Facelift technique: Skin only pull vs Muscle pull
Doctor Answers 14
Is a skin lift useful?
Tightening the smas
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SMAS vs. Skin Only Facelift
Samir Shureih MD.FACS
There are many different ways to get great results in a facelift procedure
SMAS Lift is the better Option
The first techniques attempted utilized pulling of only the skin. Early on it became apparent that pulling of the skin alone led to early recurrence and excess scarring - not an ideal outcome. Other techniques have been attempted with a modicum of success. The most prominent of these other procedures is the deep plane technique whereby the entire sandwich of tissue (Skin, fat, muscle and fascia) is lifted together. This technique leads to a large amount of swelling but an early recurrence of the signs of aging. But most importantly, this technique does not allow us to lift the tissues vertically.
The process of aging is caused by gravity, facial animation, stresses on the skin (weight gain, smoking, drinking, sun damage and age). The combination of gravity and facial animation pulls the tissues of the face in a downward and inward direction. Smiling reverses the sag - so look in the mirror and smile to see where your facial tissues use to be and where you hope that surgery would replace them. It is for this reason that the SMAS lift should move all tissues in a vertical direction - put the tissues back to where they once were.
So with that said, what are the risks and benefits of the Vertical SMAS Facelift.
- More natural lifting of the fascial tissue avoids the windblown or pulled look of many other techniques.
- Vertical lift adds to the volume of the cheek, removes the jowl and marionette lines to yield a more oval face.
- Vertical lift often eliminates the malar depression or tear trough.
- The SMAS facelift has a lower risk of facial nerve injury than the deep plane facelift and recovery from swelling is significantly shorter.
- Perhaps the only really increased risk relative to other techniques is the risk of bleeding or hematoma. The creation of two flaps of tissue can result in an increase risk of bleeding. But these small blood clots under the skin are still infrequent and ultimately resolve.
- All facelift procedures have risks to the sensory and motor nerves of your face. This technique does not have the same risks as a deep plane for motor nerve injury.
- A SMAS facelift does not address the forehead (Brow lift) or the lower lid bags (Blepharoplasty) but they are often performed together.
If you would like more information on facelifts, please read my book " A More Beautiful You - Reverse Aging Through Skincare, Plastic Surgery and Lifestyle Solutions".
- It would be best to get the answer out of your surgeon
- If you have seen before and after pics of patients that have similar anatomy, then this may be indicated
- For a full facelift, we usually tighten the skin and muscle to get the most natural result
- A second opinion may help you get piece of mind
SMAS vs Skin-only Facelifts
Earl Stephenson Jr, MD DDS FACS
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.