title: A method of augmenting the cheek area through SMAS, subSMAS, and subcutaneous tissue recruitment during facelift surgery.
abstract: BACKGROUND
  As the human face ages, there is a depletion of fat that occurs in the submalar region. Various techniques such as fat transfers, fillers, alloplastic implants, and composite rhytidectomies have been used to augment this area in the past.
  
  
  OBJECTIVE
  To describe a technique that augments the submalar areas during facelift surgery without the use of fat transfer, fillers, alloplastic implants, or a risky composite technique.
  
  
  METHODS
  An oval is scribed over the depressed submalar areas preoperatively. During facelift surgery, a fusiform area is scribed over the SMAS. This fusiform is scribed so that the medial end is directed at the center of the submalar depression, and the lateral end is toward the posterior earlobe. A defect is created within the lateral aspect of the fusiform, but not the medial portion. The fusiform is subsequently closed with a 2-0 Ethibond suture using three horizontal mattress sutures and two interrupted sutures. Upon closure of this defect, SMAS, subSMAS, and subcutaneous tissue overlying the SMAS are recruited into the submalar defect by the simple phenomenon of dog-ear formation. Additionally, there is a component of frank elevation of the tissues inferior to the medial aspect of the fusiform and submalar space.
  
  
  RESULTS
  The aforementioned technique has been performed on 123 patients over 7 years and has resulted in consistently good improvement in the submalar space. The procedure is not difficult to learn, and good results can be achieved with initial cases. The learning curve was not found to be steep, with good results being achieved quickly.
  
  
  CONCLUSIONS
  Depression of the submalar space plays a significant role in creating an aged face. In the past, various fillers and/or alloplastic implants have been used to augment this region. A low-risk method is described that mobilizes SMAS, subSMAS, and subcutaneous tissues into the submalar space through the phenomenon of dog-ear formation after fusiform closure.
authors.affiliation: Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Brandy
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D002610:Cheek / Q000601:surgery*; D006801:Humans; D015361:Rhytidoplasty / Q000379:methods*; D013536:Suture Techniques