Is a composite facelift worth the extra risk over a SMAS facelift?

Thank you for your question.  Both SMAS and composite facelifts can produce wonderful results and turn back the clock, making your face look years younger.  However, I would caution you against choosing the type of facelift based on your own research.Each facelift method was designed with a specific face in mind. For some, SMAS facelift would do wonders.  Others, might need the added benefits of a composite facelift.  Unfortunately, there is no easy way of figuring out which type of facelift would be the best for you, unless you consult a facelift expert. Do a thorough research, look at many before-and-after photos and choose a best facelift specialist you can find.  Once you found the right doctor, explain to them what result you wanted to achieve and let them choose the best way to accomplish it.Good luck!Dr. Konstantin

There are numerous facelift techniques and when performed correctly on the right candidates they seem to be relatively equivalent, though the comparison has so many variables that it is really hard to objectively compare. Even on identical twin studies, factors such as skin quality, sun exposure and smoking directly affect the result long term. When comparing facelift techniques, the majority are safe when performed by an experienced plastic surgeon. Most plastic surgeons will rely on one or two techniques primarily and refine their techniques based on their comfort level. Caution should be given to the plastic surgeon who is constantly changing techniques. That directly leads into what technique is more natural, and when the aging face is repositioned correctly and harmoniously which addresses the neck, jaw line, vertical midface lift, correction of the lower lid and excess upper eyelid skin and brow position, the face will be set up for a natural result no matter what technique is used. With the manipulation of the SMAS with repositioning rather than pulling, the facelift will last. I prefer a High SMAS technique which involves a deeper SMAS release, but enables a vertical vector of repositioning that lasts. I actually see the facial nerves and know what plane I am in, which helps to limit the risk of nerve injury. When performed correctly this does deliver a natural and more importantly predictable facial rejuvenation.  

There are a number of techniques for facelift surgery. The SMAS technique is quite common and usually predictable in result. However, techniques are often dependent on the surgeons performing them. One technique that may be better in one patient may not be indicated in another. Always discuss with your surgeon his or her rationale for your type of procedure. If it is one of the higher risk procedures, you have to discuss what the added benefits or advantages are for you.

Thank you for your question. There are many types of facelifts available to the modern day plastic surgeon and there is no clear evidence demonstrating that one technique is superior to another. Rather than choosing a technique you should choose a plastic surgeon based on trust, a mutual understanding of your goals and expectations and a track record of good results.Best of luck!RegardsDr Guy Watts

Composite facelift and SMAS facelifts are both good techniques in the right hands.  I think the risk of a composite facelift outweigh its benefits to achieve the same end. 

The question you pose is an excellent one. There is much confusion in
the use of words such as deep plane and SMAS as these mean different
things to different people. Usually when a surgeon refers to a SMAS
facelift they are referring to an extended SMAS flap like James Stuzin
is known for but some mean imbrication or SMAS-ectomy. I once performed
only SMAS flap lifts but have evolved to a special modification of a
deep-plane composite lift for many reasons including those you have
noted. In my opinion the important value of a composite deep plane lift
is that the skin flap and SMAS are not delaminated and weakened. the
SMAS and skin come up as a composite unit and are tensioned on
appropriate vectors with all support being deep. This results in truly
tension free skin and a natural drape , quicker healing and recovery
than I have ever seen with a SMAS technique that completely elevates
skin flaps. With composite technique I have not seen a hematoma and the
scars heal quickly to near imperceptable. This is a more advanced type
of facelift and requires sufficient comfort with facial anatomy to work
in the plane of many branches of the facial nerve. Most surgeons that
perform these techniques feel very comfortable in this plane and one can
directly observe that the nerves are out of harms way. I actually feel that composite facelifts have less risks if the surgeon is aware of anatomy.  Much less vascularity is disturbed and if the premasseteric space is enterd directly it is a loose areolar plane with the nerves emerging on the deep wall where they can be clearly seen before encountering them.  The view of upcoming nerves through an extended SMAS technique can be easily obscured and frequently the nerves are never seen putting them at theoretical risk from blind suture placement.  There are many
different ways to get a good result in face lifting. IThe details of vector adjustment and extended dissection must be customized to the details of each individual patient's face.  I hope this helps!All the best,Rian A. Maerkcs M.D.

The answer is that it depends on who is doing it.  For an experienced Facelift Surgeon neither approach to the procedure should place a patient at significant risk for facial nerve injury.  There are a variety of SMAS techniques which relate to whether the SMAS is sutured without elevation (plication), or elevation and suturing (imbrication).  The composite technique is a form of imbrication, but it differs from standard imbrication in that the skin and SMAS are elevated together. I personally utilize the composite technique for initial elevation of the SMAS, followed by later skin separation to allow for a slightly different vector between skin and SMAS.  I feel that the results are very natural, but I have seen excellent results from well trained colleagues who use a bilaminar SMAS approach.  This returns to the point that the single most important factor in a patient's outcome is not the method of SMAS handling, but the skill and experience of the Surgeon involved. I recommend that you ask to see a few dozen results and make your decision based on your comfort level with the Surgeon.

After more than twenty years of practice in cosmetic surgery. Plastic surgeons spend many hours and days in each conference and meetings discussing the facelift and what every one does , what works and does not work. There are many variation to the facelift, and what goes with aging, Each one of us ages differently than the other, that what makes us humans. We analyze each face, each line, and how to correct it. At the very end, there are a variety of procedures that work well, each has its pluses and downfalls. The secret is to analyze the facial aging, choose the right procedure for each line and aging aspect of the face and customize the facelift by taking what works for each line and apply it to the particular face. Facelift has the skin facelift, the SMAS flap, the SMASectomy, the SMAS plication, the SMAS lateral lift, the SMAS deep plane, the SMAS composite lift, The sub-periosteal lift, and many other variations. the art is the right surgeon with knowledge of all the above facelift procedures, the knowledge of analyzing the aging process and then applying the right procedure for each aspect of the aging process particular to that face. Then the experience of the surgeon, and the technical expertise.

 A comprehensive lower face neck lift  involves tightening the facial muscles, tightening  the  platysma muscle in the neck in 3 locations, removing fat deposits above and below the platysma muscle, and tightening loose facial and neck skin. The nuances of a SMAS facelift are too technical for patient's to understand, so it is better to pick your surgeon, not your SMAS procedure. For many examples of SMAS face lifting, please see the link below

A SMAS lift or a composite lift.  Either one can give you a good result but there are many factors that contribute to the longevity of a facelift.