PSP Facelift Results As Dramatic As SMAS Facelift?

I am seeing a surgeon tomorrow, who suggests going ahead with a PSP Facelift. I'd like to know first, will PSP facelift results look as dramatic as SMAS facelift?

Doctor Answers 15

Worry About the Sausage-Maker, Not About How the Sausage is Made

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For the sake of simplicity, patients should focus much less on technical jargon, and much more on what they can see with their own eyes. A catchy name for a procedure creates a marketing buzz or tries to draw a distinction between one surgeon who offers it, and the next who perhaps doesn't. A reliable procedure performed with technical skill and artistry by an experienced surgeon, and simply called a "Facelift", trumps any "facelift of the week" technical jargon term, any day of the week.

As a patient, you will never see "under the hood" to know what technique was used below the skin surface during your operation. What counts is what your own two eyes can tell you before surgery, when you look at before-and-after results from different surgeons, or see their patients "in the flesh". Patients with natural-looking results and good improvement of signs of facial aging, are a much better endorsement of a surgeon's skill and artistry than any hair-splitting technical jargon term to describe which suturing technique will be used deep to the skin, that you will never see anyway.

As surgeons, it is our responsibility to keep up with advances in the field as far as new techniques, materials and methods are concerned. It is far better for the patient to trust the sausage-maker, rather than to obsess about how the sausage is made.

Focus on the surgeon, not on the technique

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Many of the deeper facelift techniques elevate or tighten the deep layer, or SMAS. Depending on which layers exactly are involved, and where exactly the surgeon changes planes, the Composite Facelift, the Deep Plane facelift , Standard SMAS, facelift, SMAS-ectomy facelift, SMAS plication facelift, Extended SMAS Facelift, PSP facelifts, 360 Facelift, are all techniques which can be used.

Certainly every experienced facelift surgeon should be capable of performing each and every one of the above techniques if necessary. But the above techniques are just a start to comprehensive rejuvenation.

Modern facelifts don't just pull. They pull in different directions. They redistribute volume in the face, not just "really really tight" as was the goal in the past. They keep earlobe architecture natural appearing, not pulled or canted. They presefrve the hairlines. They keep the direction of pull on the face minimally detectable. They use scar minimizing and concealing techniques.

Expert facelifts often involve one of these techniques above plus many, many ancillary procedures such as volume restoration (fat injection, LiveFill or implants), periorbital surgery (fat preservational vs fat removal), midfacial/cheeklift surgery (many types of cheeklifts), browlift surgery (many types of browlifts), lip/periorbital volume restoration, resurfacing of the facial skin with lasers, etc.

The goals and the specific plan of the surgeon should be crystal clear to the patient before the surgery proceeds. When they wake up in the recovery room, the procedure will be done. The result they get for the rest of your life will depend on the artistry, style, experience, customization to the patient's specific needs, not on whether the patient chooses a doctor based on wanting to have a "PSP or a SMAS lift" .

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

The results are often similar but not as long lasting!

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A PSP (platysma SMAS plication) lift initially is usually as powerful as a true SMAS operation without the same level of risk to the facial nerve and lymphatic drainage vessels. It is the procedure of choice in my practice because the recovery is significantly faster.

The procedure lifts the skin off the platysma muscle on the neck and SMAS layer on the cheeks/jowls and then plicates, or hems, the layers onto themselves with long-lasting or permanent suture (like one would cuff a pair of trousers.) The underside of the platysma or SMAS, where the branches of the facial nerve reside are not entered keeping the nerve safe in most cases. The lymphatic vessels below these layers are also undisturbed making recovery faster in general. Only one layer of scar (between skin and platysma/SMAS) exists however.

A true SMAS operation involves going deep to the SMAS in the cheek/jowl area and results in two layers of scar being formed: one between the skin and platysma/SMAS and the other under the SMAS itself. Theoretically, this should provide longer lasting results. The downside is that you also injure the lymphatic drainage vessels under the SMAS theoretically prolonging recovery from swelling.

Most surgeons dedicated to facelifting will be able to help you navigate these waters. The other things to think about are the elastic nature of your skin and and how much volume loss you have in your face, as it is important to address all the dimensions of facial aging: skin, muscle, fat and bone.

Good luck with your consultation.

Dr. Shah

PSP Facelift is useful in some circumstances

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The names can be confusing. There are mini-, mid-, smas- deep plane- facelifts and now platysma smas plication facelifts. What they all have in common is the desire to address the sagging structures of the aging face.

From the outside inward, there is excess and sagging skin. This skin is most obvious in the marionette lines and jowls on the face as well as the waddle under the chin. The only way to treat these problems is by removal of the skin. Sometimes, we can be confused by deeper tissues sagging, which is interpreted as sagging skin. The reason why this recognition is important is because, deeper tissues can be tightened through minimal incisions.

The deeper tissues referred to above are the SMAS (submusculoaponeurotic system) and the Platysma muscle of the neck. These tissues are responsible for the shape and intact nature of the substructures of the face. They will sag and make the overlying structures look saggy as well. These structures can be repaired by tightening them and putting them back where they were before gravity and aging took over. Plication implies that the structures are cinched tighter and sutures are placed to hold them in the new position. This plication does not give the same a mount of correction as does the technique whereby the SMAS and Platysma are lifted off the connecting tissues and pulled in the desired direction. So in effect, plication is good for more moderate deformities.

A couple of warnings. 1- All facelifts should avoid the pulled look by lifting the SMAS vertically - not horizontally towards the ear. 2-All incisions should be performed without tension to avoid an unnatural pull on the ear, displacing the lobe forward.

Robert M. Freund, MD, FACS

Don't get lost in the trees!

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I receive questions like this often from patients trying not to make a mistake. Forget about what technique the doctor says he uses, since you'll be asleep and won't know what he does anyway! My son can show you pictures and diagrams of facelifts or noses---he knows nothing about these, but is very good with a computer.
Instead, find a surgeon you trust, shows you one year photographs or longer of his results, and lets you see real patients who have had a facelift by him or her. That's what really counts.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

The Surgeon is more important than the Name of the Facelift

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As surgeons we all have egos - it's part of what makes us choose a demanding and competitive field that we want to excel at (or frankly be the best at!).

So while the technique being used is very important, of greater importance is your surgeons training, experience, inherent skills and ethics. With these factors in place you can be assured that your surgeon is choosing the facelift technique they believe is the best for you and can back it up by delivering the results you wanted. Without those factors in place you may fall victim to marketing hype, greed and unethical practices no matter what technique is being offered.

Kamran Jafri, MD
New York Facial Plastic Surgeon

Platysma SMAS Plication Face Lift

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The Platysma SMAS Plication face lift is one of many techniques that have been employed for facial rejuvenation.  While this technique can lift the facial tissues it is limited by the fact that the tissues are only lifted in one direction.  Thus it is an effective technique but is more limited than the use of a multivectored SMAS flap.

Michael Sundine, MD
Orange County Plastic Surgeon

Understand your goals and find a surgeon you trust

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Hi- I agree with my colleagues below- you should try not to get caught up in the nuances of the various techniques available- the most important factors in the achievement of your goals are a very clear understanding of what those goals are on your part, a clear communication of those goals to your surgeon, and finding a Board Certified Plastic Surgeon or Facial Plastic Surgeon that you trust and get along with.

Your surgeon's training and expertise, your ability to communicate clear goals to them, and a positive relationship between the two of you are much more important to the likelihood of you ending up happy than the details of the technique chosen for your procedure.

Facelift techniques

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I can't answer for "dramatic," but a SMAS facelift if done correctly will probably look better than a platysma and SMAS plication. This is because a SMAS facelift elevates the tissues and detaches certain ligamentous attachments that allow the soft tissue around the mouth and cheek to be placed in a more aesthetically pleasing position. The PSP doesn;t really allow you to do that.

PSP facelift vs SMAS facelift

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Initially, the results look very similar and the recovery maybe shorter by 1-3 days.  It will last longer than a minifacelift but, depending on the amount of excess skin you have and skin elasticity, a SMAS facelift may give you more longevity.  Surgeons have used both types of facelifts for decades and in general are similar. 

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.