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.
Is the Method of Fixation Different for a Facelift?
Doctor Answers (23)
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 imbrications or the excision technique is the same, what varies is more of a selling point than a reality. I will say that if the stitches are placed under tension, they will not hold as long, but that can happen with both techniques.
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.
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
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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). In my experience for patients 55 plus, plication doesn't provide the longevity of result seen with imbrication. The type of suture varies with the experience of the Surgeon but is less critical than the previous point. My opinion is that a long lasting absorbable suture like PDS or permanent suture (Mersilene or Silk) provide the best results. As far as fixation points, I believe that the least common denominator is the strength of the SMAS. Although fixation to the root of the zygoma has been described, I am not sure that it offers any benefit to fixation to the lateral SMAS/ preauricular fascia. The most imporatnt variable is the experience and results of the Surgeon you choose.
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.
What makes a facelift last
Best of luck,
Peter Johnson MD
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.
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. There are also SMAS flaps and Cranial Suspension SMAS. The idea is to move the deeper layers of the face upward and back into position and then carefully lay the skin on top so that it is relatively tension free. The details can be confusing and I would try not to get too caught up in them. Instead I would see 3 or more board certified plastic surgeons in your area and see what they recommend for you. They might each have a different way to get the same result. If this is the case I would pick the one I related to best and go from there, because after you are into an advanced facelift with SMAS manipulation of some kind you are definitely on the right track. Hope that helps, Dr. Kerr
Methods of Fixation in Facelift
The truth is that SMAS plication or SMASectomy or any number of variants have less to do with longevity than how that technique is executed. Kenneth Hughes, MD Los Angeles, CA
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.