Composite sub-SMAS face lift – How I do it!

課程語言：英文

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Background
Pronounced nasolabial fold, labiomandibular fold and mandibular jowl are the ageing stigmata that appear early and are difficult to treat in facial rejuvenation.
The classic face lift using SMAS lift and further, deep plane facelift were not the ideal technique for these  conditions .
Recently, a formal anatomy analysis of the face showed that there are true facial spaces.
There are 5 main spaces: temporal, prezygomatic, premasseteric and upper cervical spaces can be used in face lift for better result.. The facial space is a virtual space under a facial muscle delineated by surrounding ligaments or septum. This loose area permit the muscles contract more freely.  There are no vessels or nerves in the space, these elements follow the ligaments or run at the bounderies of the space.
The premasseteric space plays an important role in the ageing stigmata at the mid and lower face. The expansion of the spaces with aging, secondary to the weakness of the anterior and inferior boundaries results in formation of the jowls and pronounced nasolabial, labiomandibular folds.
In this study, the spaces are safe central rooms for the dissection and suspension of the composite skin-SMAS flap in the cervico-facial lift.
Patient and Method:
The surgeries were done either composite sub-SMAS lift only or combined with temporal-midface subperiosteal lift or frontal-facial full face lift.
The skin dissection areas were limited to 4cm anteriorly from the tragus. 
The SMAS was incised at the location of posterior border of the premasseteric, upper cervical spaces and they were entered from behind. The digital dissection was spread out anteriorly and inferiorly to the location of nasolabial and labiomandibular folds and neck.
Strong imbrication suspensions of the complex skin- SMAS to the parotido-masseteric fascia.
Because the spaces are naturally occurring cleavage planes, dissection is bloodless and safe, as all facial nerve branches are outside.
The assessment of the results was done by comparison the appearance of the patients on pre and post-operative photos.
 
Results:
Since 2015 to 2019, we have collected a series of 107 operated patients with composite sub-SMAS lift. A follow-up was set up at least 6 month after surgery.
Most of patients are satisfied with their appearance: an improvement of the nasolabial, labiomandibular folds; the diminution of the jowls and nice mandibular contour, acute mandibular-cervical angle.
Besides, low complication rate with mild bruising and no hematomas occurred
 
Conclusion:
We think the application of the concept dissection through the facial spaces is “a turning point in the evolution of  facelifts”. The premasseter spaces should be considered as the best dissection plane on cervicofacial facelifts. It provides significant benefits of aesthetic and safety for the surgery.
Understanding the anatomy of the spaces, the retaining ligaments and their relations to the nerves and blood vessels gives the surgeon the confidence to operate safely and effectively the facial rejuvenation surgery.