The “Segmental SMAS Model”: A Didactic Concept of Face and Neck Lift Anatomy

Profound understanding of the surgical anatomy of the face and neck is the key to successful face lift surgery. The “Segmental SMAS Model” presented herein is the result of a decade-long effort in teaching fellows a logical and coherent anatomic model of face lift anatomy. The superficial musculo-aponeurotic system (SMAS) consists of segments with distinct surgical characteristics. These are determined by the presence of a deep gliding plane and/or adhesion through fibrous insertions. In this article, we define SMAS segments that are profoundly heterogeneous in their behavior and have surgical implications on the maneuvers required for a deep plane face lift. The present model introduces several novel interpretations of the surgical anatomy of the face and neck lift procedure and hopes to convey a better understanding of face lift anatomy to training surgeons.

Deep Plane Facelift: An Evaluation of the High-SMAS versus Standard Incision Points

In surgery of the aging face, operative adjustments of the superficial musculoaponeurotic system (SMAS) enhance facial contours. The senior author has observed that the standard deep plane face lift entry points on the SMAS do not provide as much tissue movement in a vertical direction as high-SMAS deep plane face lift entry points. In this study, tissue movement was measured comparing the conventional SMAS entry point with a high-SMAS entry point for deep plane face lifts. Institutional review board approval was obtained. Fourteen facelift patients were enrolled, 10 female and 4 male. Average age was 63.4 (50–81) years. Tissue movement at three points along the jaw line was measured intraoperatively. Standard SMAS entry point suspension resulted in average vertical movements of 6.4, 10.3, and 13.8 mm and average horizontal movements of 3.5, 5.7, and 6.5 mm. High-SMAS entry point resulted in average vertical movements of 11.8, 17.9, and 24.1 mm and average horizontal movements of 5.8, 9.8, and 9.9 mm. This resulted in a 77.3% increase (p = 0.03) in vertical movement and a 61.4% increase (p = 0.02) in horizontal movement with a high-SMAS entry compared with standard SMAS entry. The high-SMAS entry point for a deep plane facelift resulted in a significant increase in lift for both the horizontal and vertical vector on the facial skin flap when compared with the conventional entry.

2-(5-Fluoro-1-methyl-2-oxoindolin-3-ylidene)-N-[4-(methylsulfanyl)phenyl]hydrazine-1-carbothioamide

The title molecule, C17H15FN4OS2, obtained from 5-fluoro-1-methyl-1H-indol-2,3-dione, and 3-[4-(methylsulfanyl)phenyl]thiosemicarbazide, has an essentially planar conformation (r.m.s deviation for all non-H atoms = 0.116 Å). Intramolecular N—H...N and N—H...O hydrogen bonds generateS(5) andS(6) ring motifs, respectively. In the crystal, C—H...S hydrogen bonds occur between layers of molecules parallel to the (10-1) plane. Face-to-face π–π stacking interactions are also observed.