Perfusion of the Superficial Musculoaponeurotic System and the Superficial Temporal Fascia During Facelift, as Assessed by Indocyanine Green Angiography

Perfusion of the buccal-mandibular area SMAS originated from a transverse facial artery perforator in the deep layer and remained poor during extended SMAS rhytidectomy. Because of the poor perfusion of the buccal-mandibular area SMAS after elevation, high-risk patients may benefit from composite facelifts, less extensive skin dissection, or preservation of the transverse facial artery perforator. The superficial temporal fascia can be harvested as an inferior-pedicled flap down to the zygomatic arch, whereas the buccal-mandibular area SMAS cannot be reliably harvested in this manner.