Facial rejuvenation using a combination of lateral SMASectomy and thread-lifts.

Original lateral SMASectomy has several advantages over conventional SMAS elevation. However, it was felt that lateral SMASectomy alone caused unsatisfactory results with regard to undercorrection of midface ptosis. Thread lifting was added to counteract the remaining aesthetic problem. The purpose of this study is to describe the combined surgical techniques adopted. The procedure was performed under local anaesthesia with intravenous sedation. When indicated, liposuction for free fat transfer to the malar area, nasolabial folds, is performed with a Coleman fat aspiration cannula. After access skin incision, dissection extends across the zygoma to release the zygomatic ligaments and masseteric cutaneous ligaments. Then the SMAS flap was designed. The superior border of the incision was approximately at the level of the zygomatic arch and the inferior border was ∼4-5 cm below the jaw line. After SMAS resection, closure is performed by elevating the inferomedial corner of the flap in a superolateral direction, fixed lateral portion suture to mobile anterior fascia. Then, thread lifting was performed to correct midface ptosis (medial side). The skin was marked preoperatively to determine the appropriate vector of the thread and its 2-3 end fixation points. The facelift sutures were inserted through the cannula from the midface to the dissected open wound. After that free fat graft was performed for volumetric support, when indicated. The overall surgical time was less than 90 minutes. This combination therapy would be ideal therapy with elderly patients with significant midface ptosis and prominent nasolabial folds.