High SMAS (Suprazygomatic) Facelift with Simultaneous Lipofilling

摘要

The superficial musculo-aponeurotic system (SMAS) has long been employed as the foundation for facial rejuvenation procedures. While a SMAS dissection has traditionally been confined to below the zygomatic arch, we believe that this does not adequately address changes associated with midfa-cial aging. Undertaking a SMAS dissection superior to the zygomatic arch allows for a higher arc of rotation of the midface resulting in a more successiui midfacial rejuvenation. In this presentation I will describe a High SMAS approach to facial rejuvenation in which the SMAS is elevated vertically and fixed to the deep temporal fascia. Pearls and pitfalls in this technique will be highlighted as well as a discussion of the relevant anatomy of the frontal branch of the facial nerve. We have also become aware that in addition to the effects of gravity, age results in facial soft tissue atrophy both at the skin level and the subcutaneous fat level. Although the High SMAS is helpful in lifting the malar structures back to their youthful location, the volume of tissue is less than what was previously present This is evident when patient photos are compared with photos taken at a younger age.