Individualized Considerations Regarding Sub- Superficial Musculoaponeurotic System Facelift Techniques

Since the introduction of the technique reported by Skoog [1] and the study of Mitz and Peyronie [2] regarding the superficial musculoaponeurotic system (SMAS), the concept of facial rejuvenation has entered a new phase, going beyond the conventional subcutaneous facelift technique. However, Mitz and Peyronie [2] focused on the SMAS layer lateral to the zygomaticus major muscle—in other words, the lower face. In response to the development of the SMAS technique for facial rejuvenation, the emphasis in the approach to the lower face including the lateral neck has changed accordingly, recently being referred to as cervicofacial rhytidectomy. Cervicofacial rhytidectomy may offer successful lower cheek and jawline rejuvenation, but shows less success for rejuvenation of the malar region and of the infraorbital area medial to the zygomaticus major muscle. When using this technique, due to poorly balanced descent of the untouched malar area, a well-rejuvenated lower face will appear dissonant with the malar region over the years. Remnants of the dissonance may sometimes be noticeable, and this is called a lateral sweep deformity. In an effort to overcome the problem posed by lateral sweep deformities, facial rejuvenation techniques have evolved to focus on various sub-SMAS facelift methods. The evolution of facial rejuvenation surgery reflects recent innovations in the detailed understanding of the retaining ligament, as described by Furnas [3] and Stuzin et al. [4], and has been further improved by a sophisticated theoretical approach to the midface and periorbital region [5-9]. The most commonly adopted techniques may be the composite facelift described by Hamra [5,6], the extended SMAS technique developed by Stuzin et al. [4], the high SMAS technique proposed by Barton [8], and the subperiosteal facelift developed by Ramirez et al. [7]. Since each technique has specific advantages and disadvantages, we believe that proper indications must be identified for Joo Heon Lee, Won Suk Oh, Sung Wan Park, Jin Woo Song, Jae Hoon Kim