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The Superficial Musculo-Aponeurotic System (SMAS) in the Parotid and Cheek Area
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
The “superficial muscular and aponeurotic system (SMAS)” is a fascial layer in the parotid and cheek regions which is described in classic anatomy textbooks such as Gray's1 textbook of anatomy. In this paper, both the anatomical and potential surgical applications of the SMAS are considered.
Anatomy of the Lower Face and Neck
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Evan Ransom, Stephen A. Goldstein
The superficial musculoaponeurotic system (SMAS) is the tissue layer continuous with the platysma, which invests the mimetic muscles in the lower face. Laterally, the platysma muscle fibers reach the parotid tail before dissipating and becoming the parotid fascia. In the middle of the platysma, muscle fibers cross over the mandibular body loosely, accounting for the relative mobility of the facial skin in this area. More anteriorly, overlying the parasymphysis, the platysma is attached to the mandible at a band of tissue called the mandibular septum or mandibular retaining ligament (19,20).
Facial Layers
Published in Ali Pirayesh, Dario Bertossi, Izolda Heydenrych, Aesthetic Facial Anatomy Essentials for Injections, 2020
Eqram Rahman, Yves Saban, Giovanni Botti, Stan Monstrey, Shirong Li, Ali Pirayesh
In youth, the facial fat consists of a diffuse, balanced spread of superficial and deep fat which create the different arcs and convexities of the face. The superficial and deep layers are separated by the superficial muscular aponeurotic system (SMAS). Superficial fat is understood to be separated into unique compartments, which are divided by fascial septae containing vascular structures [2,5]. The major role of the fat layers is as a gliding plane for the facial mimetic muscles [5].
Auricular reconstruction after Mohs excision utilizing combination of pre-auricular transposition and chondrocutaneous advancement flaps
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Annet S. Kuruvilla, Jared M. Gopman, Peter W. Henderson
A unique combination procedure was designed that consisted of a unilateral chondrocutaneous advancement (Antia-Buch) flap (to improve the shape of the ear) and a pre-auricular fasciocutaneous transposition flap (to provide skin coverage) (Figure 2). The Antia-Buch flap was designed along the lateral helical rim, the posterior skin was kept intact as the vascular support to the helical rim cartilage, the cartilage was advanced, and a small amount of cartilage was debrided and removed as a wedge extending into the scapha to allow for appropriate closure without disruption of normal contour. Separately, a superiorly-based pre-auricular fasciocutaneous transposition flap was raised superficially to the superficial musculoaponeurotic system (SMAS)/parotid fascia. The flap was rotated approximately 90° and draped over the helical root, and inset with 5-0 nylon sutures to the leading edge of the helical rim chondrocutaneous advancement flap.
Two years’ outcome of thread lifting with absorbable barbed PDO threads: Innovative score for objective and subjective assessment
Published in Journal of Cosmetic and Laser Therapy, 2018
Aging is inevitable and a progressive process, and face is the mirror of total body aging. Aging in face affects all facial layers (1), skin, subcutaneous fat, superficial muscular aponeurotic system (SMAS), deep facia, the retaining ligaments, neurofacial muscles activity, and even the facial bony skeleton. Variable procedures for facial rejuvenation have been innovated through surgical and nonsurgical techniques, according to degree of tissue laxity, surgeon assessment, and patient preference. The most common nonsurgical tools for face rejuvenation are the dermal fillers, Botox, peeling, laser resurfacing, platelets rich plasm (PRP), and lifting using threads. Thread lifting has long history (2) and debate because of high record of complications of non-absorbable threads recorded previously. It was approved in 2005 by the FDA (3) and lost approval years later. With the introduction of absorbable threads, made of polydioxanone (PDO), thread lifting has gained interest and popularity again among diverse manufacturing companies that produce many types with many techniques, either for rejuvenation and/or skin lifting. Thread lifting is neither alternative to surgery nor magic per se, but it could have good results for rejuvenation and skin lifting, especially when combined with another method of facial rejuvenation. Many histopathological studies indicated dermal and subcutaneous foreign body reaction after inserting the thread, in forms of lymphocytes infiltration, collagen deposition, and fibrosis (4–6). This fibrosis could explain the tightening effect throughout contracture and remodeling and subsequent skin tightening.
Patient and Clinician Satisfaction With Shared Medical Appointments for Glaucoma
Published in Seminars in Ophthalmology, 2022
Emily K. Tam, Sofia De Arrigunaga, Madhura Shah, Haben Kefella, Scarlet Soriano, Susannah Rowe
We believe that SMAs are beneficial to patients with ophthalmological diseases and can be implemented in this setting. Future studies are warranted to expand on glaucoma-related outcomes and to evaluate whether SMAs can benefit both patients and clinicians in the context of other ophthalmological conditions beyond primary care settings may benefit from SMAs. Additionally, in the Covid-19 era providers are decreasing the number of patient visits while increasing virtual visits. SMAs- both virtual and in-person- may be a tool through which to reach out to make care more accessible and improve patient outcomes with meaningful use of providers’ limited clinical time.