title: The face lift SMAS plication flap for reconstruction of large temporofrontal defects: reconstructive surgery meets cosmetic surgery.
abstract: BACKGROUND
  Reconstruction of large defects in the temporal region can be performed with skin grafts or pedicled or free flaps. Results are often not optimal because of the patch of a skin graft, lack of availability of local flaps, and distant skin from free flaps. A technique for reconstruction of these defects with local tissue is presented in this article that uses superficial musculoaponeurotic system (SMAS) plication to allow wide advancement of a cervicofacial flap.
  
  
  METHODS
  Once the defect is outlined, a face-lift-like skin incision is used to raise the flap. The SMAS is plicated with two purse-string sutures that relieve tension on the flap and allow maximal advancement. Thirteen face-lift SMAS plication flaps were used in 12 patients (mean age, 70.2 years) after cancer resection, which was bilateral in one case. Defects up to 8 cm in largest diameter can be closed. In one case of an 8 × 6-cm defect, a 1 × 1.5-cm skin graft was necessary.
  
  
  RESULTS
  All flaps healed uneventfully, and no reoperation was necessary. Scars are almost completely hidden and the cosmetic result is satisfactory. The asymmetrical face-lift effect fades out within 6 months.
  
  
  CONCLUSIONS
  The face-lift SMAS plication (FLISP) flap allows reconstruction of large defects in the temporal region with a local flap providing an excellent cosmetic result and avoiding the need for distant tissue and multiple scarring. This flap provides an example of how reconstructive surgery and cosmetic surgery are complementary and can be mutually beneficial.
authors.affiliation: Palermo, Italy From the Cattedra di Chirurgia Plastica e Ricostruttiva, Dipartimento di Discipline Chirurgiche ed Oncologiche, Università di Palermo, and Plastic Surgery, University of Basel.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Arpa
authors.forename: Adriana
authors.initials: A
authors.lastname: Cordova
authors.forename: Roberto
authors.initials: R
authors.lastname: Pirrello
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zabbia
authors.forename: Daniel
authors.initials: D
authors.lastname: Kalbermatten
authors.forename: Francesco
authors.initials: F
authors.lastname: Moschella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003357:Cosmetic Techniques; D005145:Face / Q000601:surgery*; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome