The Key Structure of the Facial Soft Tissue: The Superficial Musculoaponeurotic System

KOICHI WATANABE; AYA HAN; EIKO INOUE; JOE IWANAGA; YOKO TABIRA; AKIHIRO YAMASHITA; KEISHIRO KIKUCHI; YUTO HAIKATA; KUNIMITSU NOOMA; TSUYOSHI SAGA

doi:10.2739/kurumemedj.MS682008

Review Article

The Key Structure of the Facial Soft Tissue: The Superficial Musculoaponeurotic System

KOICHI WATANABE, AYA HAN, EIKO INOUE, JOE IWANAGA, YOKO TABIRA, AKIHIRO YAMASHITA, KEISHIRO KIKUCHI, YUTO HAIKATA, KUNIMITSU NOOMA, TSUYOSHI SAGA

Author information

KOICHI WATANABE
Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
AYA HAN
Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
Department of Plastic, Reconstructive, and Maxillofacial Surgery, Kurume University School of Medicine
EIKO INOUE
Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
Jyosui Dermatology Clinic
JOE IWANAGA
Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine
YOKO TABIRA
Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
AKIHIRO YAMASHITA
Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
Department of Orthopedic Surgery Kurume University School of Medicine
KEISHIRO KIKUCHI
Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
Department of Orthopedic Surgery Kurume University School of Medicine
YUTO HAIKATA
Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
KUNIMITSU NOOMA
Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
TSUYOSHI SAGA
School of Nursery Kurume University School of Medicine

Keywords: SMAS, superficial musculoaponeurotic system, platysma, superficial temporal fascia, superficial fascia, retaining ligament, facial nerve

JOURNAL FREE ACCESS

2021 Volume 68 Issue 2 Pages 53-61

DOI https://doi.org/10.2739/kurumemedj.MS682008

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Abstract

Summary: The superficial musculoaponeurotic system (SMAS) was advocated by Mitz and Peyronie in 1976. The concept of this superficial fascia was established by surgical findings of facelift surgery and is familiar to plastic surgeons and anatomists. However, detailed characteristics of this fascia are still not widely known among head and neck surgeons. Moreover, the SMAS is generally located at the parotid and cheek regions and divides facial fat into superficial and deep layers. The SMAS connects to the superficial temporal fascia cranially and to the platysma caudally. The frontal muscle and the peripheral part of the orbicularis oculi are also in the same plane. The exact expanse of the SMAS in the face is controversial. Some authors claimed that the SMAS exists in the upper lip, whereas others denied the continuity of the SMAS to the superficial temporal fascia in a histological study. There are various other opinions regarding SMAS aside from those mentioned above. The concept of the SMAS is very important for facial soft tissue surgeries because the SMAS is a good surgical landmark to avoid facial nerve injuries. Therefore, this article summarized SMAS from an anatomical point of view.

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