The “High SMAS” facelift technique

CHAPTER 11 The “High SMAS” facelift technique

Technical steps

Begin the dissection by elevating the skin flap in the preauricular area about 4 to 5 cm. Elevate only the skin that you anticipate removing. Perform subcutaneous dissection above the zygomatic arch in the lateral orbital area to release the cutaneous attachments of the crow’s feet and to facilitate a smooth redraping of the temporal skin. This maneuver also exposes the superficial side of the upper SMAS that will be divided later (Fig. 11.1).

From the mastoid, carry subcutaneous dissection below the mandible to join the anterior neck dissection, if present. In the neck, the skin and platysma are managed as separate layers because more skin than platysmal advancement is desired. A separate submental approach is added when defatting or when midline platysmal plication is indicated (Fig. 11.2).

Begin dissecting the SMAS in the cheek just anterior to the tragus leaving a cuff for later suturing. Maintain the upper lateral corner of the SMAS at the root of the helix to serve as a point of later fixation. Proper SMAS dissection depth can be safely established here because the facial nerve is well protected by the substance of the parotid gland. Anatomically, the SMAS is fused to the parotid capsule.

Mar 4, 2016 | Posted by in Aesthetic plastic surgery | Comments Off on The “High SMAS” facelift technique
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