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The Inclusion of Orbicularis Oculi Muscle in the SMAS Flap in Asian Facelift: Anatomical Consideration of Orbicularis Muscle and Zygomaticus Major Muscle

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  • Facial Surgery
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Abstract

Background

In the malar region, the SMAS flap can be thin and tear easily, making it difficult to securely fix it. And the surgical anatomy of the region may be unclear and confusing. The authors performed an anatomical study on the location of the lateral margin of the orbicularis oculi muscle (OOM) and the origin of the zygomaticus major muscle (ZMM) when using a high-SMAS facelift with finger-assisted spaces dissection technique, which included elevation of the SMAS flap with OOM.

Methods

One hundred twenty-one Asian patients underwent this facelift procedure. Of those, the distances between the posterior margin of tragus and the lateral margin of the OOM and the center of the origin of the ZMM were measured in 20 patients.

Results

The mean age of the initial 121 patients was 50.9 years. In all cases, improvement was seen in soft tissue sagging of the midface and lower face. There was no functional impairment of the OOM. In 20 patients of them, the lateral margin of the OOM and the center of the origin of the ZMM were located at mean distances of 50.6 (range 48–53 mm) and 61.0 mm (range 60–65 mm) from the posterior margin of the tragus.

Conclusions

The SMAS flap with the OOM is sufficiently strong enough so that it can maintain the pulling force and also helps to securely fix it. The authors hope that these anatomical findings would be useful when performing it and aid in the understanding of the relationship between the muscles in the malar area.

Level of Evidence IV

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Acknowledgements

The authors deeply appreciate Dr. Bryan C Mendelson for professional guidance and advice. They greatly thank Dr. Byung Jung Kim for his invaluable encouragement and thoughtfulness. And they are grateful to Ms. Hong Bichira for her exquisite illustrations. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Plastic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, NO. 109 Nongguangli, Chaoyang District, Beijing City, 100021, China

    Min-Hee Ryu

  2. Division of Plastic, Reconstructive Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, Lake Success, NY, USA

    Victor A. Moon

  3. Shenzhen Guanghe Dr. Yin’s Cosmetic and Plastic Surgery Hospital, Shenzhen, China

    Weimin Yin

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  1. Min-Hee Ryu
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  2. Victor A. Moon
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  3. Weimin Yin
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Correspondence to Min-Hee Ryu.

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The authors have conformed to the Declaration of Helsinki.

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Ryu, MH., Moon, V.A. & Yin, W. The Inclusion of Orbicularis Oculi Muscle in the SMAS Flap in Asian Facelift: Anatomical Consideration of Orbicularis Muscle and Zygomaticus Major Muscle. Aesth Plast Surg 42, 471–478 (2018). https://doi.org/10.1007/s00266-017-1056-z

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  • DOI: https://doi.org/10.1007/s00266-017-1056-z

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