Aesthetic Plastic Surgery

, Volume 42, Issue 6, pp 1531–1539 | Cite as

The Super-High SMAS Facelift Technique with Tailor Tack Plication

  • Bahman GuyuronEmail author
  • Nazilla S. Seyed Forootan
  • Kris Katira
Original Article Facial Surgery



Super-high superficial musculoaponeurotic system (SMAS) suspension and tailor tack plication are powerful facelift tools used in cases of primary facial rhytidectomy.


Thorough pre-operative patient screening and counseling are completed in an outpatient cosmetic surgery center. A super-high SMAS flap is developed by undermining and incising along a line extending from the tragus to lateral canthus and dissecting the SMAS sufficiently to induce movement of the lateral nose and the oral commissure with traction on the SMAS. The SMAS is suspended from the deep temporal fascia using 4-0 Mersilene sutures. Tailor tack sutures are placed strategically in the SMAS caudal to the malar bone to eliminate any residual laxity in the SMAS close to the oral commissures and the cheek area. This is repeated until the laxity of the SMAS is completely eliminated. The orbicularis muscle is conservatively suspended laterally from the deep temporal fascia, facial volume is restored with fat grafting, the neck is contoured, if necessary, and the vest-over-pants platysma overlap technique is commonly utilized. Concomitant forehead rejuvenation, blepharoplasty, and laser resurfacing are extremely common.


Of the 72 cases of primary rhytidectomy performed by the senior author on consecutive patients included in the study, there were 64 (89%) female and 8 (11%) male patients. The average age of the patient at the time of primary facelift was 58 years old. Fifteen out of 72 (21%) patients received one dose of desmopressin (DDAVP) injection during the surgery, and one patient received DDAVP the day after surgery to maintain hemostasis. There was no incidence of facial nerve injury. Of those 72 cases, 3 (4%) developed minor hematomas that were resolved by aspiration. There were no expanding hematomas that required surgery. Of the 26 patients whose satisfaction was documented, 24 were very satisfied. Two patients expressed their dissatisfaction with the results, and one of these patients underwent a revision operation by the senior author. The other patient was mainly not pleased with the recovery duration.


An alteration in the SMAS elevation and suspension is described with strategic submalar plication, providing a powerful technique for primary facial rhytidectomy that offers reliable and significant malar lift, orbicularis suspension, improvement in jowls, and repositioning of the oral commissure. The technical details are demonstrated through complete video segments along with many nuances that make delivery of optimal and natural outcomes possible, while maintaining the normal anatomy.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Facelift technique Tailor tack plication Rhytidectomy 



The authors have no financial interest to declare in relation to the content of this article.

Supplementary material

266_2018_1223_MOESM1_ESM.mp4 (67 mb)
Video 1: Design of Incision (MP4 68641 kb)
266_2018_1223_MOESM2_ESM.mp4 (4 mb)
Video 2: Cotton placement (MP4 4128 kb)
266_2018_1223_MOESM3_ESM.mp4 (43.4 mb)
Video 3: Injection of incision (MP4 44413 kb)
266_2018_1223_MOESM4_ESM.mp4 (16.4 mb)
Video 4: Skin incision (MP4 16770 kb)
266_2018_1223_MOESM5_ESM.mp4 (24.9 mb)
Video 5: Anterior skin flap elevation (1) (MP4 25501 kb)
266_2018_1223_MOESM6_ESM.mp4 (11.4 mb)
Video 6: Post-auricular incision (MP4 11643 kb)
266_2018_1223_MOESM7_ESM.mp4 (16.3 mb)
Video 7: Anterior skin flap elevation (2) (MP4 16734 kb)
266_2018_1223_MOESM8_ESM.mp4 (12.3 mb)
Video 8: Extend of skin flap (MP4 12641 kb)
266_2018_1223_MOESM9_ESM.mp4 (9 mb)
Video 9: SMAS incision marking (MP4 9222 kb)
266_2018_1223_MOESM10_ESM.mp4 (52.2 mb)
Video 10: SMAS incision (MP4 53428 kb)
266_2018_1223_MOESM11_ESM.mp4 (11.5 mb)
Video 11: SMAS dissection (MP4 11765 kb)
266_2018_1223_MOESM12_ESM.mp4 (30 mb)
Video 12: Extend of SMAS flap (MP4 30745 kb)
266_2018_1223_MOESM13_ESM.mp4 (29.1 mb)
Video 13: Sideburn elevation (MP4 29786 kb)
266_2018_1223_MOESM14_ESM.mp4 (31.7 mb)
Video 14: SMAS fixation (MP4 32415 kb)
266_2018_1223_MOESM15_ESM.mp4 (28.2 mb)
Video 15: Anterior SMAS fixation (1) (MP4 28848 kb)
266_2018_1223_MOESM16_ESM.mp4 (14 mb)
Video 16: Anterior SMAS fixation (2) (MP4 14363 kb)
266_2018_1223_MOESM17_ESM.mp4 (19.2 mb)
Video 17: Posterior SMAS fixation (1) (MP4 19636 kb)
266_2018_1223_MOESM18_ESM.mp4 (33.5 mb)
Video 18: Orbicularis muscle suspension (MP4 34346 kb)
266_2018_1223_MOESM19_ESM.mp4 (42.4 mb)
Video 19: Posterior SMAS fixation (2) (MP4 43466 kb)
266_2018_1223_MOESM20_ESM.mp4 (19 mb)
Video 20: Sideburn Suspension (MP4 19440 kb)
266_2018_1223_MOESM21_ESM.mp4 (19.4 mb)
Video 21: Posterior SMAS incision (MP4 19909 kb)
266_2018_1223_MOESM22_ESM.mp4 (28.9 mb)
Video 22: Post-auricular SMAS suspension (MP4 29563 kb)
266_2018_1223_MOESM23_ESM.mp4 (31.8 mb)
Video 23: Redefining tragus (MP4 32544 kb)
266_2018_1223_MOESM24_ESM.mp4 (23.4 mb)
Video 24: Tailor tack technique (1) (MP4 23944 kb)
266_2018_1223_MOESM25_ESM.mp4 (30.8 mb)
Video 25: Tailor tack technique (2) (MP4 31575 kb)
266_2018_1223_MOESM26_ESM.mp4 (18.6 mb)
Video 26: Tailor tack technique (3) (MP4 19037 kb)
266_2018_1223_MOESM27_ESM.mp4 (6.4 mb)
Video 27: Tailor tack technique end-point (MP4 6528 kb)
266_2018_1223_MOESM28_ESM.mp4 (20.1 mb)
Video 28: Jawline trimming (MP4 20544 kb)
266_2018_1223_MOESM29_ESM.mp4 (49.7 mb)
Video 29: Median/caudal dissection of SMAS (MP4 50849 kb)
266_2018_1223_MOESM30_ESM.mp4 (38.6 mb)
Video 30: Supra-auricular skin re-draping (MP4 39552 kb)
266_2018_1223_MOESM31_ESM.mp4 (17.6 mb)
Video 31: Post-auricular skin re-draping (MP4 17999 kb)
266_2018_1223_MOESM32_ESM.mp4 (121.4 mb)
Video 32: Sideburn skin trimming (MP4 124294 kb)
266_2018_1223_MOESM33_ESM.mp4 (20.5 mb)
Video 33: Tragus skin re-draping (1) (MP4 21024 kb)
266_2018_1223_MOESM34_ESM.mp4 (37 mb)
Video 34: Tragus skin re-draping (2) (MP4 37919 kb)
266_2018_1223_MOESM35_ESM.mp4 (22.2 mb)
Video 35: Tragus skin trimming (MP4 22710 kb)
266_2018_1223_MOESM36_ESM.mp4 (47.2 mb)
Video 36: Earlobe skin trimming (1) (MP4 48314 kb)
266_2018_1223_MOESM37_ESM.mp4 (6.6 mb)
Video 37: Post-auricular crease trimming (MP4 6741 kb)
266_2018_1223_MOESM38_ESM.mp4 (21.2 mb)
Video 38: Recreating post-auricular sulcus (MP4 21755 kb)
266_2018_1223_MOESM39_ESM.mp4 (45.9 mb)
Video 39: Earlobe skin re-draping (2) (MP4 47014 kb)
266_2018_1223_MOESM40_ESM.mp4 (17 mb)
Video 40: Earlobe reattachment (MP4 17430 kb)
266_2018_1223_MOESM41_ESM.mp4 (38.5 mb)
Video 41: Earlobe reduction (MP4 39420 kb)
266_2018_1223_MOESM42_ESM.mp4 (13.4 mb)
Video 42: Post-auricular incision repair (caudal portion) (MP4 13752 kb)
266_2018_1223_MOESM43_ESM.mp4 (18.9 mb)
Video 43: Post-auricular skin trimming (cephalic portion) (MP4 19402 kb)
266_2018_1223_MOESM44_ESM.mp4 (31.2 mb)
Video 44: Drain placement and fixation (MP4 31978 kb)
266_2018_1223_MOESM45_ESM.mp4 (33.7 mb)
Video 45: Incision superficial repair (MP4 34534 kb)


  1. 1.
    Pessa JE (2000) An algorithm of facial aging: verification of Lambros’s theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show, and the lateral suborbital trough deformity. Plast Reconstr Surg 106(2):479–488PubMedGoogle Scholar
  2. 2.
    Guyuron B, Rowe DJ, Weinfeld AB, Eshraghi Y, Fathi A, Iamphongsai S (2009) Factors contributing to the facial aging of identical twins. Plast Reconstr Surg 123(4):1321–1331PubMedGoogle Scholar
  3. 3.
    Warren RJ, Aston SJ, Mendelson BC (2011) Face lift. Plast Reconstr Surg 128(6):747e–764ePubMedGoogle Scholar
  4. 4.
    Connell BF. SMAS facelift. InSeminars in Plastic Surgery 2002 (Vol. 16, No. 04, pp. 305-318). Copyright© 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: + 1 (212) 584-4662Google Scholar
  5. 5.
    Aston SJ, Steinbrech DS, Walden JL (2012) Aesthet plast surg E-Book. Elsevier Health Sciences, AmsterdamGoogle Scholar
  6. 6.
    Zwiebel SJ, Lee M, Alleyne B, Guyuron B (2013) The incidence of vitamin, mineral, herbal, and other supplement use in facial cosmetic patients. Plast Reconstr Surg 132(1):78–82PubMedGoogle Scholar
  7. 7.
    Guyuron B (2004) Secondary rhytidectomy. Plast Reconstr Surg 114(3):797–800PubMedGoogle Scholar
  8. 8.
    Guyuron B, Watkins F, Totonchi A (2005) Modified temporal incision for facial rhytidectomy: an 18-year experience. Plast Reconstr Surg 115(2):609–616PubMedGoogle Scholar
  9. 9.
    Mowlavi A, Majzoub RK, Cooney DS, Wilhelmi BJ, Guyuron B (2007) Follicular anatomy of the anterior temporal hairline and implications for rhytidectomy. Plast Reconstr Surg 119(6):1891–1895PubMedGoogle Scholar
  10. 10.
    Camirand A, Doucet J (1997) A comparison between parallel hairline incisions and perpendicular incisions when performing a face lift. Plast Reconstr Surg 99(1):10–15PubMedGoogle Scholar
  11. 11.
    Guyuron B, Sadek EY, Ahmadian R (2010) A 26-year experience with vest-over-pants technique platysmarrhaphy. Plast Reconstr Surg 126(3):1027–1034PubMedGoogle Scholar
  12. 12.
    Guyuron B, Majzoub RK (2007) Facial augmentation with core fat graft: a preliminary report. Plast Reconstr Surg 120(1):295–302PubMedGoogle Scholar
  13. 13.
    Guyuron B, Michelow B, Schmelzer R, Thomas T, Ellison MA (1998) Delayed healing of rhytidectomy flap resurfaced with CO2 laser. Plast Reconstr Surg 101(3):816–819PubMedGoogle Scholar
  14. 14.
    Guyuron B, Zarandy S, von Tirgan A (1994) Willebrand’s disease and plastic surgery. Ann Plast Surg 32(4):351–355PubMedGoogle Scholar
  15. 15.
    Faber C, Larson K, Amirlak B, Guyuron B (2011) Use of desmopressin for unremitting epistaxis following septorhinoplasty and turbinectomy. Plast Reconstr Surg 128(6):728e–732ePubMedGoogle Scholar
  16. 16.
    Jalili J, Askeroglu U, Alleyne B, Guyuron B (2013) Herbal products that may contribute to hypertension. Plast Reconstr Surg 131(1):168–173PubMedGoogle Scholar
  17. 17.
    Barton FE (2002) The “high SMAS” face lift technique. Aesthet Surg J. 22(5):481–487PubMedGoogle Scholar
  18. 18.
    Marten TJ (2008) High SMAS facelift: combined single flap lifting of the jawline, cheek, and midface. Clin Plast Surg 35(4):569–603PubMedGoogle Scholar
  19. 19.
    Coleman SR, Grover R (2006) The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthet surg J 26(1 Supplement):S4–S9PubMedGoogle Scholar
  20. 20.
    Guyuron B, Michelow B (1994) The nasolabial fold: a challenge, a solution. Plast Reconstr Surg 93(3):522–529PubMedGoogle Scholar
  21. 21.
    Guyuron B (1988) Modified temple incision for facial rhytidectomy. Ann Plast Surg 21(5):439–443PubMedGoogle Scholar
  22. 22.
    Guyuron B (1992) Subcutaneous approach to forehead, brow, and modified temple incision. Clin Plast Surg. 19(2):461–476PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Department of Plastic SurgeryUniversity Hospitals Cleveland Medical CenterClevelandUSA
  2. 2.School of MedicineCase Western Reserve UniversityClevelandUSA
  3. 3.ClevelandUSA

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