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Is the Method of Fixation Different for a Facelift?

asked 4 months ago by NHaven in Oklahoma City, Oklahoma
Latest answer by Teanoosh Zadeh, MD
Question viewed 256 times
Tags: longevity, normal, SMAS, technique

where the SMAS is elevated by plication (folding) rather than imbrication (trimming)? I the tissue fixed onto itself or into the bone? There seems to be a difference of opinion regarding technique ad longevity; and, this is very important to a patient! I know everyone's skin differs, but photos are not reliable since every doctor takes them at a different phase of recovery.

22 answers to Is the Method of Fixation Different for a Facelift?

SMAS Fixation and the Duration of a Facelift

You correctly describe the difference between SMAS plication and imbrication. In both techniques the adjacent SMAS layers are sutured to each other, not to the bone. I use both techniques depending on the facial contours of the patient but don't feel either results in more longevity when properly applied. Pictures will help you evaluate results if you see patients who look like you and ask when the pictures were taken.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon

www.bevhills.com

Fixation Techniques in Facelift: Important or Not?

Imbrication means lifting up or dissection underneath the SMAS and suturing of the SMAS flap to the fascial layers (under tension) to achieve a lift. The key in any imbrication technique is release of the deep facial ligamentous structures to allow for more complete mobilization. Some Surgeons take this step and some don't. If this element of dissection isn't completed, there isn't much difference between a mini imbrication and a plication (folding over of the SMAS)... more

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon

www.drprendiville.com

Is the Method of Fixation Different for a Facelift

When an imbrication or folding over on itself is done, the sutures go into the tissue directly below it, and not in the bone. The same goes when you are lifting and excising excess SMAS. There is only one place where a stitch could be placed deeply to the bone and that is in the lateral cheek temple area and the possibility of injuring a nerve is high so it is not done. Even it were done, the stitch can break off the bone or tissue in the same way. Since the materials used to fixate the... more

Julio Garcia, MD
Las Vegas Plastic Surgeon

lvcosmeticsurgery.com

Technique is one factor to longevity of facelift results

Some surgeons perform imbrication and some perform plication. Trimming excess fascia, suturing down from a fascia-to-fascia layer is extremely important for longevity of the facelift. Another important factor in the longevity of facelift results is skin tone, which become lax with age. The first signs of aging after a facelift is due to skin laxity. So a patient with good skin tone will have longer lasting results than a patient with poor skin tone. more

William Portuese, MD
Seattle Facial Plastic Surgeon

www.seattlefacial.com

Best method of face lift

In general the best method is the one that gives the best results with the least amount of risk. Proper mobilization of a SMAS flap (through imbrication) using permanent sutures gives a better result than plication

Sam Naficy, MD
Seattle Facial Plastic Surgeon

What makes a facelift last

By fixation I think you mean what is done so the facelift will last. We all understand the importance of the deeper tissues or SMAS to support and maintain the lift. The SMAS can be raised and overlapped to give a broad area of adherance, or can be trimmed or imbricated so that it heals firmly to itself. The key is that sutures will be temporary and longevity depends on tissue to tissue healing. Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon

SMAS- Plications

This a very good question. The smas is usually sewn to itself. This is a very strong deep structure that maintains strength over time. Plastic surgeons may use permanent or temporary sutures to accomplish this task. see video

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon

www.dr-delgado.com

Facelift methods

There are many different ways to do a facelift. It seems the most important way has already been addressed by your plastic surgeon--meaning that some type of SMAS procedure will occur during the operation. Plastic surgeons have been arguing for eons about what makes a lasting or better facelift. They literally come to blows about it at national meetings. Plication and imbrication are basically the same thing so I wouldn’t get too caught up with those. ... more

Mahlon Kerr, MD
Austin Plastic Surgeon

Facelift techniques

Dear patient, There are different techniques described for face lifting. However, generally speaking a face lift should include some form of manipulation of the SMAS. Techniques include imbrications (folding), trimming, and flap elevation. The method of fixation is another variable but not an essential component of the surgery.

Teanoosh Zadeh, MD
Montreal Plastic Surgeon

Smas

There is much disagreement among plastic surgeons regarding the best treatment of the SMAS during a facelift. I perform imbrication instead of elevation and trimming.Extensive elevation of the SMAShas a higher risk of injury to the facial nerve and there is no evidence that it has better longevity. Base your selection of surgeon on your overall impression of the quality of work they do, independent of how they deal with the SMAS. After all, the most important thing is the... more

Ronald J. Edelson, MD
San Diego Plastic Surgeon

The tissue is fixed differently

Some plastic surgeons will excise a portion of the SMAS and then re-approximate it with either permanent or absorbable sutures. When the tissue is plicated as in a MACS lift small bites of the SMAS are taken and then sutured to the deep fascia which is not mobile. This anchors the SMAS more reliably than suturing it to itself. Most well-trained plastic surgeons utilize three or four different techniques depending on the patient's needs. Some facelifts are done subcutaneously without any... more

Joseph M. Perlman, MD
Houston Plastic Surgeon

doctorperlman.com

Facelift Techniques

There are several methods of repositioning and fixing the SMAS layer. Fix technique will determine to a degree the longevity of the procedure. It is best to visit with several plastic surgeons and discuss their technique. I will have to go with the surgeon you feel most comfortable. Dr. ES

Earl Stephenson Jr., MD, DDS
Atlanta Plastic Surgeon

SMAS Options

I believe that each case ( and even one side of the face vs. the other ) is different, and therefore individual analysis is the best approach- and thereforethe best answer to your question. I would get an options from several different surgeons and select the one that discusses and reviews why they would utilize a specific technique.

William Loutfy, MD
Albuquerque Plastic Surgeon

SMAS plication versus excision and advancement for Facelift

Yes, you are right. There are a lot of different opinions regarding SMAS plication, SMAS excision and advancement, deep plane vs. not deep plane for facelift surgery. The results of the Facelift depend greatly on the skill of the surgeon and the ability of your tissues to heal well to each other. Each of the above techniques works well in good hands. Also, regarding longevity, if you are vigilent about avoiding prolonged exposure to the sun, not smoking, no significant weight... more

J. Jason Wendel, MD
Nashville Plastic Surgeon

www.mc.vanderbilt.edu

Is the Method of Fixation Different for a Facelift?

I have been performing Face Lifts for well over 22 years and I really do not believe that plication, teathering or any fixation method is as effective as imbrication (dissecting, lifting, trim and re-suture) of the SMAS during a Face Lift. IMHO, these other plication and fixation methods are easier and quicker to do but not as effective and for that reason, I would not use them for Face Lifts. Be sure that your Face Lift Surgeon understands and follows the proper aesthetics of... more

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon

Types of Facelifts

There are many types and techniques to doing a "facelift" surgery. The most long lasting and natural results are those that reposition tissues and allow those tissues to heal in that position. Relying on a suture or a thread or some other device makes "less invasive" techniques much more prone to failure. Repositioning the SMAS is now the most accepted way to maintain a lift. This can also be done in different ways with great results.... not one... more

Henry Daniel Sandel IV, MD
Annapolis Facial Plastic Surgeon

SMAS fixation during a facelift

SMAS fixation during a facelift: most studies show that this layer is very strong it can be imbicated (folded) on itself for volume plication is similar it can be elevated lifted and trimmed it can be sewn as a purse string MACS method it depends on the experience and preference of the surgeon

Jed H. Horowitz, MD
Orange County Plastic Surgeon

www.pacificcenterplasticsurgery.com

Facelift fixation

You are right photos may be taken at different times and the timing of the photo will definitely affect the appearance of the patient. One of the main advantages of a facelift procedure performed by a board certified plastic surgeon is that it offers a tremendous ability to improve the aging signs of the face and neck and gives a very long lasting result. There are many very good plastic surgeons who get great results doing the same basic operation but they each perform various... more

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon

Facelift fixation methods.

The answer you are searching for will not be found that way. There are so many variables--that is why we do specialization. The way to find out the best way is to meet with the surgeon's patients who are similar to you--that is where "the rubber meets the road".

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon

Facelift Techniques

There are many facelift techniques and none is "better" than the others. Each patient must be evaluated individually and the specific procedure tailored to their individual anatomy. folding of the tissues may be used to add additional fullness over the cheek bone, while trimming may be used to allow for a nice pull while not adding too much fullness or volume to the area. Good Luck.

David Shafer, MD
New York Plastic Surgeon

www.ShaferPlasticSurgery.com

Methods of fixation of the SMAS

Thank you for the question. It is a very complicated one without consensus. If you get two plastic surgeons in a room and ask them that question you would get 10 opinions. Most important is that some form of SMAS manipulation is combined with limited skin excision. I perform all types of SMAS lift and base what kind on a multitude of factors including but not limited to skin elasticity and thickness, width of the face, and amount of surgery necessary to improve the neck. When patients ask me... more

Jacob Freiman, MD
Miami Beach Plastic Surgeon

These are technical details.

Sometimes we end up focusing on technical details because we don't know what to focus on. A great facelift that looks serene and natural is a work of art that requires sophisticated tailoring of the flaps. What was done under that flap and precisely how it was done is less important. Studies have shown that after 6 months it is impossible to guess which method was used anyway. What does not go away is the tailoring. Done well, a great facelift is the single... more