Facial Rejuvenation with SMASectomy and FAME Using Vertical Vectors

Abstract

The quest for better results in the midface after a face lift has led to the repositioning of a structure called the malar fat pad. Finger-assisted malar elevation (FAME) consists of detaching the malar fat pad from the underlying SMAS, which allows for the elevation of this structure. Two hundred five patients (189 females and 16 males) from January 2002 to August 2007 underwent a facial rejuvenation procedure comprising short-scar rhytidoplasty, SMASectomy, and FAME, with or without a simultaneous endobrow, blepharoplasty, and lipofilling. The midface fixation technique consisted of a stitch from the malar fat pad and SMAS flap to the periosteum at the zygomatic arch which was performed in every case. Elevation of the midface and improvement of the nasolabial fold and the mandible contour were obtained in all cases. Facial aging should be evaluated as a global process instead of a segmented one. Aging occurs in every structure of the face in different ways, depending on the vector of descent, thereby treatment must be individualized. We have observed improvement of the midface when using the FAME procedure in a rhytidoplasty with SMASectomy with deep fixation.

Presto lift—a facelift that preserves the retaining ligaments and SMAS tethering

“…At the same time, undesired standard outcomes of facelift surgery are avoided. The general concept that the natural facial boundaries and fixation points deserve to be respected is already reflected in the SMASectomy approach of Baker [33] and its modification by Graf [34], which is characterized by non-undermining of the SMAS and by vector limitation through the removed tissue section. This, however, may even aggravate the appearance of facial aging because of volume reduction.…”

Suture Lifting and Liposculpture Integration in the Creation of Facial Esthetic Harmony

“…Correction involves vertical or superolateral elevation of an adequately volumized malar fat pad in order to restore a youthful midface esthetic. [7], [8] The retaining ligaments of the malar fat pad and midface consist of the orbital retaining ligaments and lateral orbital thickening. [9] It should also be considered in relation to lower eyelid fat pad herniation that additional to the anterior migration that occurs through a weakened orbital septum, orbitomalar ligament fatigue permits an inferior migration of orbital fat.…”

Anatomical Evaluation of Facial Nerve Pathways and Dissection of “Premasseter Space” for Rhytidectomy in Asians

“…Superficial musculoaponeurotic system (SMAS) [12,18]based tightening procedures have recently become the standard for elderly and middle-aged Caucasian patients undergoing rhytidectomy [3,8,9,19,22,28]. Some surgeons harbor concerns, however, over the inadequacy of simple SMAS-based face-lifts, especially for some patients with rigid subcutaneous structures.…”