Search Our Scientific Publications & Authors

Facial Plast Surg 2022 Dec 23;38(6):613-622. Epub 2022 Dec 23.

Otolaryngology Division, Vito C. Quatela, MD PLLC, Rochester, New York.

The subperiosteal midface lift is a powerful tool that allows the surgeon to reposition the SOOF and malar fat pad in a vertical direction. Additionally, it significantly softens deep nasolabial folds. Its effect, however, is minimal with regards to addressing the jowl, jawline, gonial angle and cervicomental angle. Read More

Facial Plast Surg 2022 Dec 23;38(6):593-612. Epub 2022 Dec 23.

Marten Clinic of Plastic Surgery, San Francisco, California.

The traditional deep plane and "low" cheek superficial musculoaponeurotic system (SMAS) flaps elevated below the zygomatic arch suffer the drawback that they cannot, by design, exert an effect on tissues of the midface and infra-orbital region. Traditional deep plane and low designs target the lower cheek and jowl only and produce no improvement in the upper anterior cheek and "midface" area. Planning the flap "higher," along the zygomatic arch, and extending the dissection medially in an "extended SMAS" fashion to release and mobilize midface tissue, overcomes this problem and allows a combined, simultaneous, single flap lifting of the jawline, cheek, and midface. Read More

Plast Reconstr Surg 2023 Feb 8;151(2):223e-233e. Epub 2022 Nov 8.

From the Division of Plastic Surgery, The Warren Alpert Medical School, Brown University.

Background: Rhytidectomies are performed to rejuvenate the aging face. Various techniques exist to achieve soft-tissue elevation and skin tightening. This study analyzes three common face-lift techniques: skin-only, superficial musculoaponeurotic system (SMAS) plication, and extended SMAS lifts. Read More

J Craniofac Surg 2023 Jan-Feb 01;34(1):206-213. Epub 2022 Sep 29.

Department of Plastic and Reconstructive Surgery, Seoul Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

In this study, the authors report the experience of extended superficial musculoaponeurotic system (SMAS) face-lift with the vertical vector in Asian ethnicity and investigate the 3-dimensional change of facial contour. A total of 32 patients with Korean ethnicity underwent extended SMAS face-lift with vertical vector from 2015 to 2018. Patients with aging face were included for the study subjects, whereas those who were diagnosed with any craniofacial deformity were excluded. Read More

Facial Plast Surg 2022 Dec 16;38(6):540-545. Epub 2022 Jun 16.

Private Practice at FACEISTANBUL, Istanbul, Turkey.

Facelift techniques can be classified according to the depth and extent of the dissection applied. Imbrication and plication of the superficial musculoaponeurotic system (SMAS) referred to as "SMAS lifts" or "classical facelifts" are the most commonly used techniques. Plication techniques involve in-folding of the SMAS and suture suspension without any SMAS incision whereas imbrication techniques involve a SMAS incision with a portion of the SMAS either removed or transposed with or without limited sub-SMAS dissection. Read More

Facial Plast Surg 2022 Dec 26;38(6):584-592. Epub 2022 May 26.

Department of Otorhinolaryngology, Acibadem University, Istanbul, Turkey.

The attenuation of retaining ligaments with aging leads to downward displacement of facial fat compartments and is responsible for many of the stigmata that occur with aging. The zygomatic cutaneous and masseteric cutaneous ligaments prevent the transmission of adequate traction to the malar portion of the dissection during traditional low superficial muscular aponeurotic system (SMAS) facelift techniques which involve plication or imbrication of the exposed surface of the SMAS because they do not include surgical release of these ligaments. Inadequate release of these ligaments, especially the zygomatic cutaneous ligament may lead to an unbalanced, unnatural appearance with unopposed nasolabial folds. Read More

Facial Plast Surg 2022 Dec 11;38(6):575-583. Epub 2022 May 11.

Department of Facial Plastic Surgery, Meridian Plastic Surgery Center, Indianapolis, Indiana.

Over the past four decades, the senior author has evolved and perfected his preferred method for face and neck lifting, the extended superficial musculoaponeurotic system deep plane rhytidectomy, and submentoplasty. With this procedure, the superficial musculoaponeurotic system layer is addressed both in the face and neck, repositioning the tissues in a superior and posterior vector and creating a sling in the cervicomental area. Outcomes have proven to be both successful and long lasting. Read More

Aesthet Surg J 2022 Aug;42(8):845-857

Department of Otorhinolaryngology/Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Montefiore Medical Center, Bronx, NY, USA.

Background: Aging changes in the neck, including platysma banding (PB), skin laxity (SL), and submandibular gland visibility (SGV), have a high degree of recurrence after rhytidectomy.

Objectives: The authors sought to assess the long-term improvement in PB, SL, and SGV with addition of aplatysmal hammock flap to the extended deep-plane facelift and assess patient satisfaction.

Methods: This was a prospective study of 123 consecutive patients undergoing extended deep-plane facelift incorporating platysma hammock flap with or without midline platysmaplasty. Read More

J Craniofac Surg 2021 Mar-Apr 01;32(2):759-761

Department of Plastic Surgery, Inha University School of Medicine, Incheon, South Korea.

In this paper, the authors attempted to determine the extent of the superficial fascia of the cheek using P45 sheet plastination.Three head and neck specimens were sliced in horizontal (46 slices), coronal (30 slices), and sagittal (29 slices) sections using P45 sheet plastination (special polyester resin corrosion-resistant method designed to preserve biological sectional specimens in situ). Through slicing, bleaching, dehydration, casting, forced impregnation, curing, cutting, and sanding the molds, P45 plastination sheets provided good light transmission, allowing the internal structures within the sheet to reveal clearly in their intact form. Read More

Aesthet Surg J 2021 Sep;41(10):NP1276-NP1294

Department of Plastic Surgery at Cleveland Clinic Foundation, Cleveland, OH, USA.

Although previous publications have reviewed face and necklift anatomy and technique from different perspectives, seldom were the most relevant anatomical details and widely practiced techniques comprehensively summarized in a single work. As a result, the beginner is left with a plethora of varied publications that require sorting, rearrangement, and critical reading. A recent survey of US plastic surgery residents and program directors disclosed less facility with facelift surgery compared with aesthetic surgery of the breast and trunk. Read More

Aesthet Surg J 2021 Feb;41(3):NP113-NP123

Department of Radiology, St. Marianna University School of Medicine, Kanagawa, Japan.

Background: The superficial musculoaponeurotic system (SMAS) is an important structure to understand for face-lift surgeries. However, the detailed distribution and imaging findings of the SMAS have not been established yet.

Objectives: The aim of this study was to establish the accurate distribution and computed tomography (CT) imaging findings of the SMAS based on cadaveric studies. Read More

Facial Plast Surg 2021 Oct 16;37(5):556-563. Epub 2020 Sep 16.

Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

Facelift surgery has become a beautifully predictable, safe, and extremely effective operation. Our patients can expect natural and long-lasting results as a direct outcome of our improved understanding and applications of surgical facial anatomy. Rhytidectomy, once an operation of simple well-placed elliptical skin excisions, evolved to include longer skin flaps, skin and platysma flaps with various superficial muscular aponeurotic system (SMAS) manipulations, and various deep plane techniques involving the skin and SMAS as a single unit composite flap. Read More

Facial Plast Surg 2020 Aug 31;36(4):376-385. Epub 2020 Aug 31.

Perth Facial Plastic and Cosmetic Surgery, Perth, Western Australia, Australia.

The mini facelift, often referred to as short scar or minimum incision facelift or rhytidectomy, is a facial rejuvenation procedure with limited incisions. It aims to lift and tighten the superficial musculo-aponeurotic system to restore the lower midface and the mandibular contour, thus eliminating undesirable jowls. By performing the deep plane or extended deep plane facelift with short incisions, the midface and upper neck can also be improved without the full face and neck incisions as in the typical rhytidectomy. Read More

Facial Plast Surg 2020 Jun 17;36(3):309-316. Epub 2020 Jun 17.

Department of Otorhinolaryngology, Acibadem University, Istanbul, Turkey.

Preservation of the facial nerve is crucial in any type of facial procedure. This is even more important when performing plastic surgery on the face. An intricate knowledge of the course of the facial nerve is a requisite prior to performing facelifts, regardless of the technique used. Read More

Facial Plast Surg Clin North Am 2020 Aug;28(3):331-368

NY Center for Facial Plastic & Laser Surgery/JSpa Medical Spa, 630 Park Avenue, New York, NY 10065, USA. Electronic address:

Traditional superficial musculoaponeurotic system (SMAS) facelifting surgery uses a laminar surgical dissection. This approach does not treat areas of facial volume loss, and requires additional volume supplementation with fat grafting or fillers. The novel volumizing extended deep-plane facelift uses a composite approach to the facelift flap. Read More

Facial Plast Surg Clin North Am 2020 Aug 6;28(3):303-310. Epub 2020 May 6.

The Piazza Center for Plastic Surgery, 7900 FM Road 1826, Building 2, Suite 206, Austin, TX 78739, USA.

The various rhytidectomy techniques share a common goal of safe repositioning of the facial soft tissues with a lasting effect. This article reviews rhytidectomy approaches and the current methods and practice patterns of the senior author. It includes a discussion of the extended sub-superficial musculoaponeurotic system rhytidectomy technique, which, in the opinion of the senior author, offers the best result with respect to neck rhytids, cervicomental angle and jawline definition, and improvement of jowling. Read More

Aesthet Surg J 2021 Feb;41(3):277-283

Department of Plastic Surgery, University of Texas Southwestern, Dallas, TX.

Background: Suspension of the superficial muscular aponeurotic system (SMAS) is generally believed to be necessary in facelift surgery. Although many techniques have been suggested, all rely on the viscoelastic properties of the SMAS.

Objectives: The aim of this study was to determine the viscoelastic properties of bursting strength, stress relaxation, and creep in the lateral, mid-cheek, and medial regions of the SMAS. Read More

Clin Plast Surg 2019 Oct 18;46(4):533-546. Epub 2019 Jul 18.

Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA. Electronic address:

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. Read More

Clin Plast Surg 2019 Jan 23;46(1):105-114. Epub 2018 Oct 23.

Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA.

After massive weight loss, deflation of the tissues and loss of skin elasticity in the face and neck can result in the appearance of accelerated facial aging. Surgical facial rejuvenation can be successfully performed with several modifications. Proper preoperative counseling and expectation management regarding staged or ancillary procedures is recommended. Read More

Clin Plast Surg 2018 Oct;45(4):527-554

New York Center for Facial Plastic and Laser Surgery, 630 Park Avenue, New York, NY 10065, USA.

This article describes our extended, deep plane facelift technique. This procedure releases 4 key retaining ligaments in the face and neck, the zygomatic cutaneous, masseteric cutaneous, mandibular cutaneous, and cervical retaining ligaments. Once released, the composite deep plane flap is repositioned to volumize the midface and gonial angle. Read More

Aesthetic Plast Surg 2018 Dec 19;42(6):1531-1539. Epub 2018 Sep 19.

Department of Plastic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.

Background: Super-high superficial musculoaponeurotic system (SMAS) suspension and tailor tack plication are powerful facelift tools used in cases of primary facial rhytidectomy.

Technique: Thorough pre-operative patient screening and counseling are completed in an outpatient cosmetic surgery center. A super-high SMAS flap is developed by undermining and incising along a line extending from the tragus to lateral canthus and dissecting the SMAS sufficiently to induce movement of the lateral nose and the oral commissure with traction on the SMAS. Read More

Facial Plast Surg 2018 Oct 18;34(5):539-544. Epub 2018 Sep 18.

Atlanta MediSpa and Surgery Center, L.L.C., Marietta and Atlanta, Georgia.

Facelifts remain a critical part of a facial plastic surgeon's cosmetic practice. Techniques continue to evolve, while at the same time patients demand less invasive procedures with less morbidity. The authors present a facelift plication technique using wide purse-string sutures placed into the superficial musculoaponeurotic system and platysma. Read More

Aesthet Surg J 2019 Jan;39(1):1-7

Department of Plastic Surgery, Lenox Hill Hospital and Manhattan Eye, Ear and Throat Hospital, New York, NY.

Background: Recurrent platysma bands remain a common problem in neck rejuvenation.

Objectives: The goals of this cadaver study were to document the course of the cervical branches of the facial nerve and investigate the pattern of platysma muscle innervation before and after various platysmaplasty maneuvers.

Methods: A total of 8 fresh cadaver specimens were dissected for a total of 16 hemifaces/necks. Read More

Ann Plast Surg 2018 Jun;80(6S Suppl 6):S406-S409

From the Division of Plastic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.

Facelift techniques widely vary with known individual surgeon modifications of and preference for particular techniques. This article provides an overview of the history of the superficial musculoaponeurotic system (SMAS), the changes of aging related to the soft tissues of the face, and the history of facelift procedures, including techniques to address the SMAS. In addition, a description of past studies and literature analyzing techniques of facelift procedures, safety of interventions involving the SMAS, low, extended, and high SMAS techniques, and evaluations of patient satisfaction with facelift outcomes including use of the FACE-Q are discussed. Read More

Aesthetic Plast Surg 2017 Dec 12;41(6):1351-1359. Epub 2017 Jul 12.

Plastic and Reconstructive Surgery Department, Bani Swaif University, Bani Swaif, Egypt.

Restoration of the esthetic neck contour is an integral component of facial rejuvenation. Characters of the aging neck include lipodystrophy, platysmal bands and jowls that extend into the neck, reducing the esthetic characters of the lower face. The authors present a new, simplified and economic method to manage platysmal bands as an office procedure under local anesthesia using a standard 18-gauge syringe needle as a cutting tool. Read More

Plast Reconstr Surg Glob Open 2017 Feb 24;5(2):e1244. Epub 2017 Feb 24.

April 31 Plastic Surgery Clinic, Seoul, Korea.

Supplemental Digital Content is available in the text. Read More

JAMA Facial Plast Surg 2017 Jan;19(1):34-39

Department of Family Medicine, University of Mississippi Medical Center, Jackson.

Importance: To our knowledge, long-term, objective results of lip augmentation using superficial musculoaponeurotic system (SMAS) tissue transfer beyond 1 year have not been previously described.

Objective: To evaluate the efficacy, longevity, and safety of lip augmentation using SMAS tissue transfer.

Design, Setting, And Participants: A retrospective single-blind cohort study was designed to evaluate all patients who underwent surgical lip augmentation using SMAS following rhytidectomy between January 1, 2000, and November, 16, 2015, at a private facial plastic surgery practice in Birmingham, Alabama. Read More

Aesthet Surg J 2015 Aug;35(6):633-43

Dr O'Connell is a Senior Attending Plastic and Reconstructive Surgeon, Bridgeport Hospital, Bridgeport, CT.

This article outlines a new rhytidectomy technique, developed by the author, that utilizes bidirectional self-retaining (barbed) sutures for superficial musculoaponeurotic system (SMAS) plication and, in some instances, skin closures. Short-scar and traditional versions of the procedure are presented, and the history of purse-string SMAS plication and the advantages for using self-retaining sutures in this application are discussed. Read More

J Plast Reconstr Aesthet Surg 2015 Oct 19;68(10):1332-7. Epub 2015 Jun 19.

Struck Plastic Surgery, 3301 El Camino Real, #200, Atherton, CA 94027, USA. Electronic address:

Background: The combination of simultaneous surgical rhytidectomy with ablative resurfacing has been a controversial procedure due to the concern of postoperative wound healing. Traditional ablative resurfacing lasers are believed to have higher rates of complications, leading to delayed healing and skin flap loss when combined with face rhytidectomy surgeries. With the development of fractionated ablative laser therapy, there has been increased interest in combining these two procedures. Read More