"TOTAL SMAS: A SYSTEMATIC APPROACH TO COMPREHENSIVE FACIAL REJUVENATION".

[INTRODUCTION] Face and neck lifting is the cornerstone in the treatment of the lower third of the face and the neck but, as classically described, it has not a significant impact on the middle third, and fails to rejuvenate the upper third of the face, which in most patients need to be addressed as well. Considering the crucial role of the orbicularis oculi muscle in the periorbital aging process, the Authors described a comprehensive approach to facial rejuvenation combining an OOM flap with the SMAS/platysma flap used in more traditional procedures.

[MATERIAL AND METHODS] 237 consecutive patients who underwent Total SMAS were evaluated prospectively. Each patient completed a FACE-Q questionnaire preoperatively and 12 months postoperatively. Five independent surgeons were asked to score the results evaluating patients' preoperative and postoperative photographs. Complications were recorded.

[RESULTS] No major complications occurred. FACE-Q preoperative score was 47,72±18,79, whereas postoperatively it was 79,80±6,13 (P < 0.05). A similar increasing trend was shown for surgeons' questionnaire data (from 35,32±7,48 to 83,65±4,52) (P < 0.05). The most satisfying result of this technique was the powerful and balanced rejuvenation of the whole face, from the periorbital area to the neck.

[CONCLUSION] Total SMAS allows to comprehensively treat the defects of the aging face and neck through repositioning of a single large flap, simply extending the SMAS dissection upwards to the OOM. In this cohort, patients and surgeons' satisfaction with the result was remarkable.