The Extended Superficial Musculoaponeurotic System

The extended superficial musculoaponeurotic system (SMAS) facelift targets the 2 cardinal signs of facial aging: (1) descent of the malar fat resulting in deepening of the nasolabial folds as well as accentuation of the palpebral malar groove and tear trough deformity; (2) formation of jowls, which also obscure the definition of the lower mandibular border. In this article the authors describe the concepts behind the extended SMAS operation, importantly the extent of skin dissection and SMAS elevation. They present a brief history of the operation and landmark papers and supplement with fresh cadaver dissections.