I have been to two cosmetic surgeons. One says necklift and plastyma muscle that includes midface (Smas). The other says can do necklift with plastyma muscle and fill mid face with fat transfer. Or Necklift with SMAS and cheeklift with suspension system. I am so confused as to the difference between a lower face lift and a SMAS facelift? Help!
What's the Difference Between a Lower Facelift and a SMAS Facelift?
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Facelift vs. SMAS Facelift
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Facelift names and terminology
A lower facelift includes a SMAS lift and is the facial component of the lower face/neck lift. A neck lift only addresses the neck itself by tightening the platysma muscle and removing fat. We do not perform mid facelifts and do not recommend a cheek lift with any suspension systems since they are only temporary.
A comprehensive face/neck lift performed by a board certified facial plastic surgeon with many years of experience is probably going to be your best alternative. This includes the SMAS facelift that addresses the neck and jowls. Fat is removed above and below the platysma muscle, the muscle is then tightened, transection of the anterior platysma cords is done along with tightening the neck muscles at the jawline.
Lower facelift vs. SMAS facelift
It is very difficult for patients to decide on what facelift procedure to choose. One surgeon's SMAS operation is equivalent to another doctor's minilift. It is better to choose an expert facelift surgeon than to choose a particular technique. I think my colleagues would agree that this applies to most procedures in plastic surgery.
Technically SMAS refers to the deep layer or "muscles", even though it is not muscle tissue except for a few fibers at the jawline.
The "lower facelift procedure", however, is specific to the lower face. It does not rejuvenate the upper face. Therefore a dysharmony can be created with a tight neck but medium jowls and drooping upper face in patients who just have a lower facelift done.
Remember this is your face. Do the right procedure, the best procedure, not just what might be the cheapest or the most convenient.
We prefer complete SMAS preservation procedures, not incisions and tightening of the SMAS with removal of SMAS (depleting the face further of volume) or SMAS-ectomy procedures. We believe this maximizes volume retention and redistribution to the upper face. We also do not believe the skin and the SMAS should be tightened in the same direction, or alterations in the hairline occur.
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Facelifts - What's in a name?
Wyou are not alone. The terminology in facelifts for the consumer has become very convoluted and difficult to decifer. Very often I see patients coming to see me who 10-15 years minifacelift. To them, this meant theydin'tt have a browlift or their eyes done. So don't geterr therms
Thhink ofthe SMAS as a thick layer under the skin and fat. Tightening this layer helps the entire face and neck. The platysma is the muscle that forms the 2 vertical bands in the neck from the chin down to the chest. Tightening or repairing this will improve the neck and jawline. The incisions like lower face, short scar, S-lift, MACS lift etc. are all ways to redrape the skin to take out the extra skin from tightening the face. Look at the results of his work by seeing photos of patients with mild to severe deformities (aging status) and then decide which results sre the best.
Find a surgeon you trust and listen to what he or she is trying to do. Sometimes a little more incision gives you alot more result. Don't be consumed by the different names. Good Luck
Not all facelifts are SMAS
The SMAS is a complex structure of the face that is the supporting muscle and tissue of the face. Many facelifts are performed by lifting and tightening the skin that gives it a pulled stretched skin appearance. Lifts that tighten this SMAS result in a more natural and longer lasting result.
SMAS and Platysma in a Facelift
The Platysma is the muscle that lies just under the skin in the neck area. The platys ma is typically pulled and tightened to eliminate the sagging skin of the neck. It also takes the tension off the skin incision to prevent healing with stretch marks.
The SMAS ( SubMuscularApenueroticSystem) lies just under the skin in the face. The SMAS is contiguous with the Platysma in the neck. SMAS is also tightened to lift the jowl and sometimes the midface (esp. deep plane facelifts).
If your issue is the jowl and neck, then tightening the platysma and SMAS is the way to go.
Difference Between a Lower Facelift & SMAS Facelift
The difference is that a lower facelift includes a lower face and necklift and is synonymous with a SMAS facelift as I do a multiple layer “Lift & Fill” facelift which is both a SMAS facelift and lower face/necklift. It is sometimes confusing to the consumer, but a real facelift consumes the superficial and deep facial layers with repositioning and shaping, as well as “Lifting & Filling” to correct aging and to restore your natural facial appearance.
Lower Facelift Versus SMAS Lift
There are many different types of facelifts. It is sometimes better to focus less on semantics and more on what is anatomically being done. A lift should focus on the area(s) which require rejuvenation which can include the neck, platysmal bands, jowling, cheek pad, shape of the face, etc.
There are no standardized terms for the facelift techniques. Most patients would be better served by focusing on the results they see from different doctors and which they like best than to focus on the "name" of one procedure vs another.
A lower facelift is one that addresses the face from the cheeks to the neck. A SMAS lift is often done at the same time as part of the lower facelift. The SMAS portion is what is done to lift the deeper tissues of the cheek back up to where the descended from in aging.
Again, try to find the doctor whose results most impress you and don't dwell too much on the terminology.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.