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Facial Plast Surg 2018; 34(06): 646-650
DOI: 10.1055/s-0038-1675634
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Deep Plane Facelift: An Evaluation of the High-SMAS versus Standard Incision Points

Jordan P. Sand
1   Spokane Center for Facial Plastic Surgery, Spokane, Washington
,
Chiara Andretto Amodeo
2   Plastic Surgery Casa di Cura La Madonnina, Milano, Italy
3   Research Unit in Anatomy URDIA, University of Sorbonne Paris Cite Descarte, Paris, France
,
Vishad Nabili
4   Division of Facial Plastic and Reconstructive Surgery, Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California
,
Gregory S. Keller
4   Division of Facial Plastic and Reconstructive Surgery, Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California
› Author Affiliations
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Publication History

Publication Date:
04 December 2018 (online)

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Abstract

In surgery of the aging face, operative adjustments of the superficial musculoaponeurotic system (SMAS) enhance facial contours. The senior author has observed that the standard deep plane face lift entry points on the SMAS do not provide as much tissue movement in a vertical direction as high-SMAS deep plane face lift entry points. In this study, tissue movement was measured comparing the conventional SMAS entry point with a high-SMAS entry point for deep plane face lifts. Institutional review board approval was obtained. Fourteen facelift patients were enrolled, 10 female and 4 male. Average age was 63.4 (50–81) years. Tissue movement at three points along the jaw line was measured intraoperatively. Standard SMAS entry point suspension resulted in average vertical movements of 6.4, 10.3, and 13.8 mm and average horizontal movements of 3.5, 5.7, and 6.5 mm. High-SMAS entry point resulted in average vertical movements of 11.8, 17.9, and 24.1 mm and average horizontal movements of 5.8, 9.8, and 9.9 mm. This resulted in a 77.3% increase (p = 0.03) in vertical movement and a 61.4% increase (p = 0.02) in horizontal movement with a high-SMAS entry compared with standard SMAS entry. The high-SMAS entry point for a deep plane facelift resulted in a significant increase in lift for both the horizontal and vertical vector on the facial skin flap when compared with the conventional entry.

Keywords

facelift - aging face - high-SMAS

Note

This paper was presented at the following meetings.


• European Academy of Facial Plastic Surgery Annual Meeting in Lisbon, Portugal, September 28–30, 2017.


• American Academy of Facial Plastic and Reconstructive Surgery Annual Meeting in Phoenix, AZ, October 26–28, 2017.


• Institutional Review Board Approval was obtained for this study from the University of California, Los Angeles.


Author Contributions

All authors substantially contributed to the design, acquisition, and interpretation of the data. All were involved in drafting the article, providing final approval, and agree to the accuracy and integrity of the work.


Financial Disclosure

None.


 

  • References

  • 1 Lemmon ML, Hamra ST. Skoog rhytidectomy: a five-year experience with 577 patients. Plast Reconstr Surg 1980; 65 (03) 283-297
    CrossrefPubMedGoogle Scholar
  • 2 Hamra ST. The deep-plane rhytidectomy. Plast Reconstr Surg 1990; 86 (01) 53-61 , discussion 62–63
    CrossrefPubMedGoogle Scholar
  • 3 Hamra ST. Building the composite face lift: a personal odyssey. Plast Reconstr Surg 2016; 138 (01) 85-96
    CrossrefPubMedGoogle Scholar
  • 4 Stuzin JM, Baker TJ, Gordon HL, Baker TM. Extended SMAS dissection as an approach to midface rejuvenation. Clin Plast Surg 1995; 22 (02) 295-311
    CrossrefPubMedGoogle Scholar
  • 5 Mitz V, Peyronie M. The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg 1976; 58 (01) 80-88
    CrossrefPubMedGoogle Scholar
  • 6 Tessier P. Le lifting facial sous-périosté [in English]. Ann Chir Plast Esthet 1989; 34 (03) 193-197
    PubMedGoogle Scholar
  • 7 Krastinova-Lolov D. Mask lift and facial aesthetic sculpturing. Plast Reconstr Surg 1995; 95 (01) 21-36
    CrossrefPubMedGoogle Scholar
  • 8 Mendelson BC. Surgery of the superficial musculoaponeurotic system: principles of release, vectors, and fixation. Plast Reconstr Surg 2001; 107 (06) 1545-1552 , discussion 1553–1555, 1556–1557, 1558–1561
    CrossrefPubMedGoogle Scholar
  • 9 Keller GS, Seth R, Andretto Amodeo C, Lee M. Aesthetic Surgery of the Midface. Sataloff's Comprehensive Textbook of Otolaryngology Head and Neck Surgery. Philadelphia, PA: Jaypee Medical Inc; 2015: 217-252
    Google Scholar
  • 10 Kamer FM, Frankel AS. SMAS rhytidectomy versus deep plane rhytidectomy: an objective comparison. Plast Reconstr Surg 1998; 102 (03) 878-881
    CrossrefPubMedGoogle Scholar
  • 11 Litner JA, Adamson PA. Limited vs extended face-lift techniques: objective analysis of intraoperative results. Arch Facial Plast Surg 2006; 8 (03) 186-190
    CrossrefPubMedGoogle Scholar
  • 12 Siwani R, Friedman O. Anatomic evaluation of the vertical face-lift in cadavers. JAMA Facial Plast Surg 2013; 15 (06) 422-427
    CrossrefPubMedGoogle Scholar
  • 13 Jacono AA, Parikh SS, Kennedy WA. Anatomical comparison of platysmal tightening using superficial musculoaponeurotic system plication vs deep-plane rhytidectomy techniques. Arch Facial Plast Surg 2011; 13 (06) 395-397
    CrossrefPubMedGoogle Scholar
  • 14 Keller GS, Cray J. Suprafibromuscular facelifting with periosteal suspension of the superficial musculoaponeurotic system and fat pad of Bichat rotation. Tightening the net. Arch Otolaryngol Head Neck Surg 1996; 122 (04) 377-384
    CrossrefPubMedGoogle Scholar
  • 15 Andretto Amodeo C, Casasco A, Icaro Cornaglia A, Kang R, Keller GS. The suborbicularis oculi fat (SOOF) and the fascial planes: has everything already been explained?. JAMA Facial Plast Surg 2014; 16 (01) 36-41
    CrossrefPubMedGoogle Scholar
  • 16 Andretto Amodeo C, Chevallier JM, Delmas V, Keller GS. The relationship between the McGregor ligament, the masseteric ligaments and the deep fascia of the infraorbital region. FASEB J 2017; 31 (01) 901.2
    PubMedGoogle Scholar
  • 17 Andretto Amodeo C, Delmas V, Casasco A, Keller GS. The relationship between the parotid fascia and the deep fascia of the infraorbital region: a new concept in descriptive and applied anatomy. FASEB J 2016; 30 (01) 1046.15
    PubMedGoogle Scholar