The application of basic SMAS rhytidectomy and comprehensive SMAS rhytidectomy

Abstract

Rhytidectomy has made great progress in the past 50 years, especially after the proposition of the concept of superficial musculoaponeurotic system (SMAS). Our previous research had classified SMAS rhytidectomy into basic SMAS rhytidectomy (B-SMAS) and comprehensive SMAS rhytidectomy (C-SMAS) according to whether the treatment of SMAS aponeurosis is combined with retaining ligament, fat pad, mimetic muscles, etc. The purpose of this paper is to compare the outcomes of the 2 methods. Through multicenter collaborative research, 21 cases of B-SMAS and 18 cases of C-SMAS were collected. Photographs were taken pre- and post-operation for each patient, and the facial width of the lateral canthus level (upper face), the alar base level (middle face), and the oral commissure level (lower face) were measured. We compared the statistics of upper, middle, and lower face pre- and post-B-SMAS and C-SMAS to assess the ramifications of each operation. We used preoperative measurements minus corresponding postoperative measurements of specific operation to assess which position would acquire superior improvements. We also recruited 3 professional plastic clinicians to rate the ramifications of specific positions and approaches after pre- and post-photo comparing. Through comprehensive analyzing, we compared the improvements between B-SMAS and C-SMAS to assess which method is more beneficial concerning facial rejuvenation. Both B-SMAS and C-SMAS would acquire optimal changing concerning facial width in middle and lower face after operation (P < .05). Two methods all harvested better width changing effects in middle and lower face than upper face (P < .05). However, C-SMAS acquired better effects in middle and lower face than B-SMAS (P < .05). Both B-SMAS and C-SMAS are beneficial to facial rejuvenation. The effects in middle and lower face are better than upper face. In addition, C-SMAS may be more effective than B-SMAS.

Figure 1.

B-SMAS. Left: before operation, L1: facial width of the lateral canthus level (upper face), L2: facial width of the alar base level (middle face), L3: facial width of the oral commissure level (lower face). Right: after operation, L4: facial width of the lateral canthus level (upper face), L5: facial width of the alar base level (middle face), L6: facial width of the oral commissure level (lower face). B-SMAS = basic SMAS rhytidectomy.

Figure 2.

C-SMAS. Left: before operation, L7: facial width of the lateral canthus level (upper face), L8: facial width of the alar base level (middle face), L9: facial width of the oral commissure level (lower face). Right: after operation, L10: facial width of the lateral canthus level (upper face), L11: facial width of the alar base level (middle face), L12: facial width of the oral commissure level (lower face). C-SMAS = comprehensive SMAS rhytidectomy.

Figure 3.

In measuring assessing, both B-SMAS and C-SMAS would acquire optimal changing concerning facial width in middle and lower face after operation (P < .05). (“*” means P < .05, “**” means P < .01). B-SMAS = basic SMAS rhytidectomy, C-SMAS = comprehensive SMAS rhytidectomy.

Figure 4.

In measuring assessing, 2 methods all harvested better width changing effects in middle and lower face than upper face (P < .05). (“*” means P < .05, “**” means P < .01).

Figure 5.

In measuring assessing, C-SMAS acquired better effects in middle and lower face than B-SMAS (P < .05). (“*” means P < .05, “**” means P < .01). C-SMAS = comprehensive SMAS rhytidectomy.

Figure 6.

In pointing assessing, C-SMAS acquired better effects in middle and lower face than B-SMAS (P < .05). (“*” means P < .05, “**” means P < .01). C-SMAS = comprehensive SMAS rhytidectomy.

Figure 7.

In pointing assessing, 2 methods all harvested better width changing effects in upper, middle and lower face than upper face (P < .05). (“*” means P < .05, “**” means P < .01).

Figure 8.

Pearson r test were used to analyze practical significance of the effect.