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SMAS vs. Deep plane

Postby harri » Fri Nov 30, 2007 4:04 pm

atlanti wrote:Harri - well now I am totally confused. Am in mid-fifties and had an SMASectomy - to include submental lipo under chin and neck lift - but it appears that my scars are identical to the SMAS - in the tragus, up behind the ear and into the hairline for the neck. This was done by one of the top UK surgeons BJ. It would appear that "terminology" is used differently by different people. But it would seem that the
SMASectomy is gaining ground in the Uk also.

Atlanti I found this posted by someone who had consulted Baker. I think it can be combined with different sort of neck lifts. Did BJ give you your operating notes?

I was reading some of Baker's published papers today, and one had a diagram showing how he likes to do his incisions. He actually seems to do three variants, depending upon the person:

1. His basic scar is a short one in front of the ear.

2. For some people he takes the scar under and behind the ear, close to the ear.

3. For the really tough jobs, he takes the scar out behind the ear in addition to the above (so I guess in that case it's not a short scar lift at all).

For all of the above, he also has a short temporal scar just above the ear, either hidden in the hair or going around the hairline.

And the lucky ones get the under chin incision too.

And this is the modified version developed by Norman Waterhouse, Barry Jones and Bulstrode.

BACKGROUND: The modified lateral superficial musculoaponeurotic system (SMAS)-ectomy is an evolution of the technique described by Baker. This modification of the lateral SMASectomy improves and simplifies the procedure by addressing the SMAS and platysma in one surgical procedure. METHODS: A rectangle of SMAS and platysma, parallel to the nasolabial fold (1 cm inferior to the zygomatic arch, 4 to 5 cm below the jaw line, and 3 cm wide), was marked. This plane was undermined anteriorly with blunt dissection, leaving the facial nerve deep to the deep cervical fascia. After excision of the rectangle, the defect was closed, leading to a correction of the neck, jowl, and nasolabial folds. Superolateral elevation of the inferior portion of the flap in particular addresses the problem of neck laxity and platysma redundancy. RESULTS: A total of 359 patients have undergone this procedure performed by the senior author (N.W.). CONCLUSION: This technique gives pleasing, durable results, with minimal morbidity.
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