During a SMAS facelift can too much SMAS be removed resulting in distortion, overly tight or odd looking?

Question

Also, if the skin is pulled too tight (pixie ears, scars, etc) does that mean the smas was not dissected or plicated properly or at all? Also, if the skin is pulled too tight and that is whats holding up the lift, wouldn't it eventually loosen and return back to your original shape in time or must the skin be cut and redraped? Thank you.

Kevin Sadati, DO · Answer

A well-performed facelift will not result in a “pulled look”. There are many celebrities who have had facelift with youthful and natural results. The bad one are so obvious that become a hot topic and joke for media. Things can go wrong once there is a miscommunication between the doctor and the patient. Expectation are not properly addressed or checked. Some of the facelift surgeons apply too much tension and improper vector on their muscle tightening sutures resulting in pulled look. I apply a gradual tension during my muscle (SMAS) tightening. At the temple region I only apply about 20% tension to the muscle, and as I descend toward the mandible and the jawlines tension on the muscle reaches 100%. Neck requires much higher tension, depending on the amount of laxity. In 2011, I published my unique facial tightening technique in the AJCS evaluating 1500 of my patient’s results. 
  
Please look at the before and after pictures of your doctor, that is a good indicator of how they perform their surgeries. Be aware of the surgeons who give you a menu list of things that you actually don’t need and those extra suggestions may lead to artificial look.

Catherine Winslow, MD · Answer

Hello! You ask a number of questions. A SMAS facelift has two layers that are relatively independent. The SMAS excision does not result in a distorted look but over-dissection can, as can pulling on the skin too tightly. If the skin was pulled too tightly that has nothing to say about SMAS dissection or suspension- it is a different layer entirely. While the skin CAN be pulled too tightly over the SMAS, the theory of sub-SMAS dissection is that all tension is only the SMAS layer, so the skin can be closed with NO tension or pull, preventing pixie ear etc. Your tissues WILL continue to age- both SMAS and skin- and results of surgery are permanent but your face is not!! I hope that helps. Good luck!

Edwin F. Williams, III, MD · Answer

There are several variations of facelift surgery, and most of them involve some form of SMAS manipulation. Regardless of the specific type, you will need to discuss your goals and expectations with your surgeon. A youthful neck contour with a natural look is an achievable goal in many cases. In terms of durability, a well done facelift can last for 10 or more years. I would recommend having a consultation with a Facial Plastic and Reconstructive Surgeon, where you can discuss your exact goals of surgery and get some more specific information. Hope this helps!

During a SMAS facelift can too much SMAS be removed resulting in distortion, overly tight or odd looking?

Answers (3)

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