Male, going bald - is the incision different & smaller with Deep Plane vs High SMAS?

Question

I am male and pretty much going bald. I have a turkey neck and face needs refresh. I would love a FL but with no Hair I really need to be careful about scar and incision and dont want any PS to be obvious or have a bad scar. Thanks

Jeffrey H. Spiegel, MD · Answer

The high SMAS vs Deep Plane tends to refer to techniques underneath the skin.  You are right to concerned about the incisions. For men (and women) we customize the incision to hide well in wrinkles, grooves, etc in a way that will target the lift you need.

Mansher Singh, MD, FACS · Answer

Hi. That’s a good question. The incision for deep plane facelift is very similar to the what’s done for smas procedure. The difference lies in the technique that’s done underneath in the smas and platysma layer. A more important discussion might be the difference in incision in male patients vs female patients.

Maribel Belmontes Castillo, MD · Answer

In a surgery the scar is inevitable. We try to place it very close to the ear so that it is less visible. In male patients it is more complex since it can be more noticeable at the time of hair loss. We take care of every detail, avoiding skin tension, using fine sutures, to try to obtain the best scar, according to the healing genetics of each patient.

Ronald J. Edelson, MD · Answer

Facelift in men can be designed to deal with men with very little of no hair. There are a number of modifications that can be done friending on the situation

Dean P. Kane, MD, FACS · Answer

Dear tosh2147, 
Information is power but not a guarantee. As much as a Board Certified Plastic Surgeon is aware of and skilled at choosing and making the incisions to best camouflage them, all healing leaves a scar. I understand the concern as I, too, am bald and wear my side hair short. Considerations:
1.	Irish, African, some Mediterranean or Asian skin may heal thicker
2.	Oily skin may heal thicker and redder for longer period of time
3.	I have seen both obvious and imperceptible, pre – or over-tragal scars
4.	Consider intra-op hair removal or post-op laser reduction of ear-bearing hair when using a over-tragus incision. 
5.	Pre and post procedural use of retinoids improves scar quality
6.	Tight closures develop more obvious scars due to widening or separation with secondary healing
7.	Additional support of the incision such as taping and immobility will reduce closure tension
8.	Deep plane vs high SMAS facelift technique incision skin closure tightness is dependent on the skills of the surgeon. Outcome is the same. 
There are options to assist in a disappointing scar result such as retinoids, peels, steroid cream/tape/injection, laser, revision.

Please discuss your concerns with several talented and skilled Board Certified Plastic Surgeons until you find the team you trust. All the best. Happy Holidays!

Robert Singer, MD · Answer

There are a variety of procedures that are called “facelifts.”  A well performed facelift which elevates and supports the deeper tissue of the face called the SMAS as well as removing the excess loose skin and adding appropriate amounts of volume to deficient areas of hollows and depressions not only turns back the clock, but also slow the aging process. However, the clock keeps ticking. 
Good results can be achieved with either technique, a SMAS or Deep plane, in the appropriate patient. What is more important than the specific technique is the experience and artistry of the plastic surgeon.  The scars are the same for both.

Some surgeons claim that “Deep Plane Facelifts” last longer, but there is no valid scientific evidence to support those claims.

I would suggest your  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

William Portuese, MD · Answer

The deep plane versus hi-SMAS has to do with how the muscles and fascia layers are tightening underneath the skin, and has nothing to do with the skin incisions themselves. The length of the incision for the facelift is directly related to how much loose skin need to be tightened and removed.

Male, going bald - is the incision different & smaller with Deep Plane vs High SMAS?

Answers (7)

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