Clinical Application of the High Superficial Musculoaponeurotic System for Facial Rejuvenation in Chinese Patients

Face lift surgery can improve facial sagging and reestablish a youthful relationship between the soft tissues and the underlying skeleton. The early manifestations of aging in the periorbital region include sagging of the lateral eyebrows, which can lead to changes in facial expression and the appearance of fatigue and anxiety. In this study, we investigated the clinical outcomes of superficial musculoaponeurotic system (SMAS) face and neck lift combined with a subperiosteal brow and tail lift in a specific cohort of patients from China.

One hundred fifty patients underwent high-SMAS face and neck elevation between September 2018 and September 2022; 28 cases were combined with subperiosteal brow-tail elevation. SMAS separation was performed upward, flat with the lateral canthus; downward to approximately 2 cm below the mandibular margin; and inward over the zygomaticus major muscle, extending forward medially to the prezygomatic and masseteric spaces. Next, the temporal ridge was moved medially by subperiosteal stripping, achieving a full separation of the periorbital and frontal-temporal migratory zones. The temporoparietal fascia was lifted and fixed tension-free to the deep temporal fascia until the tail of the eyebrow was effectively elevated.

Most patients achieved facial rejuvenation, and no permanent damage to the facial nerve or serious complications, such as flap necrosis, were observed.

Combining a high-SMAS flap with subperiosteal elevation of the brow tail restores youthfulness in aging candidates. As the follow-up period of the study was limited, additional time is required to determine the most appropriate face lift method.