SMASectomy Face-Lift

DEFINITION

Surgery is the standard for addressing descent and laxity in the aging face.
SMASectomy refers to the removal of a strip of superficial musculoaponeurotic system (SMAS) at the junction of the fixed and mobile SMAS.

ANATOMY

Relevant anatomy is the recognition of the difference between fixed and mobile SMAS. The location of this intersection varies between patients but is roughly found on a diagonal line connected the earlobe to the lateral canthus (FIG 1).

PATIENT HISTORY AND PHYSICAL FINDINGS

Beyond usual history and physical findings to indicate a patient for a face and neck lift, the specific question to note is whether the patient has a full, wide face or a thinner face that could benefit from SMAS being “stacked” on itself to add volume.
The authors refrain from providing specific guidelines or measurements as the ultimate decision is a function of the aesthetic sense of the surgeon.

SURGICAL MANAGEMENT

Surgery should be performed in an accredited operating room.
SMASectomy can be performed under local anesthesia with or without sedation or general anesthesia.

Preoperative Planning

Consideration should be given as to whether the surgeon believes the patient will benefit from an SMASectomy (removal of tissue) or a plication (imbrication of tissue); however, this decision can also be made intraoperatively.
The rest of the surgery is planned like any other biplanar face-lift.

Positioning

The patient is supine on the procedure table.
Usually, the head of bed is slightly elevated.
The authors prefer to sit for maximum stability.

Approach

An incision pattern is chosen (either preauricular or intratragal).
The skin is elevated in the subcutaneous plane after infiltration with local anesthesia with epinephrine.
The SMAS is identified, and a plan is created.

FIG 1 • Although the junction of the fixed and mobile SMAS may vary from patient to patient, it is generally found near a line from the lobule of the ear to the lateral canthus.

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