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Updated: Mar 14, 2026

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
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Facelift Techniques That Restore Facial Volume.

Harry Mittelman1, Summit Kundaria1, Herman P Lam1

  • 1Mittelman Plastic Surgery, Los Altos, California.

Facial Plastic Surgery : FPS
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PubMed
Summary

Facial aging causes skin laxity and volume loss, particularly in the midface. A new multivector high SMAS plication technique effectively addresses this midface volume loss, unlike traditional methods.

Area of Science:

  • Plastic Surgery
  • Facial Rejuvenation
  • Aesthetic Medicine

Background:

  • Facial aging is characterized by skin laxity and volume deficits, most notably in the midface.
  • Traditional superficial musculoaponeurotic system (SMAS) rhytidectomy primarily addresses laxity but not volume loss.
  • Midface volume loss significantly contributes to an aged appearance.

Purpose of the Study:

  • To introduce and evaluate the multivector high SMAS plication technique for facial rejuvenation.
  • To assess the efficacy of this technique in addressing midface volume loss.
  • To determine if the technique offers benefits for lower facial volumization.

Main Methods:

  • A novel surgical approach termed multivector high SMAS plication was employed.
  • This technique involves repositioning excess tissue to areas of volume deficit.

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  • The procedure was evaluated for ease of performance and reproducibility.
  • Main Results:

    • The multivector high SMAS plication technique effectively addresses midface volume loss.
    • The technique allows for natural redistribution of excess tissue, enhancing facial volume.
    • Positive outcomes were observed in volumizing the lower face as a secondary benefit.

    Conclusions:

    • Multivector high SMAS plication is a reproducible and effective method for facial rejuvenation.
    • This technique successfully corrects midface volume loss, a key aging feature.
    • The procedure offers an additional benefit of lower facial volumization.