (SMAS): a microscopic and mechanical study. Aesthetic Plast Surg. Jul-Aug 1997;21(4):219-24. [Medline].

  15. Hoefflin SM. The extended supraplatysmal plane (ESP) face lift. Plast Reconstr Surg. Feb 1998;101(2):494-503. [Medline].

  16. Ivy EJ, Lorenc ZP, Aston SJ. Is there a difference? A prospective study comparing lateral and standard SMAS face lifts with extended SMAS and composite rhytidectomies. Plast Reconstr Surg. Dec 1996;98(7):1135-43; discussion 1144-7. [Medline].

  17. Jost G, Lamouche G. SMAS in rhytidectomy. Aesthetic Plast Surg. 1982;6(2):69-74. [Medline].

  18. Jost G, Levet Y. Parotid fascia and face lifting: a critical evaluation of the SMAS concept. Plast Reconstr Surg. Jul 1984;74(1):42-51. [Medline].

  19. Jost G, Wassef M, Levet Y. Subfascial lifting. Aesthetic Plast Surg. 1987;11(3):163-70. [Medline].

  20. Levet Y. Comparative anatomy of cutaneous muscles of the face. Aesthetic Plast Surg. 1987;11(3):177-9. [Medline].

  21. Mendelson BC. Correction of the nasolabial fold: extended SMAS dissection with periosteal fixation. Plast Reconstr Surg. May 1992;89(5):822-33; discussion 834-5. [Medline].

  22. Mendelson BC. Surgery of the superficial musculoaponeurotic system: principles of release, vectors, and fixation. Plast Reconstr Surg. May 2001;107(6):1545-52; discussion 1553-5, 1556-7, 1558-61. [Medline].

  23. Mitz V. Current face lifting procedure: an attempt at evaluation. Ann Plast Surg. Sep 1986;17(3):184-93. [Medline].

  24. Mowlavi A, Wilhelmi BJ. The extended SMAS facelift: identifying the lateral zygomaticus major muscle border using bony anatomic landmarks. Ann Plast Surg. Apr 2004;52(4):353-7. [Medline].

  25. Owsley JQ Jr. SMAS-platysma face lift. Plast Reconstr Surg. Apr 1983;71(4):573-6. [Medline].

  26. Pearl RM, Johnson D. The vascular supply to the skin: an anatomical and physiological reappraisal--Part I. Ann Plast Surg. Aug 1983;11(2):99-105. [Medline].

  27. Pearl RM, Johnson D. The vascular supply to the skin: an anatomical and physiological reappraisal--Part II. Ann Plast Surg. Sep 1983;11(3):196-205. [Medline].

  28. Pellegrini VM. Platysma muscle and subcutaneous tissue in face-lift operations. Rev Ital Chir Plastica. 1988;20:219-236.

  29. Robbins LB, Brothers DB, Marshall DM. Anterior SMAS plication for the treatment of prominent nasomandibular folds and restoration of normal cheek contour. Plast Reconstr Surg. Nov 1995;96(6):1279-87; discussion 1288. [Medline].

  30. Stuzin JM, Baker TJ, Gordon HL. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg. Mar 1992;89(3):441-9; discussion 450-1. [Medline].

  31. Waterhouse N, Vesely M, Bulstrode NW. Modified lateral SMASectomy. Plast Reconstr Surg. Mar 2007;119(3):1021-6; discussion 1027-8. [Medline].

  32. Whetzel TP, Mathes SJ. Arterial anatomy of the face: an analysis of vascular territories and perforating cutaneous vessels. Plast Reconstr Surg. Apr 1992;89(4):591-603; discussion 604-5. [Medline].

Further Reading

Keywords

facelift, extended SMAS, cervicofacial rhytidectomy, face lift, superficial musculoaponeurotic system, superficial musculoaponeurotic plane, SMAP, SMA plane, superficial musculoaponeurotic system, SMAS

Contributor Information and Disclosures

Author

Andrew Jacono, MD, Chief, Section of Facial Plastic and Reconstructive Surgery, The North Shore University Hospital at Manhasset; Assistant Professor, Division of Facial Plastic Surgery, The New York Eye and Ear Infirmary, New York Medical College; Assistant Professor, Department of Head and Neck Surgery, Albert Einstein College of Medicine; Director, The New York Center for Facial Plastic and Laser Surgery
Andrew Jacono, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

David W Furnas, MD, Clinical Professor Emeritus, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California at Irvine
David W Furnas, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Head and Neck Society, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society of Transplantation, California Medical Association, Phi Beta Kappa, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, and Society of University Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Lawrence Ketch, MD, FAAP, FACS, Head, Program Director, Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Colorado Health Sciences Center; Chief, Pediatric Plastic, The Children's Hospital of Denver
Lawrence Ketch, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Plastic Surgery Research Council
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jorge I de la Torre, MD, FACS, Professor of Surgery and Physical Medicine and Rehabilitation, Residency Program Director, Division of Plastic Surgery, University of Alabama at Birmingham; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Practice Director, Colorado Plastic Surgery Center at Swedish Medical Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Deepak Narayan, MD, FRCS, Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center
Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Indian Medical Association, Plastic Surgery Research Council, Royal College of Surgeons of Edinburgh, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.