SMAFS (Superficial Musculoaponeurotic-Fatty System): A Changed SMAS Concept; Anatomic Variants, Modes of Handling, and Clinical Significance in Facelift Surgery

Abstract

The original concept described by Mitz and Peyronie states that the fibro-aponeurotic part of the superficial cervical fascia of the face and neck ensheathing the superficial mimetic muscles of the face is the SMAS (superficial musculoaponeurotic system). Since, after its discovery, lifting and plicating the SMAS has been traditionally considered essential in order to achieve better and long lasting results in face and neck lift procedures. The authors have modified the original SMAS concept, which they call as SMAFS (superficial musculoaponeurotic-fatty system). The authors believe that the superficial muscles of facial expression, the fibro-aponeurotic sheath encircling the muscles, together with the superficial fat, should be considered as a single unit in facial and neck lifting. In order to achieve good longer lasting results, it is essential that not only the fibro-aponeurotic part, but also the superficial muscular part must be plicated, lifted, and attached to the bony periosteum, if required. Since the SMAFS is considered together as a unit and is subject to considerable variations, surgeons performing facial and neck surgery must be able to assess various types and gross parameters of SMAFS by external examination preoperatively. The various types of SMAFS should be handled according to the nature and type of tissues present. Only in this way, the most appreciative and durable results of face and neck lifting will be achieved.