Assuming that a surgeon believes (as I do) that lifting and repositioning the SMAS is very important to obtaining an outstanding result, the next question becomes where on the face should the surgeon make the cuts in the SMAS to be able to move the SMAS in the most advantageous manner.
A high or low positioning of the SMAS incision can substantially impact the results of a facelift. If the SMAS incision is positioned below the zygomatic arch, it cannot lift the mid-face or the area underneath the eye socket. This causes improvement only in the lower cheek and jowl. In order to create elevation in the upper and lower cheek, orbital area, and jowl, the SMAS must be lifted higher on the zygomatic arch and pulled medially onto the tissues of the mid-face. When the SMAS is lifted higher, the upper cheeks appear fuller, the lower eyelid and infra-orbital region are rejuvenated, and nasolabial folds are less noticeable. If additional volume is needed in the mid-face or orbital area, fat injections can be administered.