Lumps/bumps after SMAS facelift

Question

Had a neck (plastysmapexy) and SMAS facelift. Initially discussed SMAS imbrication only but afterwards was told there was plication done to improve cheek hollowness. Now that swelling is resolving, this unatural lateral bulkiness is showing up below normal cheek roundness (for me). I also have asymmetry - right jowl is still present. Some skin puckering (excess?) Upper left side. Surgeon only acknowledges plication was done and that some fat transfer would resolve everything. Is this a normal way to fold the SMAS, in such a horizontal position? Can this be revised/corrected surgically? I realize l should wait 1 year for revision (maybe deep plane?) But in the meantime what could improve this uneveness, unatural look for my face? I am submitting before photos for comparison

Frank Agullo, MD · Answer

Your lateral cheek bulk is the plication itself, not residual swelling, and fat transfer will not solve it. Fact transfer would help camouflage the indentations below. When the SMAS is plicated horizontally, the folded edge sits as a ridge under the skin. Once swelling clears, that ridge becomes the new contour. Adding fat over a bulk problem makes the face look heavier, not smoother.

The right move at six months is a focused revision through the existing incisions: release the plication suture, redistribute the SMAS as a true vertical lift or convert to a deep plane, then address the right jowl and the upper left skin pucker at the same setting. Twelve months is fine for major redo work, but a small targeted release can be done earlier if you have a specific anatomic problem like this one.

Some of the jowl volume could be your submandibular glands.

#StayBeautiful,

@RealDrWorldWide

Stephen Prendiville, MD · Answer

Thank you for your question.  I am unsure how far along you are postoperatively.  However, one thing that is common for many patients is to go through a phase of extreme analysis of the result and any postoperative sequellae.  I would generally recommend against any form of revision for 1 year and stay in close contact with your Surgeon.  I personally prefer a deep plane approach, which is a composite approach to the SMAS.

Thomas A. Mustoe, MD, FACS · Answer

A common technique for SMAS facelift is to use sutures to fold or lift the SMAS in the midface so that the SMAS (suoerficial muscle fascia layer) is pulled into a new position rather than fully released and repositioned .  There are some limitations to this technique because the SMAS has  multiple vertically oriented collagen fibers that anchor the SMAS and limit its movements unless released which is most completely doe with an option ally performed deep plane facelift. Fat grafti grafting could improve the unevenness bit will not fully correct it. If they do not resolve satisfactorily the best approach Woukd be a well executed deep plane facelift I. Which the superficial muscle veritably oriented t fixation points (retaini gmigemts are fully relwaed almost out to the nasilabial folds This procedure requires a lot of precision and should be done by a surgeon very experienced I. 2ndary facelifts.

Lumps/bumps after SMAS facelift

Answers (3)

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