During a Full Face and Neck Lift Which is More Effective: SMAS Plication or SMAS Trimming?

Direct sutures or suspension (NOT thread) sutures into the SMAS? What has been your experience long term?

Doctor Answers 14

Appropriate technique for SMAS facelift

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My opinion is that no technique is as effective and capable of creating a natural appearance as selective SMAS dissection and suspension.  The decision to conserve or trim SMAS is made on an individualized basis.  I see imbrication and plication without dissection as a shortcut that dampens the response to the intervention.  That being said, an excellent surgeon with a different preferred techniqaue will deliver a superior result to a poor surgeon using the best technique.  I think its best to find a sureon that you trust and respect and let them guide you.  An attachment to technique and pull you away from what is really important!



All the best,


Rian A. Maercks M.D.

Both SMAS Plication and Resection are Effective - It's the surgeon that counts

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Over the past two and a half decades I have had the opportunity to do both SMAS excision and SMAS Plication facelift procedures and have found no difference in results.Both Techniques are effective. This has also been written about and discussed at our annual meetings. The bottom line is that "great surgeons get great results" which don't seem to be specific technique dependent. 

Probably most important factor of all is in fact  the skill and experience of the surgeon. Always check out his/her before and after photos and ask to see long term results and most of all that he is trained and a board certified plastic surgeon by the American Board of Plastic Surgery or board certified facial plastic surgeon. It is their role to see you through this complicated decision making process

SMAS plication vs trimming

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SMAS trimming with tightening is always better than plication since the fascia layer is actually advanced and tightened more significantly than just simple plication.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Effectiveness of Various Facelift Techniques

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With SMAS plication no SMAS is excised. Following SMAS imbrication excess tissue is usually removed. However, as I have said before, pick the surgeon and not the technique. Facelift  is a very generic term - there are many procedures and variations of those techniques. Find an experienced surgeon whose results you like in faces that resemble yours.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

SMAS - Let the surgeon choose the technique

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You are not really asking the appropriate question.  There are many maneuvers that can be done on the SMAS layer, and the decision making process is much more complex than "which is more effective."  For instance, in someone who has a very thin face where I want to maintain as much facial volume as possible, I am more likely to perform imbrication / plication on the SMAS layer rather than any excisional technique (SMASectomy or advancement flaps).  For someone with a "full" face, a SMASectomy may be the ideal technique, as it allows for volume removal, and prevents widening of the face.

You should visit a surgeon who customizes their procedures to fit your anatomy, rather than a following a cook-book procedure.  Allow them the latitude to make appropriate intraoperative decisions.  If you generally like the results they display in their photo galleries, you should feel comfortable that they will make similar appropriate choices when it comes to your surgery.

Best regards,


SMAS Plication or SMAS Trimming

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    In general, there is both a loss of volume with facial aging and a descent of that volume.  Due to the volumetric loss, resuspending the fallen tissue to a more youthful architecture makes the most sense to me.  A lot of the result depends upon vector of pull, tightness of suspension, the distance of translocation of tissues, and intrinsic fatty volume of the face.  I find that added fat grafting to the facelifting techniques is frequently needed to enhance the result as well.  Once again, this supports the concept that facial aging is the result of tissue descent and tissue loss.  Kenneth Hughes, MD Los Angeles, CA

SMAS plication and SMAS trimming during a facelift

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Whether a surgeon uses SMAS plication or SMAS trimming depends on your aging process. Incorporation of the SMAS Layer is paramount during a facelift or neck lift. How it's used will depend on the surgeon and the individual's aging process

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

SMAS options

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The procedures are really not interchangeable. In people with full round faces you are best to trim the SMAS and mere plication can make them look more round. In thin faces you like to imbricate the SMAS to add volume to places where it has been lost. Properly done with stitches that are not too tight, they should both last equally as long.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

SMAS plication vs trimming

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I prefer SMAS trimming and imbrication to tighten the SMAS layer, though some surgeons have very good results using plication.

Like many of the others here have written, I would focus more on your potential surgeon's long term end results (Are the results durable and natural?) rather than the specific technique used.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews


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The manipulation of the SMAS is an excellent way to give natural results with a facelift. Both techniques are equal but should not be used on all patients. Anyway who says only one technique is best does not know how to perform both techniques. The same is true for cranial suspension sutures. There is the correct procedure for each patient. To say one procedure is superior assumes all people have the same faces.

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.