I was told an SMAS Facelift would not help folds running from the nose to mouth, is this true?

Question

Why do most surgeons not perform a deep plane facelift for the fold running between nose to mouth. Would a Smas facelift give the same result as a Deep plane facelift? I know everyone has but mine are more since getting older.

Jeffrey M. Darrow, MD · Answer

There are a number of different dissections which of been described for doing a facelift.  No one technique has proven to be superior to the other in achieving results  and at all of the national meetings I hear very few people talking about deep plane facelifting anymore.  However, most plastic surgeons agree that some dissection, elevation and suturing of the SMAS layer of the face must be done for a long lasting result. The other dissections typically increase your bruising and prolong your recovery without added benefit. There is no way to permanently remove the nasolabial fold. It is created by muscle insertion in the skin and can not be completely removed.   A facelift will help to make the nasal labial fold slightly less prominent and facial filling of the midface will also help.  You should see a board-certified plastic surgeon and have an in-depth consultation about how best to treat your issue. Best wishes.

Lucian Ion, FRCS · Answer

Thank you for your question.

In practice, facelift surgery of any type shows significant limitations when it comes to improvement of the nasolabial folds.

Correcting the nasolabial folds through tension leads to distorted appearance of the mouth. For this reason, the nasolabial folds are often treated with additional fat transfer, subscision and fat transfer or fillers, to produce an improvement without excessive tension.

If you look online and the results of all types of facelifts and you isolate in the photographs the nasolabial folds, you will notice that the degree of improvement is mild-to-moderate including full deep plane techniques. The overall improvement of the facial appearance however can make of the impression that the nasolabial folds have become a lot less visible.

In particular, the deep plane facelift has in my opinion a more consistent impact on the marionette lines or labio-mandibular lines which can appear to be connected with the nasolabial folds in some people. Improvement of the marionette lines also creates the impression of an improvement of the nasolabial folds because the lines that run in those instances from the corner of the nose to the jawline are clearly shorter.

Alejandro J. Quiroz, MD · Answer

Thank you for your question.   The nasolabial folds are multifactorial  but the lifting of the SMAS  will definitely help. It is important to evaluate if you need additional treatment for them

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question.  A Facelift main target is the jawline therefore jowls have appeared giving loss of definition to the jawline.  The lines between the nose and mouth could be lessen with the facelift however this isn't the main target so may need a filler to soften after the facelift.  Alternatively, resurfacing options such as laser or chemical peels can also help lessen these.  The facelift I perform is under a local anaesthetic which means a significantly reduced downtime.
Most of my patients want a facelift however do not want the downtime associated.  The Concept Facelift and Necklift is the procedure I perform, which combines the latest surgical techniques with the use of local anaesthetic to dramatically reduce the risks associated with traditional facelifts, while significantly reducing the bruising and downtime of your recovery, from months to a matter of days. 
If you have lax facial skin, lost volume and feel that you have jowls and wrinkles on your cheeks and you look tired when you're not then the concept facelift can help improve your appearance. With concept facelift you will look natural and fresh just like the way you feel inside. There are no bandages, drains and hospital stay but with lasting results of traditional facelift techniques it fits with today's age
 Typically recovery period is 7-10 days as you do tend to bruise more with your eyes than facelift and necklift.  You would need to return for a follow up appointment 7 days later to check your healing progress.  This can be combined with lower eyelid surgery which I think will give you a fresher appearance.
What are the benefits of a local anaesthetic facelift?
Minimally invasive as it is a short scar facelift, although has the same effects as the Traditional Facelift as the SMAS muscle is tightened along with the skin.There is minimal bruising and swelling, especially when compared to traditional faceliftsAs the procedure is performed under local anaesthetic, you can go straight home following the procedureFull recovery in a matter of days rather than monthsSignificantly less risk than Facelifts performed under general anaestheticFresh, youthful and long lasting resultsPlease make sure you find a reputable and qualified plastic surgeon

Kevin Sadati, DO · Answer

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.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  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.
 In my experience when evaluating the face, it's key to determine the following:  Are the cheeks, chin and lips the ideal aesthetic shape?  Are "jowls" present and is there excess fat and skin in the face and neck.  Once these factors are determined, the proper aesthetic plan can be determined to make the face balanced, (for women) feminine and more naturally youthful and beautiful (while for men creating a more chiseled, angular and handsome face).
 The folds that you mentioned are called "nasolabial folds" and are caused by two factors:  1. When there is an excess amount of mid face fat, gravity pulls the fat layer towards the nose and mouth with aging to create nasolabial folds and jowls.  2. Another significant contributing factor is the presence or absence of sufficient cheek bone volume in the front of the cheeks and face to support the cheek tissues.  When the front portion of the cheeks are flat or concave, this lack of bony support allows the cheek tissues to sag off of the cheeks towards the nose and mouth creating nasolabial folds and jowls.  Often both factors are at play when significant nasolabial folds are present in the face.  Performing a more aggressive and invasive facelift (like a deep plane facelift, subperiosteal facelift and others) by itself will not adequately address both causes of nasolabial folds. If the cheeks lack underlying volume in the front portion(s), precise volume must be added to the cheeks in order to properly support the overlying cheek tissues. 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.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  Conversely, men appear chiseled and handsome when angularity is created in the cheeks, chin and mandibular angles.
 A weak chin 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.
 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.
 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
proper SMAS Imbrication technique
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.

I was told an SMAS Facelift would not help folds running from the nose to mouth, is this true?

Answers (6)

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