Extended Superficial Muscular Aponeurotic System Rhytidectomy: A Graded Approach

ic s. co m The acceptance of rhytidectomy has been a relatively recent phenomenon. Until the twentieth century, aesthetic surgery was shrouded in secrecy, and well into the twentieth century prominent physicians often were guarded in sharing their experience, despite rumors of cosmetic surgery taking place in private offices and clinics. After World War II, Fomon came to prominence as one of the founders and leaders of the American Academy of Facial Plastic and Reconstructive Surgery. Fomon willingly taught cosmetic surgery to those who were interested. One of his contributions was his recognition of the limits of subcutaneous rhytidectomy: ‘‘The average duration of the beneficial effects, even with the best technical skill, cannot be expected to exceed three to four years’’. By the 1960s and 1970s, advances in anesthesia allowed elective surgery to be performed safely. Cosmetic surgery literally came out of the dark ages by embracing the free exchange of ideas between surgeons, critical analysis of shortand long-term results by a peer-reviewed scientific community, and the growing need to accommodate a rapidly growing aging population. The baby-boom generation brought a new era in facial plastic and reconstructive surgery. A major advance in the approach to rhytidectomy came in 1974 when Skoog published his thoughts on subfascial rhytidectomy. In 1976, Mitz and Peyronie described this subfascial layer anatomically as the superficial muscular aponeurotic system (SMAS). Skoog and Lemmon demonstrated that by undermining and moving SMAS, the entire