The original deep plane facelift reported by Dr. Hamra describes elevating only a short area of skin flap around the ear before focus is directed to dissecting and elevating the SMAS flap over the zygomaticus muscle and to a point near the nasolabial folds.
We believe, in order to get the best result, the SMAS flap should be repositioned. However, in our experience and opinion, the small amount of skin flap elevation limits the refinement achievable. The extended SMAS-plasty technique consists of elevating a formal facial skin flap followed by elevation of a SMAS flap similar to that described by Dr. Hamra. The SMAS elevation is also extended inferiorly to the platysma.
After all the flaps are elevated, excellent redraping can be performed to achieve a natural and long lasting refreshed look. There is a slight increase risk of injury to the facial nerve due to the extent of dissection, but in experienced hands, the risk is very low and not higher than that reported in less involved facelifts.
