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J Craniofac Surg. 2017 Jun;28(4):882-887. doi: 10.1097/SCS.0000000000003501.

Multivectored Superficial Muscular Aponeurotic System Suspension for Facial Paralysis.

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*Creighton University School of Medicine, Omaha, NE †Department of Plastic Surgery, Mayo Clinic, Phoenix, AZ ‡Department of Anthropology, Washington University, St. Louis, MO §Craniofacial Plastic Surgery, Barrows Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, AZ.



Facial paralysis is a devastating condition that may cause severe cosmetic and functional deformities. In this study we describe our technique for superficial muscular aponeurotic system (SMAS) suspension using barbed suture and compare the vectors of suspension in relation to the underlying musculature. This study also quantifies the improvements in postoperative symmetry using traditional anthropologic landmarks.


The efficacy of this procedure for improving facial paralysis was determined by comparing anthropometric indices and using Procrustes distance between 4 groupings of homologous landmarks plotted on each patient's preoperative and postoperative photos. Geometric morphometrics was used to evaluate change in facial shape and improvement in symmetry postoperatively.To analyze the vector of suspension in relation to the underlying musculature, specific anthropologic landmarks were used to calculate the vector of the musculature in 3 facial hemispheres from cadaveric controls against the vector of repair in our patients.


Ten patients were included in our study. Subjectively, great improvement in functional status was achieved. Geometric morphometric analysis demonstrated a statistically significant improvement in facial symmetry. Cadaveric dissection demonstrated that the suture should be placed in the SMAS in vectors parallel to the underlying musculature to achieve these results. There were no complications in our study to date.


In conclusion, multivectored SMAS suture suspension is an effective method for restoring static suspension of the face after facial paralysis. This method has the benefit of producing quick, reliable results with improved function, low cost, and low morbidity.

[Indexed for MEDLINE]

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