What type of facelift is best for a thin face due to volume loss from aging?

Question

I have read that plication of SMAS is preferred in patients with thin faces and that SMASectomy is preferred in patients with fuller faces. BUT then, I have also read that bunching can occur with plication of SMAS in thin faces. Is the bunching issue more or less prevalent in purse string plication lifts? Or is it technique specific to the surgeon as to whether plication results in bunching or added/needed fullness? Thank you!

Raymond E. Lee, MD · Answer

Thank you for posting your question.  I would choose your surgeon based on his experience, results, and your comfort level with him.  I have performed facelifts with either SMAS plication or SMASectomy.  SMAS plication involves folding the muscle and sewing onto itself like a pleat.  SMASectomy involves resection of the muscle and sewing together the cut edges.  I personally favor the SMASectomy as i feel it will last longer, and gives a smoother contour. The SMAS plication may be appropriate in certain instances such as excessive scar tissue or thin SMAS.  It does add fullness.  However,  I do feel that SMAS plication does not add volume where volume is needed.  If you are thin and volume deficient, fat grafting would be performed to add fullness where it is needed.  Please consult with a few board certified surgeons to help make your decision.

Lu-Jean Feng, MD · Answer

Whether you have a SMASectomy or SMAS plication, you will thin out your face in your lower half, although the SMASectomy will have greater longevity of the lift. If your cheek thins out too much, this can be injected with fat at the time of the facelift or later with fillers.

Anil R. Shah, MD · Answer

One of the challenges of a thin face is creating volume to help balance and improve the dimensions of the face.  In some facelifts, the SMAS layer is resected and removed from the patient's face.  In a thinner faced individual, ideally deeper tissues are preserved and repositioned to help with volumetric imbalance.  I prefer a version of deep plane facelift, but am conscious of creation of preservation of volume.  Other measures such as fat transfer and fillers can be helpful in achieving volume to your face if necessary.An in person consultation with a facelift expert can be helpful.

Vincent N. Zubowicz, MD · Answer

I almost always perform a full composite facelift on patients presenting with facial aging. In my opinion it gives a predictably good result and is very safe. I patients are prepared by viewing multiple galleries of patients that have undergone this operation in particular those with very similar aesthetic problems.

Jeffrey S. Rosenthal, MD · Answer

The technique utilized to lift the SMAS,  is dependent upon the degree of skin and muscle laxity present in your face.  For a thin face, without loss of neck tone, you might consider volume enhancement with either Radiesse or Voluma, rather than surgery.

Mario J. Imola, MD, DDS · Answer

In thin patients with advanced volume in the face, the ideal method to restore volume is with a fat transfer procedure.  This can often be combined with a face-neck lift procedure either simultaneously or on a delayed basis.  In all cases, the ideal plane of dissection for a face-neck lift is in the deep plane with minimal interruption of the SMAS-cutaneous layer.  This allows for re-positioning of a more robust and better vascularized tissue flap with less risk of tissue atrophy or further thinning.Mario J. Imola, MD, DDS, FRCSC, FACS.

Francisco Canales, MD · Answer

Frankly, many of the techniques are very similar and many times surgeons try to distingush themselves by marketing a "name" facelift. I would suggest in person consultation with 3 board-certified plastic surgeons or board-certified facial plastic surgeons. Look at their results, ask what technique was used and then decide. Ignore the "named" facelift marketing ploys. Best wishes.Below is a fully healed facelift patient.

Michael Law, MD · Answer

Volume loss is often part of what ages the face. Sometimes the results are quire obvious, other times, subtle changes, like hollows in the temples or flattened philtral columns may not be things a patient notices specifically, but these kinds of things add to the overall appearance of againg. Most facial rejuveation patients in my practice can benefir from at least some structural fat grafting. Some people benefit from more significant structural fat grafting than others. However, it is important not to over-correct. When performed with expertise, fat grafting can be permament. It is important not to over-fill the face.My strong feeling is that the mere plication of the SMAS is not very effective in rejunation of the the face. There are retaining ligamnets that securely hold the SMAS to the deeper soft tissues and skeletel structures of the face.Therefore, to effect a significant change in facial contour when operating on the SMAS, one has to undermine and elevate it  to make it mobile, just as one has to undermine and elevate the facial skin to make it mobile. SMAS plication amounts to putting sutures into a relatively immobile structure to effect a change in shape.  The position and contour of a non- undermined and non-elevated SMAS canot be significantly changed.One great advantage of a SMAS facelift is that the skin is advanced with the SMAS flap. All of the tention is placed on the SMAS flap closure, allowing the skin closure to be performed tension free. Skin Closed under tension, as with a non-SMAAS facelift tends to produce wider, thicker and more noticeable surgical scars, with distortion of skin contour around the ears and hairlines. No two facelifts are exactly alike. To determine what, if any, facelift would provide the improvement you would like to achieve, I would need to see multiple photos from different positions. Are your concerns the neck, jowls, cheeks, uner eyes, or a combination of those things. The goal of a facelift should be making a person look fresher, younger and happier. It should not make a person look distorted, or like a different person. Please look at many, many before and after photos of both facelifts and fat grafting. When you see results that are appealing to you, check the training, expertise and safety record of any plastic surgeon you are considering.

Barry L. Eppley, MD, DMD · Answer

In thin faces, any type of SMAS manipulation is going to thin out the lower face. Even just a skin only facelift can potentially create that same effect due to the tissue pull. How much that will occur is dependent on how much skin redraping is done. You may need to consider fat injection grafting with your facelift to avert this potential concern.

William Portuese, MD · Answer

Excellent results can be obtained with plication of the SMAS or excision of the SMAS with tightening. Choose your surgeon based upon natural results, and  let your surgeon pick the appropriate procedure based on your anatomy.    In our practice,  we perform a high-SMAS lower face and neck lift  which accomplishes  tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and a platysma plasty in the neck after the fat deposits are removed in that location.  For many examples of high- SMAS  facelift results, please see link  and the video blow

What type of facelift is best for a thin face due to volume loss from aging?

Answers (10)

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