The U-SMAS Lift

Manipulation of the superficial musculoaponeurotic system (SMAS) has become a mainstay of face-lifting procedures. The various surgical approaches to the SMAS traditionally have been classified as either "low" or "high" SMAS techniques, the former of which, although expeditious, have been criticized for suboptimal upper midface rejuvenation. High SMAS techniques, by contrast, are lauded for their ability to improve upper midface contours, but they may carry increased surgical risk, particularly in the hands of less experienced aesthetic surgeons. The authors present the U-SMAS lift: an imbricating approach to the SMAS that builds upon well-described low SMAS techniques with the addition of a malar flap of mobile-only SMAS for orbitomalar rejuvenation. This novel, hybrid technique harnesses the advantages of traditional low and high SMAS techniques while mitigating surgical risk. Of 61 U-SMAS lifts performed, a minor complication rate of 16.4% was observed. No major complications were observed. The mean follow-up period was 371 days. The U-SMAS lift is a safe and powerful facial rejuvenation technique for both beginning surgeons with advanced aesthetic training and well-versed aesthetic surgeons.