[Use of deep planes in surgery of rejuvenation of the face]

Since 1976, anatomical studies intensively performed in France have demonstrated the surgical interest in using the superficial musculo-aponevrotic system in the face, and also a subperiosteal malar approach. The SMAS is mostly a surgical structure. It could be considered as a remnant of a primitive subcutaneous muscle which would have been located in the superficialis fascia; its stays outward the parotid gland. Muscular fibers have been found inside, uniting from-down the patysma muscle toward the periphery of the frontalis muscle at the top. Risorius muscle is included in this structure. Its surgical interest is that it allows to relieve skin tension during a face lift by a fibromuscular associated stretch. The modern way in face lifting should prevent the fixed appearance of a too tight skin-pull, when skin is redraped alone. Risks of facial nerve injury are minimal when the proper technique is used. It is possible, in the same way, during a blepharoplasty to stretch the orbicularis oculi muscle, like the muscular resuturing of an inguinal hernia repair. Each of this technique has its own different indications now well defined. The authors shows this experience after 150 cases of face lift operations and makes an analysis of the advantages and draw backs of using the SMAS in cases of rejuvenating face operations.