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Perfect filler

Article-Perfect filler

Dr. Fezza
SARASOTA, FLA. — By utilizing the often discarded superficial muscular aponeurotic system (SMAS) as filler, the traditional brow lift procedure is enhanced through robust reinflation, according to oculofacial plastic surgeon John P. Fezza, M.D., director of facial cosmetic surgery at the Center for Sight in Sarasota, Fla.

53-year-old female (left) before and (right) three months after brow lift.
While the traditional principle of a brow lift is elevation, deflation of the aging face is also a factor that should be addressed by the procedure. As fillers have taken their place as beneficial adjuncts to brow elevation, longevity remains an unresolved issue with their use.

54-year-old female (left) before and (right) three months after brow lift.
"I think the best way to reinflate the brows is by using SMAS — it turns out that it's the perfect filler," Dr. Fezza tells Cosmetic Surgery Times . "A beautiful, elegant fullness can be achieved by draping SMAS along the orbital rims to reinflate the glabella and lateral brow pads."

53-year-old female (left) before and (right) three months after brow lift.
Through critical examination of his patients over the last six years, Dr. Fezza noted depression, in the long term, of the glabella area after corrugator muscle removal which caused patients to lack a "rejuvenated look." To address these relapses, Dr. Fezza utilizes the SMAS layer, a deeper, fatty fibrous and muscle tissue layer.

51-year-old female (left) before and (right) three months after brow lift.
"SMAS is a robust, natural form of filler. If you place pure fat from liposuction, the fat has much less chance of taking — but SMAS is healthy and fibrous," explains Dr. Fezza. "I find that a year after grafting SMAS to reinflate the brows, you'll have anywhere from 60 to 80 percent graft take."

PLACEMENT OPTIONS With this technique, smas is placed either endoscopically, which is dr. fezza's preference, or through an open coronal fashion after the removal of the corrugator muscles. the procedure entails full subperiosteal release of the scalp tissues, followed by removal of brow depressor muscles, such as the corrugators, procerus and depressor supercilii. the key step is to replace this lost volume with strips of robust smas harvested from the facelift procedure.

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