Facial plast Surg 2014; 30(04): 380-393
DOI: 10.1055/s-0034-1383556
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Biplanar Superficial Musculoaponeurotic System Imbrication Rhytidectomy

Daniel E. Rousso
1  Rousso Facial Plastic Surgery Clinic, Birmingham, Alabama
Kimberley D. Rutherford
2  Ear, Nose, & Throat Surgeons of Western New England, Springfield, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
30 July 2014 (online)


Rhytidectomy techniques have evolved significantly since the procedure's introduction in the early 20th century. Significant advancements in rhytidectomy techniques occurred in the 1960s and 1970s with the description of the subfascial rhytidectomy, the identification of the superficial musculoaponeurotic system (SMAS), and development of the SMAS flap. The incorporation of fascial undermining and suspension techniques have significantly improved the longevity and natural appearance of the facelift operation. More aggressive techniques including subperiosteal, composite, and deep plane techniques have been developed in the pursuit of the perfect facelift procedure. On the basis of over 25 years of clinical and surgical experience, a biplane SMAS imbrication rhytidectomy provides a natural, unstretched, and refreshed appearance resulting in high patient satisfaction. This article will present a detailed description of the rationale, technique, and nuances of the biplanar SMAS imbrication rhytidectomy. While the management of the platysma may vary depending on individual patient characteristics, the extent of subcutaneous, sub-SMAS, and neck dissection employed using the biplanar SMAS imbrication rhytidectomy minimizes patient complications and allows a relatively rapid recovery.