A PSP (platysma SMAS plication) lift initially is usually as powerful as a true SMAS operation without the same level of risk to the facial nerve and lymphatic drainage vessels. It is the procedure of choice in my practice because the recovery is significantly faster.
The procedure lifts the skin off the platysma muscle on the neck and SMAS layer on the cheeks/jowls and then plicates, or hems, the layers onto themselves with long-lasting or permanent suture (like one would cuff a pair of trousers.) The underside of the platysma or SMAS, where the branches of the facial nerve reside are not entered keeping the nerve safe in most cases. The lymphatic vessels below these layers are also undisturbed making recovery faster in general. Only one layer of scar (between skin and platysma/SMAS) exists however.
A true SMAS operation involves going deep to the SMAS in the cheek/jowl area and results in two layers of scar being formed: one between the skin and platysma/SMAS and the other under the SMAS itself. Theoretically, this should provide longer lasting results. The downside is that you also injure the lymphatic drainage vessels under the SMAS theoretically prolonging recovery from swelling.
Most surgeons dedicated to facelifting will be able to help you navigate these waters. The other things to think about are the elastic nature of your skin and and how much volume loss you have in your face, as it is important to address all the dimensions of facial aging: skin, muscle, fat and bone.
Good luck with your consultation.
Dr. Shah
