The use of resected SMAS as autologous graft for the correction of nasolabial folds during rejuvenating procedures: SMAS autologous graft for nasolabial folds corrections: a renewed “old-school” technique

The use of resected SMAS as autologous graft for the correction of nasolabial folds during rejuvenating procedures

SMAS autologous graft for nasolabial folds corrections: a renewed “old-school” technique


  • Alessandro Innocenti a:1:{s:5:"en_US";s:80:"Plastic and Reconstructive Microsurgery - Careggi University Hospital - Florence";}
  • Dario Melita Plastic and Reconstructive Microsurgery - Careggi University Hospital - Florence
  • Marco Innocenti Plastic and Reconstructive Microsurgery - Careggi University Hospital - Florence


SMAS; superficial musculoaponeurotic system; rhytidectomy; FACE-Q; face rejuvenation; cosmetic surgery;


Background and aim: Despite several techniques are proposed, treatment of nasolabial folds is often challenging. During rejuvenation procedures, the SMAS could be redraped or partially resected during the procedure. The aim of this study is to investigate the use of obtained SMAS strip as autologous graft, because of its solid but pliable consistence and fatty composition, to correct nasolabial folds during procedures with SMAS resection.Methods Between 2015 and 2018, 23 patients underwent SMAS graft for nasolabial fold correction. All procedures were performed under local anesthesia and no other cosmetic treatments, including HA fillers, have been done in the past 12 months.Results: 22 patients were declared eligible for the study. 20 patients were female, accounting for 90,91%. Mean age was 53 years old. Ancillary procedures were performed in 17 patients, including upper blepharoplasty (3, 13,63%), upper and lower blepharoplasty (5, 22,73%) and submental neck lift with platysma plication (15, 68,18%). Mean follow-up was 9 months. No major complications have been recorded: only 1 case of minimal hematoma in the retroauricular region have been recorded and 1 patient required laser treatment for pathological scars. At follow-up, graft is completely integrated into the mid-fat compartment. As evinced from the FACE-Q analysis, the overall satisfaction rate is extremely high. These are very convincing data regarding the effectiveness of the technique and, despite a little bit longer downtime, is not invasive and led to natural long-lasting results event during motion.Conclusions: The use of SMAS graft during face-lift as nasolabial fold filler results in a satisfactory but natural filling of the folds, reducing the need for lateral tension and therefore assuring more natural results. Since its nature, SMAS, reduced in width to properly fit into the nasolabial fold, can be considered as an optimal autologous graft for replenish loss volumes of the face with aging.


1. Klassen AF, Cano SJ, Scott A, Snell L, Pusic AL. (2010) Measuring patient-reported outcomes in facial aesthetic patients: development of the FACE-Q. Facial Plast Surg.Aug;26(4):303-9
2. Klassen AF, Cano SJ, Alderman A, East C, Badia L, Baker SB, Robson S, Pusic AL. (2016) Self-Report Scales to Measure Expectations and Appearance-Related Psychosocial Distress in Patients Seeking Cosmetic Treatments. Aesthet Surg J. May 24
3. Shoshani D1, Markovitz E, Monstrey SJ, Narins DJ. (2008) The modified Fitzpatrick Wrinkle Scale: a clinical validated measurement tool for nasolabial wrinkle severity assessment. Dermatol Surg. Jun;34 Suppl 1:S85-91; discussion S91
4. Innocenti A, Melita D, Ghezzi S, Innocenti M. (2018) Refinements in Tear Trough Deformity Correction: Intraoral Release of Tear Trough Ligaments: Anatomical Consideration and Clinical Approach. Aesthetic Plast Surg. Dec;42(6):1576-1581
5. Innocenti A, Melita D, Ghezzi S, Ciancio F. (2018) Extended Transconjunctival Lower Eyelid Blepharoplasty with Release of the Tear Trough Ligament and Fat Redistribution. Plast Reconstr Surg. Aug;142(2):235e-236e
6. Innocenti A., Mori F., Melita D., Dreassi E., Innocenti M. (2017) Effects of orbicularis oculi flap anchorage to the periosteum of the upper orbital rim on the lower eyelid position aftertranscutaneous blepharoplasty: Statistical analysis of clinical outcomes. J Plast Reconstr Aesthet Surg. Mar;70(3):385-391
7. Y. Ducic and Hilger P.A. (1997) The aesthetic challenges of the nasolabial fold,” FACE, vol. 5, no. 2, pp. 103–108
8. Cohen SR, Goodacre A, Lim S, Johnston J, Henssler C, Jeffers B, Saad A, Leong T. (2017) Clinical Outcomes and Complications Associated with Fractional Lasers: A Review of 730 Patients. Aesthetic Plast Surg. Feb;41(1):171-178.
9. Samadi A, Nasrollahi SA, Janani L, Moosavi ZB, Hesari KK, Kalantari AR, Firooz A. (2018) Combination of Fractional Radiofrequency and Thermo-Contraction Systems for Facial Skin Rejuvenation: A Clinical and Histological Study. Aesthet Surg J. Nov 12;38(12):1341-1350
10. Gamboa GM, Ross WA. (2013) Autologous fat transfer in aesthetic facial recontouring. Ann Plast Surg. May;70(5):513-6.
11. D.H.Suh,M.K.Shin,S.J.Leeetal. (2011) Intense focused ultrasound tightening in asian skin: clinical and pathologic results: clinical and pathological results. Dermatologic Surgery 37; 11:1595–1602
12. Robati RM, Abdollahimajd F, Robati AM. (2015) Evaluation of Subcision for the Correction of the Prominent Nasolabial Folds. Dermatol Res Pract. :976153
13. Sandulescu T, Buechner H, Rauscher D, Naumova EA, Arnold WH. (2018) Histological, SEM and three-dimensional analysis of the midfacial SMAS - New morphological insights. Ann Anat. Nov 22;222:70-78
14. Lamperti TA, Carithers JS. (2004) Subcutaneous superficial musculoaponeurotic system grafting of the aging melolabial furrow. Arch Facial Plast Surg. Nov-Dec;6(6):384-8
15. Moody MW, Dozier TS, Garza RF, Bowman MK, Rousso DE. (2008) Autologous superficial musculoaponeurotic system graft as implantable filler in nasolabial fold correction. Arch Facial Plast Surg. Jul-Aug;10(4):260-6.
16. Calderon W, Andrades PR, Israel G, Cabello R, Leniz P. (2004)SMAS graft of the nasolabial area during deep plane rhytidectomy. Plast Reconstr Surg 114:559e64
17. Stenekes MW., Van Der Lei B. (2012) Nasolabial fold augmentation with SMAS graft. J Plast Reconstr Aesthet Surg. Dec;65(12):1618-21







How to Cite

Innocenti A, Melita D, Innocenti M. The use of resected SMAS as autologous graft for the correction of nasolabial folds during rejuvenating procedures: SMAS autologous graft for nasolabial folds corrections: a renewed “old-school” technique. Acta Biomed [Internet]. 2021 Nov. 3 [cited 2024 Jul. 25];92(5):e2021299. Available from: