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If Facelift Results Are the Same Why Would I Invest More Recovery Time and Money?

If a lateral SMASectomy with platysmaplasty can be performed under oral/local in about 2 hours with much shorter recovery AND the same long lasting results why would anyone undergo a deep plane procedure at twice the surgical time, twice the cost and and a longer recovery? Since few surgeons answering here perform the deep plane routinely it must mean that their patients have the same long lasting results with less invasive procedures.

Doctor Answers (10)

Facelift, Brow lift questions

+3

Dear Grace60,

 

I noticed that you have over the last two, three  weeks asked several very specific (technical) questions about face and brow lift.

It appears that you are just not sure if and how your facelift/brow lift should be done. Most of us Plastic Surgeons have ample experience to give you a rejuvenated face you will be happy with for years to come. The technical details are not so important. You just need to make a decision if you want a surgical procedure or not. You have to find a surgeon you feel confident with and discuss your expectations "one-on-one". Our Forum cannot replace a personal consultation and examination. As already mentioned it is not the "road but the destination" which is important. How you look and feel at the end is more important than how the surgical moves were done to get you there.

Make a decision and I think you will be very pleased with your result.


Evansville Plastic Surgeon
5.0 out of 5 stars 9 reviews

Depends

+2
Grace60: I recently wrote a book chapter on facelifting and read all of the scientific publications comparing SMAS and deep-plane facelifts.  Deep-plane facelifts probably allow the removal of a little more skin, and as a result, probably have a slightly lower revision rate.  The potential downsides of a deep-plane facelift are that the nerve that moves the face is at slightly higher risk, and there is probably a more prolonged period of swelling afterwards.  A surgeon that does alot of deep-plane lifts can do it in about the same amount of time as a SMAS-type lift (2.5-3 hours).  A SMAS-type lift is not inferior though...A well-performed SMAS-type lift (+/- platysmaplasty depending on the patient) can certainly give real, natural, long-lasting results.  Hope these thoughts help, and best of luck. 

Garrett Griffin, MD
Minneapolis Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

SMAS facelift

+2

Thank you for raising an interesting question.  Most people on this forum would agree that there is a significant difference between various types of facelift in terms of extent of rejuvenation, longevity of results, duration of recovery, and how natural the results might appear.  When researching the options for facial rejuvenation many patients make a mistake (in my opinion, of course) of searching for that one "good" facelift that will be highly superior in quality over the other "not so good" ones.  However, one should remember that there is no such thing as a "bad" facelift.   Each method of facial rejuvenation was created to meet very specific aesthetic needs and will work perfectly if used in the right patient.  Each type of facelift is designed to work for a particular type of facial structures, specific skin quality, extent of aging, etc.  Just to give you an example, consider a difference between a 35-year-old photo model who is concerned with her early jowls and a 75-year-old sun worshiper whose face drooped after loosing 50 lbs.  Each of them would need a very different procedure to improve their skin laxity and hardly anyone would try to use the same type of facelift for both of them.  If you are looking to get the best possible facelift result, I would advise you to look not for a particular procedure (such as SMAS lift), but for a surgeon in your area who is well familiar with a variety of facial rejuvenation techniques.  Let him/her select the best facelift for you.  After all, be it a SMAS plication, MACS or a Deep Plane facelift what you care about is not the name of your procedure, but the result.

Konstantin Vasyukevich, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

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Deep Plane vs SMAS Facelift

+2

The answer to your question, "why would somebody do a more invasive procedure to achieve the same result",  is very obvious - they wouldn't! However your assumptions are not correct; the 2 procedures do not produce the same result nor do the results last as long. There are many variables in deciding what technique should be used during a facelift. Patients need to see results using different techniques in patients who look like them before surgery.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 15 reviews

deep plane facelift versus SMAS

+2

 We do not recommend a facelift be done under oral sedation, for patient comfort and safety. Board-certified physician anesthesiologists perform  general anesthesia in our outpatient facility. With the facelifting procedure most patients have visible bruising and swelling for approximately 2 weeks after the procedure. Deeper procedures can have extended swelling since there is more  manipulation of the deeper layers of the face.   We  perform a  modified SMAS facelift with deep plane dissection in the neck to remove the sub-platysmal fat, when present.   For examples, please see our facelift  photo gallery below

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Deep Plane SMAS or High SMAS Facelift Longevity

+1
The subSMAS facelift is a very effective technique which does deliver a longer lasting and more natural result. Problem with the technique, is less cosmetic surgeons are comfortable with it and even more are less comfortable with the added time. Tension on the SMAS laterally has a better stress relaxation profile as compared with the skin and the central SMAS. Not all facelifts are the same.

Andrew P. Trussler, MD
Austin Plastic Surgeon
5.0 out of 5 stars 15 reviews

Type of facelift

+1
Hi. By 'deep-plane' do you meant subperiosteal? - there is no doubt that these deep plane lifts have a longer postoperative recovery. Most patients do not require these for a good result. As long as you are seeing a Board Certified Plastic Surgeon who performs a lot of facial surgery he will be able to guide you as to which operation he feels would give you the best result. All the best with your choice.

Charles Cope, MD
Sydney Plastic Surgeon
5.0 out of 5 stars 2 reviews

Type of facelift

+1

The different facelift procedures suit different patients and different surgeons differently. Sometimes the surgeon is convinced that one technique provides better results than others. In some instances, patients are better candidates or would benefit from one procedure more than another. This can be dependent upon their goals and their exam. Without an examination, it is impossible to determine which technique would benefit you the most.

Patti A. Flint, MD
Scottsdale Plastic Surgeon
4.5 out of 5 stars 32 reviews

Differences between SMAS plication/imbrication and deep-plane rhytidectomy

+1

While the motivations and reasons for surgeons performing a particular procedure versus another are multifold, one of the considerations is the potential for complications between procedures.  Surgeons tend to advocate procedures they feel comfortable performing, and in general the deep-plane lift can carry a higher risk of complications when performed by surgeons not experienced in it.  Every surgeon weighs the risks versus benefits of a particular technique in their hands when choosing which one to perform.  

For surgeons adept at the deep-plane lift, it can be performed in close to the same amount of time as a SMAS imbrication facelift.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

If Only Facelift Results Were the Same

+1

There are several assumptions made in this question that require explanation.  Although it is true that the classical deep plane facelift (as described by Sam Hamra) is used less frequently in the past, many aspects of the procedure are still utilized by Surgeons.  First it is important to understand that the lateral SMASectomy sits in the category of facelift procedures known as plications.  In plication procedures, the SMAS is not lifted, but folded over on itself and sutured.  The deep plane facelift, composite facelift, and other extended SMAS procedures are known as imbrication procedures.  SMAS imbrications require elevation of the SMAS and re-suturing of this layer under tension, similar to lifting a bed sheet and resetting it with a greater pull.  Although it is true that some patients who have a lateral SMASectomy will have a nice result, it is my opinion that these patients are generally younger and with fewer aging indications.  In my experience, those patients who have more signs of aging (such as we see in SW Florida), benefit more and for longer with SMAS imbrication techniques.  Since imbrication techniques require more dissection, they take longer than plication (lateral SMASectomy) techniques with slightly more recovery time.  At the start of my career, I utilized plication techniques more heavily but found the results to be less durable and have switched for the most part to a modified composite approach.  Ultimately, it is better to utilize the right approach for the right patient and to understand that quicker and less invasive does not correlate with better.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 38 reviews

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.