The U-SMASectomy Facelift

Manipulation of the superficial musculoaponeurotic system (SMAS) has become a mainstay of face lifting procedures. Traditionally, the various surgical approaches to the SMAS have been classified as either “low” or “high” SMAS techniques, the former of which, while expeditious, have been criticized for suboptimal upper midface rejuvenation. High SMAS techniques, by contrast, are lauded for their ability to improve upper midface contours, but may carry increased surgical risk, particularly in the hands of less experienced aesthetic surgeons. Presented is the U-SMASectomy facelift (USL)- an imbricating approach to the SMAS that builds upon well-described low SMAS techniques with the addition of a malar flap of mobile-only SMAS for orbitomalar rejuvenation. This novel, hybrid technique harnesses the advantages of traditional low and high SMAS techniques while mitigating surgical risk. Of 61 USLs performed, a minor complication rate of 16.4% was observed. No major complications were observed. Mean follow-up was 371 days. The USL is thus a safe and powerful facial rejuvenation technique for both beginning surgeons with advanced aesthetic training, and well-versed aesthetic surgeons alike.