SMAS Facelift
SMAS, the Superficial Musculoaponeurotic System, is a deeper tissue layer beneath the skin and fat. An SMAS facelift is a traditional and more comprehensive approach to facelift surgery. It targets not only the skin but also the underlying muscle and connective tissue, allowing for a more extensive facial rejuvenation.
Key points about SMAS facelift:
- Comprehensive Results: SMAS facelifts provide dramatic and long-lasting results by addressing the deeper facial structures, offering a more comprehensive lift of the face and neck.
- Extended Recovery: Patients should expect a longer recovery time compared to a Mini-Facelift, typically around 2-3 weeks.
- Suitable for Severe Aging: SMAS facelifts are ideal for individuals with more significant signs of aging, including severe jowls, sagging neck skin, and deep wrinkles.
SMAS Facelift Options
There are many types of facelift which can be classified based on the type of work performed on the SMAS, and on the extent of the incisions.
Based on the depth of SMAS dissection there are 2 main types:
- Superficial SMAS procedures. This is the simplest type of intervention and can be either a plication, imbrication, or limited excision of the SMAS.
- Sub- SMAS procedures. These are more complex techniques, which involve raising a SMAS flap. Sub-SMAS facelifts can be further subdivided in:
- Lateral SMAS approaches (High or Low)
- Deep Plane Surgery. This is the most advanced facelift technique and requires detailed anatomical knowledge and surgical experience in the face and neck, hence not every cosmetic surgeon is able to offer it.
The term deep plane refers to an anatomical space located between the SMAS layer and the deeper tissue in the face and neck. By entering into this deeper space, the SMAS and the platysma can be completely released from the underlying tissues / ligaments, allowing for a more effective, tension-free suspension.
Although the Deep Plane is technically a more challenging and lengthy procedure (due to delicate facial nerve dissection) compared to superficial SMAS facelifts, it offers a number of advantages, which made it the go-to choice for natural, long-lasting results in modern facial rejuvenation surgery.
Deep Plane Facelift Surgery is undertaken for not only aesthetic reasons but also functional indications (facial paralysis).
- Firstly, the entry point of the deep plane is closer to the medial soft tissues compared to other SMAS flap techniques. This allows direct access to the drooping areas of concern that need re-suspension. This is a significant biomechanical advantage compared to the traditional facelifts. This allows a very effective re-suspension of the SMAS and platysma with no need to apply excessive tension.
- Releasing the ligaments and other dense fibrous attachments in the deep plane allows for the SMAS and platysma to be re-suspended with minimal tension. This is very important in terms of the longevity of this technique as there is less risk of early failure and snapping of the SMAS suspension sutures from too much tension. This tensionless suspension technique is largely responsible the natural results achieved with deep plane surgery; the face is rejuvenated but without the unattractive look of excessively pulled tissues (the unwanted “wind tunnel” effect of the facelift patient).
In addition, there is less risk of suture “cheesewiring” through the SMAS, a situation that often creates dents or other irregularities in the face.
- Another advantage of the deep plane technique is the improvement that can be achieved in the midface region. By freeing up the ligaments during the extended deep plane facelift, it is possible to access and reposition the ptotic midface fat compartments and restore the volume and projection on the malar eminence. This is not possible with conventional facelifts where the zygomatic ligament remains uninterrupted and the effect on the midface is minimal.
- Finally, with the extended deep plane dissection in the neck it is possible to free up the platysma muscle to approximately 5 cm below the jawline. A platysma flap is then created via a back-cut and this flap is re-suspended to the mastoid area creating a crisp, youthful jawline. The posterior jawline, which has lost volume with age, can be also augmented by repositioning SMAS tissue. The Platysma back cut transects some of the unwanted vertical bands, but also creates a flap that acts as a hammock supporting the ptotic deep neck tissues, including the submandibular glands.
There are 2 types of Deep Plane facelift:
- Short scar, with the incision running from the temporal hairline to just a few centimetres behind the earlobe. This short scar approach is best suited for patients who mostly have lower face concerns, with mild to moderate jowling and without significant excess neck skin. Despite the shorter incision it is still possible to perform extended Platysma dissection and improve neck contour and jawline definition. One of the biggest benefits of this approach is that there is no visible scarring for patients that like to wear their hair as a ponytail.
- Full scar Deep Plane. The incision is extended to the mastoid region and the posterior hairline in the occipital area. The extra incision is required to manage heavier necks with significant excess skin and avoid irregularities from bunching up the redundant skin behind the ear.
Deep Neck Lift
This is performed via an additional incision in the submental area (under the chin). A deep neck lift is indicated for patients who have symptoms and signs of neck heaviness. These include prominent platysma bands and excess deep (sub-platysmal) fat, which is not amenable to liposuction. This incision also allows access to the anterior digastric muscles and submandibular glands.
The digastric muscles are often reduced and tightened during deep neck lift surgery to smoothen the floor of mouth contour. In some patients the inferior portion of the submandibular glands are enlarged or very ptotic with age so the glands may become more noticeable after surgery. Those patients may, therefore, benefit from submandibular gland reduction. This is a challenging procedure as the anatomy of the area is very complex with nerves and vessels being very close to the glands, and the surgery itself is performed through minimal access.
Mini-Facelift
The Mini-Facelift, as the name implies, is a less invasive and more subtle version of a traditional facelift. It is often chosen by those who are looking for a more modest improvement or want a quicker recovery.
Key points about Mini-Facelift:
- Less Invasive: Mini-Facelifts involve smaller incisions and target the skin and superficial tissues, making it a less invasive procedure.
- Quicker Recovery: The recovery time for a Mini-Facelift is generally shorter, usually around 1-2 weeks.
- Ideal for Mild to Moderate Aging: Mini-Facelifts are best suited for individuals with mild to moderate signs of aging, who are looking to address early jowls or fine wrinkles.
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