Noticing Pulled Up "Muscle" Cords After SMAS, Will It Improve? (photo)

Question

Had smas lift 6 mos ago. I still see pulled-up muscles "cords" under skin. One side since surgery--pic with scar. As swelling has decreased, they're now noticeable on BOTH sides, especially in certain light--curtain pic. Looks like pulled up "austrian shade" :) My PS says they'll "soften" over time. What caused this? I don't see similar smas pix on this site. Is this a smas lift gone bad? How long do you think "over time" is? Will it ever go away? I'm starting to get embarrassed :(( P

Kenneth Hughes, MD · Answer

If there was a permanent suture used, this may need to be removed.  However, tissues and sutures, even if permanent, always relax to some degree.  The tissues cannot be held indefinitely in place in the facelift.  Therefore, this works to your advantage in a situation like this.  If the band or curtain or rope persists for a year, filler or fat grafting for camouflage is a reasonable alternative.  Kenneth Hughes, MD Los Angeles, CA

Larry S. Nichter, MD, MS, FACS · Answer

Final Healing Following SMAS Facelift is Progressive Over Many Months

	Although 6 months have passed it is likely that it will improve at least somewhat over the next 6 months. The type of swelling typical of the photo you showed is often due to induration (chronic edema) which may be due to the fact that this is where most of the SMAS plication or suturing took place. Without seeing your operative note it would be impossible to tell, but a good question for your plastic surgeon. If it does not resolve by a year post op then it is likely do to another reason such as the vector used to suspend the SMAS.

	There are many predictable portions of the healing process that ALL PATIENTS EXPERIENCE. Although both doctor and patients would like to not have this happen, it is part of the healing process. These Side effects refer to what you will be experiencing from the facelift healing process: Here are some of the common things you will experience. The common side effects include: swelling which is maximum 2-3 days later, bruising (highly variable), numbness which takes several months to resolve,  tightness takes several days to months to resolve, discomfort chewing (technique dependent), discomfort (generally mild with this surgery, nausea (variable) and in some patients emotional lability in some. Although most of the visible edema resolves in 2-3 weeks in mini-lifts and 3-4 weeks in traditional facelift approaches, residual firmness (edema you feel but don’t see) can linger for several months. Skin suppleness also takes a while to return as does scar maturation. I tell my patients it takes up to a year for final resolution of the healing process. In my experience, the above rough time table is usually delayed in smokers, when multiple procedures are performed together and when resurfacing procedures are done at the same time as the lift. The same is true if complications occur such as infection, hematoma, skin loss or compromise, etc

Scott Trimas, MD · Answer

Those areas should continue to resolve over time. They most likely represent directional vectors; that is, areas that were cut and lifted from the smas layer. Often massaging those areas can help or you may need some fillers to mask over those areas. Fat augmentation or sculptra can often correct those areas.

Chase Lay, MD · Answer

Morning Seefiddle,

	I wouldn't say you PS made any errors but it can be improved if not resolve on it's own over the next 3 months or so.  It's difficult to say without an exam but based on what I can see from your 2 wk post op it looks like the anterior and superior limit of the dissection of the cheek area was limited to about where that depressed cord appears.  If the irregularity doesn't improve on it's own, and it probably will, you can do a small revision to lift the SMAS above the irregularity and smooth that area out.  What Dr. Virden mentioned about dissolvable sutures is true.  I would ask your PS about that.  Keep in mind every facelift is a SMAS lift, if just depends how you use it.  I think the dissection on your face was more limited and in the neck area more extensive which is probably what I would have done.  This technique is common in men because you want to focus on the jawline and neck.  Much more than that and you femanize the face.  I think  you PS did and nice job and your issue can be addressed without too much trouble.  The "mini-face lift" example in this video represents about how much skin elevation I think was done on you plus your neck lift.  Hope this helps.  You'll do well.

	Chase Lay MD

Charles Virden, MD (retired) · Answer

Dear Sir, I have had extensive experience with all types  of ways to lift and tighten the SMAS. From your picture this appears to be a suspension type of suture. I surmise this from the directional vector of this pull. Ask your surgeon if he or she used a non dissolving suture devise? I'm betting that your "cord" is seen to your mid face soft tissue and suspended to the temporal fascia. By the way, if this is the case, they can be removed .

Noticing Pulled Up "Muscle" Cords After SMAS, Will It Improve? (photo)

Answers (5)

Answer: Irregularities after a facelift

Answer: Irregularities after a facelift

Answer: Visible "cord" after SMAS lift

Answer: Visible "cord" after SMAS lift

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Noticing Pulled Up "Muscle" Cords After SMAS, Will It Improve? (photo)

Answers (5)

Answer: Irregularities after a facelift

Answer: Irregularities after a facelift

Answer: Visible "cord" after SMAS lift

Answer: Visible "cord" after SMAS lift

Browse related questions

Recommended reading

Everything you need to know about SMAS Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.