Difference in Results/longevity Between SMAS Lift Done Under Oral Sedation and Deep Plane Performed Under IV Sedation?

Question

Assume the same patient consults with two highly qualified, board certified, face-only surgeons. One does 100+ procedures per/yr using a short scar, SMAS face/neck lift under oral sedation and local anesthetic at an in-office suite. The other PS does an equal # of lifts using a deep plane technique with IV sedation in an outpatient setting. .What difference in near term and long term results would you predict depending on which surgeon was chosen?

Stephen Prendiville, MD · Answer

Generally speaking, differences in results and longevity between techniques and Surgeons depend on several things.  I am assuming that the Surgeons you are seeing are board certified by the American Board of Facial Plastic and Reconstructive Surgery or the American Board of Plastic Surgery.  A lot depends on what the Surgeon actually does during the procedure and the aging indications of the patient. In my opinion, IV sedation is in the healthy patient's best interests because it offers amnesia (no memory), analgesia (pain control), and anxiolysis (takes away anxiety).  Unless you have a keen interest in being aware of the details of the surgery, I would encourage any healthy patient to seek this option.  My general feeling about short scar techniques, beyond their perceived marketing value, is that they limit the capability of the Facelift procedure. A patient in his/ her late 40's, early 50's without significant skin laxity can be well suited for this procedure.  A patient in his/ her mid 60's to 70's with significant aging changes and skin laxity  is likely to have a compromised result, in order to suit the confines of the incision length.  A well designed, well executed Facelift, with appropriate vectors placed on the SMAS, and adequate yet judicious skin removal will yield a beautiful result, despite the length of the scar.  In my hands and based on the population I see, I feel I obtain the best results with a modified deep plane technique.  The incision length chosen depends on the needs of the patient.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

The long term results do not differ in my opinion between the two techniques.  The deep plane is a more aggressive approach to achieve the same end.  That should give you food for thought.

	Dr. ES

Robert M. Freund, MD · Answer

The SMAS facelift is a general term for the lifting of the face with two separate planes of lift. The first plane is the deep tissues of the face which includes fat, muscle and fascia. The second plane is the superficial fat and overlying skin. This is the basic description for the best of all facelift techniques. The first techniques attempted utilized pulling of only the skin. Early on it became apparent that pulling of the skin alone led to early recurrence and excess scarring - not an ideal outcome. Other techniques have been attempted with a modicum of success. The most prominent of these other procedures is the deep plane technique whereby the entire sandwich of tissue (Skin, fat, muscle and fascia) is lifted together. This technique leads to a large amount of swelling but an early recurrence of the signs of aging. But most importantly, this technique does not allow us to lift the tissues vertically.The process of aging is caused by gravity, facial animation, stresses on the skin (weight gain, smoking, drinking, sun damage and age). The combination of gravity and facial animation pulls the tissues of the face in a downward and inward direction. Smiling reverses the sag - so look in the mirror and smile to see where your facial tissues use to be and where you hope that surgery would replace them. It is for this reason that the SMAS lift should move all tissues in a vertical direction - put the tissues back to where they once were.So with that said, what are the risks and benefits of the Vertical SMAS Facelift.More natural lifting of the fascial tissue avoids the windblown or pulled look of many other techniques.Vertical lift adds to the volume of the cheek, removes the jowl and marionette lines to yield a more oval face.Vertical lift often eliminates the malar depression or tear trough.The SMAS facelift has a lower risk of facial nerve injury than the deep plane facelift and recovery from swelling is significantly shorter.Perhaps the only really increased risk relative to other techniques is the risk of bleeding or hematoma. The creation of two flaps of tissue can result in an increase risk of bleeding. But these small blood clots under the skin are still infrequent and ultimately resolve.All facelift procedures have risks to the sensory and motor nerves of your face. This technique does not have the same risks as a deep plane for motor nerve injury.A SMAS facelift does not address the forehead (Brow lift) or the lower lid bags (Blepharoplasty) but they are often performed together.In the end, the SMAS facelift is an ideal procedure when performed in a vertical fashion. Find a board certified plastic surgeon with experience in performing this technique.If you would like more information on facelifts, please read my book " A More Beautiful You - Reverse Aging Through Skincare, Plastic Surgery and Lifestyle Solutions".

Guido P. Gutter, MD · Answer

Very interesting question we discuss among ourselves all the time.

	The end result is what counts ("The road to there is not so important....") for you! Most of the face lifts done show a "good" (early) result. Few an "excellent" result.

	I personally think face lift is THE cosmetic operation where experience and artistic skills are important. The best recommendation for you should come from other happy face lift patients or Nurses who see the Plastic Surgeon's work and operating skills.

	How long a face lift "lasts" is in the eye of the beholder (" How long you like the result...). Weight loss/-gain, life style, skin care, exposure to the elements and smoking can shorten the face lift dramatically.

	You have thought about this already quite a bit. Probably you have already made a closer selection of Surgeons. My thoughts may sway you to one or the other.

	Good luck! I am sure you will look "fabolous" !

Paul Gill, MD · Answer

I think there are several variables that dictate the success and longevity of your result.  I list them in order of importance:

	1.  The experience of your surgeon

	2.  Patient anatomy: degree of loose skin/fatty tissue/muscle laxity

	3.  Surgical technique chosen

	4.  Anesthesia choice

	 

	In regards to surgical technique, I would need to see your pictures to make best recommendation.

	In regards to anesthesia, I am much happier with the degree of muscle tightening and restoration of the neck/jawline that i can get under a general anesthetic or deep iv sedation.     

	I wish you a fantastic result and safe recovery.

Difference in Results/longevity Between SMAS Lift Done Under Oral Sedation and Deep Plane Performed Under IV Sedation?

Answers (8)

Answer: Difference in facelift technique/anesthesia

Answer: Difference in facelift technique/anesthesia

Answer: Facelift under oral or iv sedation

Answer: Facelift under oral or iv sedation

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Difference in Results/longevity Between SMAS Lift Done Under Oral Sedation and Deep Plane Performed Under IV Sedation?

Answers (8)

Answer: Difference in facelift technique/anesthesia

Answer: Difference in facelift technique/anesthesia

Answer: Facelift under oral or iv sedation

Answer: Facelift under oral or iv sedation

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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.