Extended SMAS Facelift Technique Effectively Controls Submandibular Gland Ptosis, Retrospective Study Shows

The extended superficial musculoaponeurotic system (SMAS) facelift technique significantly reduces submandibular gland ptosis (SMGP) and enhances neck contour, according to a retrospective cohort analysis published in Annals of Plastic Surgery.

Conventional facelift approaches can inadequately address SMGP, often leading surgeons to recommend partial submandibular gland resection. This study evaluated whether an extended SMAS dissection—mobilizing the SMAS–platysma complex—could improve lower facial and neck rejuvenation while preserving the submandibular glands.

The review included 53 patients who underwent the extended SMAS facelift over a 10-year period in the senior author’s practice. Standardized photographic analysis quantified changes in SMGP and cervicomental angle (CMA) from preoperative baseline to mean follow-up of 8.4 months (range, 1–34 months). The mean SMGP distance decreased from 8.9 mm preoperatively to 0.1 mm postoperatively, reflecting an average improvement of 8.01 mm (P < .001). Similarly, mean CMA improved significantly from 152° to 121°, with an average change of 30.8° (P < .001). Patient satisfaction was high, with only two patients (3.8 %) reporting dissatisfaction and three patients (5.7 %) requiring minor office revisions.

The authors concluded that the extended SMAS facelift technique effectively controls submandibular gland ptosis and enhances neck angularity without routine gland resection. They attribute the outcomes to comprehensive release of retaining ligaments and optimized SMAS–platysma flap mobilization, creating a sling-like support for submandibular contents. Longer follow-up and comparative studies were suggested to further delineate long-term durability and refine patient selection.