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In this paper Jacono et al1 provide intraoperative measurements of the zygomaticus major muscle, defining its long axis relative to the Frankfurt horizontal. This was done in an attempt to provide the operating surgeon with an objective measurement for ideal midface suspension. What the authors found was that the average zygomaticus major angle was 59°. However, there was significant variation both from patient to patient and with increasing age. Thus, they conclude that no standard vector can be utilized and therefore suggest that the procedure should be customized to the individual patient.

The issue they attempt to address is as controversial as it is complex. By design the study addresses the superficial muscular aponeurotic system (SMAS) layer only and not the skin. Many excellent facelift surgeons use different SMAS vectors and provide cogent arguments for their choice. Jacono et al describe the extended SMAS vector of Stuzin2 as superior lateral, although Stuzin states that this vector is adjusted depending on facial shape. In patients with wide faces Stuzin favors a more vertical vector, whereas he favors a more horizontal vector design in thin, narrow faces.2 Baker3 also alters his lateral SMASectomy according to facial shape. Whereas Marten,4 Sundine et al,5 and Owsley6 favor a superior lateral vector, Tonnard et al7 favor a pure vertical vector in his minimal access cranial suspension lift and condemn delamination. Little8 also favors a vertical vector for his low SMAS plication. Although not specifically stated, the current authors’ deep plane variant also avoids delamination and the direction of skin redraping follows their superior lateral SMAS vector.9

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Facial Surgery > Original Article
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