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In his commentary on my “Total Composite Flap Facelift and the Deep-Plane Transition Zone: A Critical Consideration in SMAS-Release Midface Lifting,”1 Dr Sam Hamra characterized my article as a “deceptive infringement” on his own “composite facelift.”2 I know that contemporary facelift surgeons stand in debt to Dr Hamra as a pioneer of SMAS-release facelift procedures. However, his critique stems from a fundamental misunderstanding and I take umbrage at many of his remarks. My article is neither a deception nor an infringement. I stand by my technique, its results, and its originality, as well as the potential value and novelty of my analysis.Dr Hamra's main critique is that my technique is not a “composite facelift.” This is true – but that claim is never made in my article. It is beyond a mere point of semantics that I refer to it instead as a “composite flap” facelift. I am using “composite flap” in its strict sense of plastic surgical anatomy: a flap which contains two or more elements, usually skin, muscle, and/or bone.3Consistent with this usage, Tim Marten and Gerald Pitman have both (in recent textbook chapters) referred to the lateral dissection of a one-layer SMAS-release flap as a “composite flap,” outside of the context of a “composite facelift.” 4,5 From Marten: The high SMAS procedure can be performed using a two-layer lamellar technique with separate skin and SMAS flaps as advocated by Connell, or using a one-layer composite flap as practiced by Barton.”4Dr Hamra states that my technique is neither “total” nor “composite,” but it is the addition of a musculocutaneous (Skoog) flap in the neck in contiguity with the one-layer facial flap which led me to use the term “total,” and Skoog's original technique as published in 1974 has been …

aesthetic surgery journal

Response to “Commentary on: Total Composite Flap Facelift and the Deep-Plane Transition Zone: A Critical Consideration in SMAS-Release Midface Lifting”