Anterior SMAS plication for the treatment of prominent nasomandibular folds and restoration of normal cheek contour.

Prominent nasomandibular folds and cheek concavities are common sequelae of the aging process. The difficulty in achieving initial and long-lasting correction has been well documented. Anterior SMAS plication as an adjunct to subcutaneous rhytidectomy has proven to be an effective, straightforward method of flattening and rejuvinating the nasomandibular folds. Ptotic cheek fat is returned to the cheek hollow, and the end result is a more youthful, symmetrical flattening of the nasomandibular folds and jowls. The anterior SMAS is plicated vertically with a row of permanent sutures placed just lateral to the nasomandibular fold. Less tension is required on the skin flaps at closure, and this permits precise control of anterior SMAS vectors without the time, expense, and potential morbidity of more extensive dissections. The additional cost is that of two sutures and an extra 10 to 15 minutes of operative time. This technique has been performed on 226 patients of both sexes, and there have been no complications, including nerve injuries, infections, or dehiscences. The longest follow-up has been 2.2 years, and there have been no asymmetries, contour irregularities, or early recurrences.