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During a Full Face and Neck Lift Which is More Effective: SMAS Plication or SMAS Trimming?

asked 7 months ago by NHaven in Oklahoma City, Oklahoma
Latest answer by Babak Azizzadeh, MD
Question viewed 203 times
Tags: effectiveness, technique

Direct sutures or suspension (NOT thread) sutures into the SMAS? What has been your experience long term?

13 answers to During a Full Face and Neck Lift Which is More Effective: SMAS Plication or SMAS Trimming?

+3

Appropriate technique for SMAS facelift

My opinion is that no technique is as effective and capable of creating a natural appearance as selective SMAS dissection and suspension. The decision to conserve or trim SMAS is made on an individualized basis. I see imbrication and plication without dissection as a shortcut that dampens the response to the intervention. That being said, an excellent surgeon with a different preferred techniqaue will deliver a superior result to a poor surgeon using the best technique... more
Rian Maercks, MD

Miami Plastic Surgeon
+2

Both SMAS Plication and Resection are Effective - It's the surgeon that counts

Over the past two and a half decades I have had the opportunity to do both SMAS excision and SMAS Plication facelift procedures and have found no difference in results.Both Techniques are effective. This has also been written about and discussed at our annual meetings. The bottom line is that "great surgeons get great results" which don't seem to be specific technique dependent. Probably most important factor of all is in fact the skill and... more
Larry S. Nichter, MD, MS

Orange County Plastic Surgeon
+2

SMAS plication vs trimming

SMAS trimming with tightening is always better than plication since the fascia layer is actually advanced and tightened more significantly than just simple plication.
William Portuese, MD

Seattle Facial Plastic Surgeon
+2

Effectiveness of Various Facelift Techniques

With SMAS plication no SMAS is excised. Following SMAS imbrication excess tissue is usually removed. However, as I have said before, pick the surgeon and not the technique. Facelift is a very generic term - there are many procedures and variations of those techniques. Find an experienced surgeon whose results you like in faces that resemble yours.
Richard W. Fleming, MD

Beverly Hills Facial Plastic Surgeon
+2

SMAS - Let the surgeon choose the technique

You are not really asking the appropriate question. There are many maneuvers that can be done on the SMAS layer, and the decision making process is much more complex than "which is more effective." For instance, in someone who has a very thin face where I want to maintain as much facial volume as possible, I am more likely to perform imbrication / plication on the SMAS layer rather than any excisional technique (SMASectomy or advancement flaps). For someone with a... more
Michael A. Bogdan, MD

Dallas Plastic Surgeon
+1

SMAS plication and SMAS trimming during a facelift

Whether a surgeon uses SMAS plication or SMAS trimming depends on your aging process. Incorporation of the SMAS Layer is paramount during a facelift or neck lift. How it's used will depend on the surgeon and the individual's aging process
Babak Azizzadeh, MD

Beverly Hills Facial Plastic Surgeon
+1

SMAS options

The procedures are really not interchangeable. In people with full round faces you are best to trim the SMAS and mere plication can make them look more round. In thin faces you like to imbricate the SMAS to add volume to places where it has been lost. Properly done with stitches that are not too tight, they should both last equally as long.
Julio Garcia, MD

Las Vegas Plastic Surgeon
+1

SMAS plication vs trimming

I prefer SMAS trimming and imbrication to tighten the SMAS layer, though some surgeons have very good results using plication. Like many of the others here have written, I would focus more on your potential surgeon's long term end results (Are the results durable and natural?) rather than the specific technique used.
Thomas A Lamperti, MD

Seattle Facial Plastic Surgeon
+1

SMAS

The manipulation of the SMAS is an excellent way to give natural results with a facelift. Both techniques are equal but should not be used on all patients. Anyway who says only one technique is best does not know how to perform both techniques. The same is true for cranial suspension sutures. There is the correct procedure for each patient. To say one procedure is superior assumes all people have the same faces.
Jacob Freiman, MD

Miami Beach Plastic Surgeon
+1

Options for the SMAS

I agree with most of the opinions on this topic. The results are more important than the technique. How the SMAS is manipulated is largely dependent on the specific needs of the patient. I wouldn't get too wrapped up in the details. Some surgeon get great long term results with plication, others with impbrication, others use a composite technique etc. I would look at the before and afters and get a look at their long term results as well and use this as a guide rather than specific... more
Todd C. Miller, MD

Orange County Facial Plastic Surgeon
+1

During a Full Face and Neck Lift Which is More Effective: SMAS Plication or SMAS Trimming?

I have performed Face Lifts for over 20 years and the SMAS undermining and trimming (Imbrication) is the only effective and reliable method of dealing with this layer, IMHO. Folding the SMAS upon itself (plication) as well as the various suture or thread suspension methods may be easier on the surgeon but do not, IMO, have the same level of long term results.
Francis R. Palmer, III, MD

Beverly Hills Facial Plastic Surgeon
+1

Technical details beyond your understanding in facelifting

When you are asking questions like these, you are really missing the point as there are many ways to do a facelift. SMAS work is key but how you do it varies with each doctor and with each patient's anatomy. The key is to find the best doctor who shows you numerous (I'd say maybe 20 patients) early and long term results that you like and you will have found the right person for you. Don't get lost in the technical detailsas it is like getting lost in... more
Richard P. Rand, MD, FACS

Seattle Plastic Surgeon
+1

Smas plication or excision in face lifting.

Smas plication or excision in face lifting is up to the surgeon based on your aging pattern. You need to look at results, not techniques that you won't understand why they are used and when. Pick an experienced facelift surgeon for the best results.
Toby Mayer, MD

Beverly Hills Facial Plastic Surgeon

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