SMAS Facelift - Sutured or trimmed?

Question

Hello, I would like to know if it is better to have a SMAS facelift sutured or trimmed? I have heard that if it is sutured it may not last very long and fall, but if it is trimmed, it will last longer. Is this true? Is one way better than the other? I know that deep plane lasts longer, but I don’t have enough aging to qualify for that. Thank you

Jeffrey M. Darrow, MD · Answer

As a general rule, in patients with a fuller or rounder face, the SMAS is trimmed so the overlapping of the SMAS doesn’t add additional fullness to an already full face.  In patients with volume depletion of their face, the overlapping of the SMAS can accentuate the facial volume resulting in a fuller more youthful contour.  In regards to the best way to treat the SMAS:  there has never been a study proving that one way of treating the SMAS is superior to the other methods, in either aesthetic results or in longevity of results.  This includes the “deep plane” facelift.  Deep plane just means that the plane of dissection is below the SMAS layer.  The high SMAS and the extended SMAS both make incisions in the SMAS, dissect under it and elevate it to improve facial contour.  The only difference with the deep plane is the location of the SMAS incision, which is more toward the front of the parotid gland.  Significantly, because of the location of the SMAS incision in the deep plane facelift, there is a slightly higher rate of facial nerve injuries with this technique.  Find a highly qualified plastic surgeon who performs many facelifts and have a detailed consultation.

Lucian Ion, FRCS · Answer

Thank you for your question.

The key factor in deciding between SMAS plication and SMAS-ectomy is whether facial volume should be preserved or reduced. In individuals with a fuller facial contour, SMAS-ectomy offers the advantage of subtly slimming the face and enhancing the V-shaped definition of the lower face. Conversely, for those with a lower BMI and naturally thinner facial structure, SMAS plication is preferable, as it maintains facial volume and ensures softer contours.

In terms of longevity, there is unlikely to be a significant difference between the two techniques.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here !My answer will be based on the limited information provided for a mode detailed and personalized plan please consult with your plastic surgeon in person.There are many ways of doing a facelift, each has it's own benefits and potential issues , a good surgeon will customize the procedure to your needs, for example if you need lateral fullness in your face then stacking the SMAS or suturing it might be of benefit ...etc, that being said age is not necessarily a contra indication for a deep plane facelift, but your needs might dictate a different technique. If you trust your surgeon then trust in their judgement just make sure that you are well informed and that you ask the right questions which you seem to be doing.Best of luck!

Zoran Potparic, MD · Answer

There is no data to support that any of the two ways of SMAS manipulation (tightening) is better. You may find equal number of very experienced face lift surgeons on both sides of the issue. Let your surgeon make decision how to do it. Good luck.

William Portuese, MD · Answer

In our practice, we remove and re-suspend a portion of the SMAS and suture it, which gives very long lasting results. Study your prospective surgeon's before and after facelift photo gallery to make sure that it is extensive with lots of results that you like.

SMAS Facelift - Sutured or trimmed?

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