The medial SMAS lift with aggressive temporal skin takeout

The ability to correct prominent nasolabial folds has remained a consistent weakness in facial rejuvenation surgery. Cadaveric studies were performed to evaluate differential properties of the superficial musculoaponeurotic system (SMAS) unit. We have found that the medial portion of the SMAS unit has a much more scattered, irregular collagen architecture and exhibits greater distensibility. Based on the regional differences in the physical properties and architecture of the SMAS, a face lift procedure is described in which the medial portion of the SMAS is resuspended, combined with aggressive temporal skin takeout in a pants-over-vest fashion. The procedure has been performed by the senior author in 89 patients. It is often combined with the "central" suspension and has provided more predictable results in this surgeon's hands.