Restoring facial superfacial muscular aponeurotic system defects after permanent fillers removal using fascial and SMAS grafts: a preliminary study

• Published in: European journal of plastic surgery 2024-04, Vol.47 (1), Article 47
• Main Authors: Zahra, Tarek, Abdelhalim, Mostafa, Zayed, Ahmed, Mousa, Khaled, El Fahar, Mohammed H., Zeina, Ahmed M.
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Original Paper; Plastic Surgery
• ISSN: 1435-0130; 1435-0130
• DOI: 10.1007/s00238-024-02193-2

Background Dermal fillers provide an appealing option for facial rejuvenation, but inappropriate filler selection and injection techniques can cause complications requiring surgical correction. This study examined the intraoperative superficial muscular aponeurotic system (SMAS) and tissue abnormalities encountered during facelift after permanent filler removal. Methods This preliminary prospective case series describes reconstructive techniques used in 10 women with SMAS defects following facelift with permanent filler extraction. Defects were repaired using temporalis fascia, and mastoid fascia, or combined platysma-SMAS grafts. Pre- and postoperative photographs were evaluated by two independent surgeons for midface volume analysis. Results Preoperative complaints included facial contour asymmetry (100%), nodules/irregularities (70%), and disfiguring edema (35%). The mean follow-up was 6 months postoperatively. No lipofilling was required in this period. Patient satisfaction at 6 months was: extremely satisfied (70%), very satisfied (20%), satisfied (10%). Facial symmetry was rated as no asymmetry (80%), moderate asymmetry (10%), and mild asymmetry (10%). Standardized photo review found that 80% of surgeons were satisfied with pre- vs. 6-month postoperative results. Conclusions This study shows promising aesthetic outcomes and high patient satisfaction at 6 months after simultaneous facelift and permanent filler removal with volume defect correction using various local tissue grafts. Larger studies with longer follow-ups are warranted to further assess these reconstructive techniques for significant SMAS defects resulting from improper permanent filler placement. Level of Evidence: Level IV, therapeutic study