A stratigraphic approach to the superficial musculoaponeurotic system and its anatomic correlation with the superficial fascia

The superficial musculoaponeurotic system (SMAS) is not included in the International Anatomic Terminology, although it is a fundamental anatomical structure in plastic surgeons. In the literature, the concept of the SMAS is not clear, leading to repercussions in the treatment of the SMAS via the various techniques for rhytidoplasty. This review article, in its aim to conceptualize the SMAS, has as a referential parameter the basic stratigraphic pattern of the human body construction. A systematic review of the literature was performed through Medline, ISI-Web of Science, and Lilacs databases as well as through classical treatises of anatomy for analyses of the stratigraphic principle of SMAS and its relationship to the fascia. In fact, SMAS, an anatomic entity, is part of this construction model. The stratigraphic approach followed in this article to describe the SMAS is novel in the literature and allows for a unified anatomic understanding of SMAS for the scientific community.