Five-year retrospective review of the extended SMAS: critical landmarks and technical refinements.

The beneficial effects of SMAS flap manipulation have been clearly demonstrated for the neck and jowls; however, safe limits of subplatysmal dissection in the neck have not been established, and recommendations vary widely. Sixty patients undergoing rhytidectomy with an extended SMAS flap were retrospectively reviewed over a 5-year period. Five critical landmarks for extended SMAS flap dissection were marked preoperatively and confirmed intraoperatively. Skin flaps were mobilized and redraped independently. All patients were available for follow-up at an average of 8.3 months postoperatively (range 5-23 months). There were no clinically apparent facial or great auricular nerve injuries or pixy-ear deformities. Wound complication rates were acceptably low and included hematoma (3%), retroauricular epidermolysis (5%), and temporal scalp alopecia (1.6%). Extended SMAS flap dissection allows safe, predictable, and durable correction of the neck and jowls. The degree of mobilization proposed in this study allows anchoring points of the SMAS flap to be removed from potentially visible and palpable areas on the face to the temporal fascia superiorly and the mastoid fascia posteriorly. The study also represents a departure from more conventional facelifting techniques that advocate dissection of a mesomandibularis.