Background: The ultimate goal of facelift is to lift the sagging soft tissue as much as possible, so as to restore them to the original anatomical position for facial rejuvenation.
Objective: In our High-SMAS facelift, the SMAS-platysma flap were tighten strongly, so as to obtain full and youthful facial morphologic characteristics. In addition, the effectiveness of high-SMAS was evaluated in this paper.
Methods: A total of 86 cases of SMAS face lift were performed in 22 months from January 2015 to November 2016. High SMAS technique was applied in 39 cases of them. All the 39 patients were female averaged 44 (29-65) years old. Postoperative follow-up wascarried out in 18 cases for an average of 13 months (4-22 months). After the SMAS-platysma flap was dissected in the lower face and neck，the key point of operating is focus on：The middle temporal fascia and superficial temporal fascia flap was dissected carefully. Break off the ligaments medial to the zygomatic arch and on the malar process exactly, and pay attention to protect the facial nerve. So that the high-SMAS and even higher-SMAS flap can be dissected.
Results: In all the 18 cases followed up, most (11/18) obtained a clear mandibular margin after operation and scored even full mark. Perfect nasolabial fold improvement was achieved in few (7/18). In terms of Ogee curve evaluation, most (15/18) made it to the level of “acceptable”, which was shared by the evaluation of lower eyelid shortening effects (13/18). Very satisfied indicators as follow: the obtuse jowl line becomes clear, midface “ogee curve” is vary from linear to curves, and the nasolabial sulcus have been improved.
Conclusion: High-SMAS Facelift is one of the most effective rhytidectomy, the most prominent parts of its effect including the improvement of midface and jowl line contour.
Level of Evidence: IV

Keywords: high SMAS, facelift, effectiveness, evaluate

1. Furnas DW. The retaining ligaments of the cheek. Plast Reconstr Surg 1989;83:11-6.
   
2. 王志军, 高景恒, 李吉. 面部韧带的解剖学研究 [J]. 实用整形美容外 科杂志 1992;3:127-30.
3. Feldman JJ. Neck lift. St Louis, MO: Quality Medical Publishing;2006.
4. 王志军, 王毅彪, 夏成俊, 李衍江, 高景恒, 李吉. 颞区筋膜结构分析 [J]. 实用美容整形外科杂志 1992;3:205-7.
5. Mendelson BC, Jacobson SR. Surgical anatomy of the midcheek:facial layers, spaces, and the midcheek segments. Clin Plast Surg 2008;35:395-404.
   
6. Barton FE Jr. Rhytidectomy and the nasolabial fold. Plast Reconstr Surg 1992;90:601-7.
   
7. 王志军，高景恒，李吉. 面部表浅肌肉键膜系统的解剖学研究 [J]. 实 用整形美容外科杂志 1992;3:115-8.
8. Barton FE Jr. The “high SMAS” face lift technique. Aesthet Surg J 2002;22:481-6.
   
9. Kang KJ, Yang HH, Chai CY. Assessment of rejuvenation by change of lid-cheek junction after transconjunctival and traditional subciliary incision blepharoplasty. J Cosmet Med 2017;1:30-8.