The High SMAS Face Lift Technique vs. SMAS Technique?

There are several different types of facelift techniques that are currently performed by facelift surgeons. The most important factor is that the technique that is used by a facial surgeon will create a youthful, natural with long lasting result. An ideal facelift result includes in part not having anyone assume you have had a face lift procedure.  I think a patient that desires improved appearance but wants a natural, non-operated result will have to communicate this to his or her prospective surgeon but also seek out an experienced facelift surgeon that prefers to achieve these types of results.  Experience is the key in facial rejuvenation. Vectors of facial tightening vary from patient to patient. For a 45- 50-year-old patient, I would not apply the same vector and tension that I normally apply to a 70-year-old face. In addition, direction of vectors must be modified during secondary or tertiary facelift to avoid artificial look.  I have performed well over 3,500 face and neck lifts and published a specific technique that describe the rotational angles and amount of tension that must be applied during SMAS plication to avoid over or under tightening.  A well-performed neck lift during facial rejuvenation is the paramount in a youthful-appearing face. I apply gradual tension on my SMAS as follow: starting at temple area there is only 20-30% tension on muscle plication, once at the jawlines the muscle is tightened 100%. This prevent pulled looked at the corner of mouth. In neck area the muscle must be tighten with greater tension than 100%, depending on the neck laxity.  Look at the doctor’s before and after pictures, a talented and experienced facelift surgeon will have a smooth and well-contoured neck that enhances the facelift results.  The face ages through a combination of changes including volume loss, skin changes, and soft tissue drooping.  When facial rejuvenation is desired all of these changes must be addressed.  Therefore, fat grafting, a facelift, and skin resurfacing frequently must be combined to accomplish a natural result.

Thank you for your question.  A high SMAS technique is a technique that please the dissection of the SMAS high to the chick bone and lift the SMAS  given volume to the chick from the lower part to the face.

What is more important than the specific technique is the experience and artistry of the plastic surgeon. In a SMAS procedure, the tissue deep to the skin is either tightened, partially resected, or elevated which generally achieves a longer lasting and better result. While I prefer the High SMAS, each surgeon has his or her own approach of how they dissect and what they do with the SMAS. In a High SMAS, the SMAS is freed from the underlying tissue at a slightly higher level on the cheek otherwise it is similar to a SMAS procedure. Artistic natural results need to be individualized depending on the patient's anatomy.

I would suggest your a 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
 

Technically, there is only a small difference in the placement of the upper limb incision of  the SMAS along the zygoma.  A high SMAS technique incision is above it, while a traditional SMAS technique is below the zygoma.  In our practice, we perform a high-SMAS lower face and neck lift which addresses tightening loose facial and neck skin, tightening the loose facial and neck muscles, lifting the jowls, and removing any fatty deposits in the neck along with a platysma-plasty.  For many examples of a high-SMAS facelift procedure from our practice, please see the video and the link below

 Hi, I have performed many facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Non smiling photos of your face from the front and side would help in the evaluation.   The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  Price is determined by the reputation, location and experience of the Facelift Surgeon.
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  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.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.
 Following my beauty principles, 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.  If the cheeks are flat or concave in the front, they can be augmented and shaped with a dermal filler or using silastic cheek implants  (permanent enhancement) to 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 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.
 "Jowls” are sagging facial tissues and the main indication for some form of a SMAS facelift.  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 SMAS facelift is the minimally invasive, short incision SMAS 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 and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
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 from the face and neck
excess skin removed from the face and neck
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.