The Utility of Superficial Musculoaponeurotic System Flaps in Facelift Procedures

Facelift techniques widely vary with known individual surgeon modifications of and preference for particular techniques. This article provides an overview of the history of the superficial musculoaponeurotic system (SMAS), the changes of aging related to the soft tissues of the face, and the history of facelift procedures, including techniques to address the SMAS. In addition, a description of past studies and literature analyzing techniques of facelift procedures, safety of interventions involving the SMAS, low, extended, and high SMAS techniques, and evaluations of patient satisfaction with facelift outcomes including use of the FACE-Q are discussed. After review of the existing literature, a knowledge of the process of aging, and its effect on facial soft tissues, there is data to support SMAS flaps as a safe, effective, and logical means to handle the SMAS in facelifts. There is a paucity of the literature directly comparing differing techniques, particularly regarding SMAS flaps, leading to a challenging review but significant opportunity for additional study.