The Inclusion of Orbicularis Oculi Muscle in the SMAS Flap in Asian Facelift: Anatomical Consideration of Orbicularis Muscle and Zygomaticus Major Muscle

Publication Date


Journal Title

Aesthetic Plast Surg


© 2018, Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery. Background: In the malar region, the SMAS flap can be thin and tear easily, making it difficult to securely fix it. And the surgical anatomy of the region may be unclear and confusing. The authors performed an anatomical study on the location of the lateral margin of the orbicularis oculi muscle (OOM) and the origin of the zygomaticus major muscle (ZMM) when using a high-SMAS facelift with finger-assisted spaces dissection technique, which included elevation of the SMAS flap with OOM. Methods: One hundred twenty-one Asian patients underwent this facelift procedure. Of those, the distances between the posterior margin of tragus and the lateral margin of the OOM and the center of the origin of the ZMM were measured in 20 patients. Results: The mean age of the initial 121 patients was 50.9 years. In all cases, improvement was seen in soft tissue sagging of the midface and lower face. There was no functional impairment of the OOM. In 20 patients of them, the lateral margin of the OOM and the center of the origin of the ZMM were located at mean distances of 50.6 (range 48–53 mm) and 61.0 mm (range 60–65 mm) from the posterior margin of the tragus. Conclusions: The SMAS flap with the OOM is sufficiently strong enough so that it can maintain the pulling force and also helps to securely fix it. The authors hope that these anatomical findings would be useful when performing it and aid in the understanding of the relationship between the muscles in the malar area. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Volume Number


Issue Number



471 - 478

Document Type





School of Medicine

Primary Department






For the public and Northwell Health campuses