Inferiorly pedicled tongue-shaped SMAS flap transposed to the mastoid to improve the nasolabial fold and jowls and enhance neck contouring during face-lift surgery

Current society is highly concerned about aging, and rejuvenation procedures are constantly demanded. Many face-lift techniques have been published that seek to enhance final outcome and durability and minimize drawbacks. An inferiorly pedicled, tongue-shaped SMAS flap is raised off the parotid fascia, similar to the lateral SMASectomy introduced by Baker, with the base 1 cm below the mandible rim. The width of the flap is assessed intraoperatively by pulling on the tissue with forceps. This fascial flap is transposed below the angle of the mandible with a posterosuperior vector and secured to the mastoid fascia, working as a bowstring. Nasolabial fold and jowl improvement and better jaw line definition are achieved, avoiding dissection into the subplatysmal plane. Lateral cervical traction is necessary to improve jaw line and neck contouring. Subplatysmal dissection and a lateral platysma flap provide this traction, as previously reported. An inferiorly pedicled tongue-shaped SMAS flap transposed posterosuperiorly enhances neck definition, excluding subplatysmal dissection, and the nasolabial fold and jowls are corrected in a manner similar to that of lateral SMASectomy. The procedure is shortened and the underlying nerve and vascular structures are not jeopardized, minimizing the morbidity that is associated to other face-lift techniques. Furthermore, the SMAS flap is not elevated and its vascular supply is preserved, preventing SMAS atrophy, which is observed in secondary procedures after face lifts with conventional SMAS dissection. ©2008American Society of Plastic Surgeons.