Face and Neck Lift Article 6

SMASectomy

SMASectomy involves removing a portion of SMAS. The mobilized SMAS flap is then rotated upward with some posterior traction to accomplish the desired vector of lift of the lower face, jaw line, and neck based on the surgeon’s judgment. The primary vector is upward, but a lateral component of tension is added to apply lifting of the labiomandibular fold. Sufficient SMAS tissue is excised to ensure a snug closure forward along the zygomatic arch, which will directly transmit a vertical lift to the platysma along the mid and anterior body of the mandible.

Stuzin’s SMAS imbrication

In 1997, Stuzin described SMAS imbrication. He also described periosteal fixation to arch with a strip of SMAS. The platysma is secured to mastoid fascia to pull neck tissues.

MACS lift

Tonnard developed the MACS (Minimal Access Cranial Suspension) lift with simple and extended versions. Simple MACS consists of limited skin undermining with 2 purse-string SMAS sutures of 2-0 permanent suture (Prolene) to the deep temporal fascia.

The extended MACS includes an incision that extends along the temporal hairline. The pull of the malar tissues is performed with a 3rd purse string suture secured to the deep temporal fascia.