Department of Otolaryngology–Head and Neck Surgery
Center for Facial Cosmetic Surgery
University of Michigan
19900 Haggerty Rd
Livonia, MI 48152
In 1974, Skoog1 described the technique of dissecting beneath the superficial musculoaponeurotic system (SMAS) of the lower cheek while leaving the overlying skin attached to the SMAS. This appeared to provide greater improvement of the jowl than conventional subcutaneous rhytidectomy. This report ushered in a revolution in rhytidectomy. The revolution was based on a plethora of anatomic studies that have identified ligaments, muscle expansions, and tissue planes not heretofore described in anatomic text. These studies have contributed to a better understanding of facial anatomy and of the changes of the face that occur with aging, especially in the midface. Concomitant with these anatomic reports were numerous clinical articles describing new surgical approaches to rhytidectomy. Most notably were descriptions of endoscopic, transoral, and transorbital approaches to midface lifting. A multitude of different planes of dissection in variable regions of the face have also been described. The most prominent of these have been sub-SMAS, extended supra-SMAS, subperiosteal, supraperiosteal, and the dissection planes described by Hamra2-3 for deep-plane and composite rhytidectomies. Most of these clinical studies describe deeper and more extensive tissue dissections than a subcutaneous rhytidectomy with suture suspension of the SMAS. These deeper planes of dissection place the facial nerve at greater risk for injury. Does the risk of nerve injury justify the potential benefit of enhanced results? Which face-lift approach is best? There is no general agreement among surgeons as to which technique is most effective. There are few 5-year outcome studies to answer the question, and it is virtually impossible to obtain a control with the exception of using identical twins.
Baker SR. Is Deep-Plane Face-lift Better Than Superficial Musculoaponeurotic System Plication Face-lift?. Arch Facial Plast Surg. 2004;6(1):14-15. doi:10.1001/archfaci.6.1.14