Facial Widening with SMAS Facelift

Question

Four months after SMAS facelift my face is still wide where the SMAS was folded for suturing. Is there a reason why a surgeon elects to fold the SMAS rather than trim (SMASectomy)?

Thomas E. Kaniff, MD, FACS · Answer

Hi Oklahoma City2013-

	There are many different ways to handle the SMAS during facelift surgery - fold, excise, reposition, purse string, long flap, short flap, deep plane, etc. The choice of which to choose is determined by the patient's physical attributes and the techniques that work best in the hands of the particular surgeon.

	Sincerely,

	Tom Kaniff

Jeffrey E. Schreiber, MD, FACS · Answer

Performing a SMAS plication versus a SMAS-ectomy depends on the experience of the surgeon. Many studies have shown no difference in the two techniques and the SMAS-ectomy, so it's really surgeon preference.

Andrew Campbell, MD · Answer

I routinely perform SMAS facelifts, but customize the actual lift for each individual's anatomy. Some patients have very thin tissue and folding, or plicating the SMAS can be appropriate. Others have thicker tissue. In these patients I remove a strip of the SMAS and then lift the SMAS and suture it back to itself. This prevents the bunching and unwanted volume in that area. You may still see some thinning of the area, but after 4 months the majority of healing has occurred. I would recommend speaking with your surgeon about your concern.

Andrew C. Campbell, M.D.

Board Certified Facial Plastic Surgeon

Andrew C. Campbell, M.D.

Board Certified Facial Plastic Surgeon

David J. Levens, MD · Answer

The SMAS can be trimmed, cinched or folded depending on the technique and goals for your surgery. Some upper facial widening may occur with repositioning the SMAS and soft tissues upward. This may be desirable and rejuvenating as it helps to transform the " triangle" of aging marked by descent of tissue resulting in widening at the jowls to the "inverted triangle" of youth with more upper fullness.

Toby Mayer, MD · Answer

The reason is personal preference of the surgeon and his aesthetic goals. You will have the swelling go down for 1 year and if it is still wide, return to your surgeon or get a second opinion.

Michael Sundine, MD, FACS · Answer

One of the advantages of the SMAS facelift is the versatility of the lift and the ability to tailor the facelift to the needs of the patient. Most patients with facial aging need the softness restored over their cheekbones and not the zygomatic arch. The SMAS will allow for the facial fat to be repositioned over the cheekbones and allow for the softness to be restored. The top of the SMAS could be folded onto itself to give volume over the zygomatic arch, but this application should be necessary only in a few cases and will result in the facial widening that you are observing. The vector of a SMASectomy is actually perpendicular to the direction that the SMAS was folded in your case.

Jay Calvert, MD, FACS · Answer

Folding of the SMAS is a way to help augment the cheeks while performing the facelift. The question of when to fold and when to excise is determined on a case by case basis. No one face is the same as another so it is a judgement call. I prefer SMAS flap with trimming of the flap. Some folks just do an excision. Some plicate. In the end, it all seems to do about the same if the surgeon is experienced and routinely gets great results.

Steven Wallach, MD · Answer

Tot rim or to fold the SMAS really depends upon your goals for surgery. If you have enough facial volume and high cheek bones then I would excise it.

Karol A. Gutowski, MD, FACS · Answer

The SMAS procedure you had may have been done to restore facial volume. However, at only 4 months after surgery, swelling is more likely to account for the facial width. You may discuss it with your plastic surgeon but waiting a few more months may help.

Scott E. Kasden, MD, FACS · Answer

The SMAS layer is folded under for two reasons.

	1. it gives extra strength to the repair where it is sutured to the cheek bone (zygoma)

	2. It gives more fullness and definition to the cheek bone area which is frequently lost over time, or not well developed in the first place.

	This is a standard practice.  The fullness should resolve over the next year.

	sek

Facial Widening with SMAS Facelift

Answers (12)

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