The Extended SMAS Controls Submandibular Gland Ptosis

Conventional facelift surgery may fail to adequately address submandibular gland ptosis (SMGP), prompting recommendations for partial gland resection. Alternatively, the extended SMAS technique involves a more extensive SMAS-platysma dissection, providing lower facial and neck rejuvenation while preserving the submandibular glands. This study aims to quantify the effect of the extended SMAS technique on SMGP.

This retrospective cohort study analyzed 53 patients who underwent extended SMAS facelift surgery over a 10-year period in the senior author's practice. Photographic analysis was used to quantify SMGP correction and cervicomental angle (CMA) improvement.

All patients were available at a mean follow-up of 8.4 months (range: 1-34 months). Mean SMGP decreased from 8.9 mm preoperatively (range: 0-23 mm) to 0.1 mm postoperatively (range: 0-3.9 mm), with an average improvement of 8.01 mm ( P  < 0.001). The mean CMA improved from 152° (range: 100-180°) to 121° (range: 92-156°), with a mean change of 30.8° ( P  < 0.001). Two patients (3.8%) were dissatisfied, and 3 (5.7%) required office revisions.

The extended SMAS facelift technique effectively controls SMGP, nearly eliminating submandibular gland visibility on postoperative photographic analysis while enhancing neck angularity. This improvement may result from the thorough release of the cervical and parotid retaining ligaments as well as the platysma-auricular ligament. This level of SMAS-platysma flap mobilization may have a more effective sling-like effect on the contents of the digastric triangle, potentially obviating the need for submandibular gland resection.