Can SMAS plication/imbrication permanent sutures be removed during a revision? There is a noticeable suture line down one cheek.

I had a facelift last year, which I believe was some sort of plication/imbrication procedure (not sure what the difference is?). I'm hoping this means that the SMAS was not actually cut or removed, so that it may be revised. I'm not sure it was the correct procedure to address my jowls which are still there. Would the suture line from the cheekbone to the middle jawline be where the SMAS was folded & stitched? Does this sound like a Quicklift-type technique using purse-string sutures? Thank you.

Doctor Answers 8

"Suture line" visible after facelift

Hello heartsease, thank you for your question. The TYPE of procedure performed on the SMAS - whether plication, imbrication, or otherwise, will typically not cause a line down the cheek as you are describing. I would discuss the case with your surgeon to see what the cause of the crease may be or provide images for review of your particular case. Permanent sutures can be removed during surgery if need be.

SMAS face lift - can visible sutures be removed

Thank you for asking about your SMAS face lift.
  • It is possible you had a MACS lift which uses a thick suture in the SMAS
  • The only way to know for sure is to ask your surgeon for a copy of the operative note.
  • Assuming your surgeon was a Board Certified Plastic Surgeon, s/he should be able to re-open the incision, remove the remaining suture if any and release the indentation.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Revising facelift and removing sutures.

Your surgeons operative notes would show what was done to your SMAS.  If sutures are palpable under your skin they should be able to be removed without disturbing any benefit the SMAS tightening has given you as the SMAS will be scarred together.  Correcting your jowls that still bother you can also be done at the same time though the extent of the surgery may be slightly longer.  Make your concerns known to your surgeon to see if he/she would revise for a reduced cost.

Revision facelift procedure

  A full set of photographs are required to make any determination about a revision surgical procedure, such as a facelift. There many different types of SMAS facelifts, so it is most likely an  in-person examination will be required. If there are permanent sutures present and are causing a problem, they can be removed. For many examples and more information, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

SMAS plication

A SMAS plication does not cut the SMAS, but the scar tissue that develops will prevent you from separating the plane where it was plicated. If the sutures were permanent, then if palpable may be able to be removed.  

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Revision facelift surgery

Hi - a SMAS plication/imbrication suggests that no SMAS was excised but you should double check with your surgeon.  If permanent sutures were used then these should be straightforward to remove during any revision procedure.  Typically to correct the jowls the dissection would have to be fairly extensive but there is such a variation in facelift techniques that it is impossible to say the exact type of facelift you had without looking at the operation notes.

Facelift last year, which I believe was some sort of plication/imbrication procedure, hoping this means SMAS can be revised.

 Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  Non smiling photos of your face from the front and side would help in the evaluation.  SMAS "plication" uses sutures to fold the SMAS upon itself while "imbrication" is the proper dissection/lift/trim technique for SMAS facelifts.  There is another possibility, especially if you see a suture "line" which would be some type of suture suspension technique that ultimately fail in my humble opinion. 

 Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift (using the SMAS Imbrication technique).  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed. My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

SMAS plication for a face lift

You should have this information in your operative report; or just ask your surgeon what type of SMAS manipulation he did? If permanent suture is visible during revision it could be removed. It is possible that a scar due to plication of tissue is causing deformity. I see no reason that this could not be corrected with revision surgery regardless of the technique used.
Frank discussion with your surgeon or a copy of operative report if you are considering second opinion consultation would be a good starting point. Good luck.

Zoran Potparic, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 15 reviews

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.