A SMAS by any other name...

Dear Susie,

Have trust in your surgeon, especially if he/she is a board certified plastic surgeon.  Your surgeon will be able to define which procedure, in his hands, for your situation, will provide the most dramatic results.  It is as surgeon dependent as it is patient dependent.  Also, consider what your goals are regarding dramatic.  Some of the deeper plane facelift techniques (subperiosteal, sub SMAS) may indeed cause such dramatic changes that your facial structural appearance is altered.  Discuss these issues in depth with your surgeon, who should be able to guide you in the right direction.  Good luck.

I can't answer for "dramatic,"  but a SMAS facelift if done correctly will probably look better than a platysma and SMAS plication. This is because a SMAS facelift  elevates the tissues and detaches certain ligamentous attachments that allow the soft tissue around the mouth and cheek to be placed in a more aesthetically pleasing position.   The PSP doesn;t really allow you to do that.

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The names can be confusing. There are mini-, mid-, smas- deep plane- facelifts and now platysma smas plication facelifts. What they all have in common is the desire to address the sagging structures of the aging face.

From the outside inward, there is excess and sagging skin. This skin is most obvious in the marionette lines and jowls on the face as well as the waddle under the chin. The only way to treat these problems is by removal of the skin. Sometimes, we can be confused by deeper tissues sagging, which is interpreted as sagging skin. The reason why this recognition is important is because, deeper tissues can be tightened through minimal incisions.

The deeper tissues referred to above are the SMAS (submusculoaponeurotic system) and the Platysma muscle of the neck. These tissues are responsible for the shape and intact nature of the substructures of the face. They will sag and make the overlying structures look saggy as well. These structures can be repaired by tightening them and putting them back where they were before gravity and aging took over. Plication implies that the structures are cinched tighter and sutures are placed to hold them in the new position. This plication does not give the same a mount of correction as does the technique whereby the SMAS and Platysma are lifted off the connecting tissues and pulled in the desired direction. So in effect, plication is good for more moderate deformities.

A couple of warnings. 1- All facelifts should avoid the pulled look by lifting the SMAS vertically - not horizontally towards the ear. 2-All incisions should be performed without tension to avoid an unnatural pull on the ear, displacing the lobe forward.

Robert M. Freund, MD, FACS

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