Is A Biltmore Lift the same as a SMAS lift?

Question

I want to tighten the jaw line and get my lower face in more of a V-shape. I do not want my mid face tightened unless it is necessary for tightening the lower part. I am so confused with the lower mini facelift options. Does the Biltmore lift also lift underlying tissue? One Dr. on RS explained the Biltmore lift as "short flap facelift" or "Signature Lift", does this mean it does not tighten underlying tissue? Do I need underlying tissue tightened for jaw line improvement?

David H. Harley, MD · Answer

Simply put, the Biltmore Lift is a face and neck lift performed at Biltmore Plastic Surgery in Asheville, NC by Dr. David Harley. Over the years, I have performed several thousand face and neck lifts using a variety of techniques, including SMAS plication, lateral SMASectomy, and the deep plane facelift technique. I have been performing mostly deep plane facelifts recently. Most of these include platysmaplasty with some sculpting and removal of fat from along the jawline and neck. The common ingredient for all of my lifts has been the use of local anesthesia and oral sedation. Patients are thus able to walk in and walk out of the office, and also they enjoy the benefit of reduced costs and practically zero anesthetic downtime. So from an anesthesia standpoint, I would describe this as minimally invasive. However, I have learned that while patients desire minimally invasive procedures, most do not usually want mini results. Therefore, I have employed what I feel is the most sophisticated face and neck lift technique available today, known as the deep plane face and neck lift. This procedure offers optimal results, both natural and long-lasting, while being done under local anesthesia. Clearly, patients agree and often travel across the country and around the world for the procedures we provide. Many times their friends and family travel the same distances after seeing their loved one’s new look.

Jeffrey M. Darrow, MD · Answer

There are a multitude of names surgeons have given to the facelift they do, in an effort to try and distinguish themselves as “doing a unique type of facelift”.  The reality is that nearly everyone not only lifts and smooths the skin but also lifts and tightens the underlying layer called the SMAS.  The SMAS layer can be treated in different ways:  simple suturing, elevating with an incision above your cheekbone, elevated with an incision below your cheekbone, placing the incision to elevate directly in front of the ear, or placing the incision to elevate in front of the parotid gland.  Elevating the SMAS and suturing it into a tighter and more vertical position helps straighten and sharpen the jawline and contour the neck, however, of the numerous different ways to treat the SMAS, there has never been a scientific review that has shown that any one technique is better than any other technique.  Therefore, the simplest way forward is usually the safest way forward.

Alejandro J. Quiroz, MD · Answer

Thank you for your question; Sorry the terminology is so confusion for you patients but everybody want to be unique by naming there own name to techniques but in reality all this can be divided in deep plane with the use of muscles and facias or superficial with the lifting of only skin. In this case the Bilmore is referring to the deep plane.

Jay Calvert, MD, FACS · Answer

So much terminology to differentiate certain techniques...I don't really know what a Biltmore facelift entails, but it does sound good! The best way to learn what a facelift entails is to ask the surgeon the exact structures they are working on in their version of a facelift.  Some surgeons make a skin incision and pull the skin - and they call this a facelift. Some surgeons lift up the skin, plicate the SMAS, and they call this a facelift. And others dissect the SMAS as a flap or as a deep plane (mobile SMAS) facelift.  You can liken this to getting to the store on a tricycle, or on a moped, or in a Bentley.  All will get you to the store, but the way you get there and how you feel when you get there is different.

William Portuese, MD · Answer

In our practice, we perform a high-SMAS lower face and neck lift. This procedure accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, tightening the SMAS, and removing any fatty deposits in the neck in addition to a platysma-plasty. A full set of facial photographs from all angles are required to make a determination as to whether not your even a candidate for a facelift procedure.

Curtis Perry, MD · Answer

Biltmore Lift, Life Style Lift, S Lift, etc. are all just minor variations on the basic SMAS face/neck lift. All those different names real purpose is to gain a marketing advantage. Any good face lift surgeon will vary the exact procedure depending on the patient's specific needs. Focusing on the marketing hype begs the real question which is: Do you need an open lift procedure at all. Based on the photo you provided you would probably be better served by having a minimally invasive Radio Frequency based procedure such as ThermiTight or another similar device. These have no open incision and faster recovery.

Robert Singer, MD · Answer

What
is more important than the specific technique is the experience and artistry of
the plastic surgeon.  Artistic natural results need to be
individualized depending on the patient's anatomy. Beware of name branded
facelifts or other cosmetic procedures which are only used for advertising
and marketing gains. 
I
would suggest your plastic surgeon be certified by the American Board of
Plastic Surgery and ideally a member of the American Society for Aesthetic
Plastic Surgery (ASAPS) that you trust and are comfortable with who has
all of the modalities of treatment available. You should discuss your concerns
with that surgeon in person. 
Facial
rejuvenation needs to be individualized. What would be an ideal approach for
one patient is not necessarily the same for someone else. Based on the
examination and discussion at the consultation, you should have a better
understanding of the various options that can achieve the best cosmetic result
for you.
Robert
Singer, MD FACS
La
Jolla, California

Is A Biltmore Lift the same as a SMAS lift?

Answers (7)

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