SMAS Facelifts are the Gold Standard in Facelifts

SMAS Facelifts are the Gold Standard in Facelifts

It can be a challenge for a patient to find a surgeon who does SMAS facelifts really well. There are a lot of surgeons who say they do a SMAS, when in effect, they do one of two things, neither of which is a SMAS. One, they may dissect 1-2 cm of this plane, right over the parotid gland, in which the nerves are not exposed, pull back and call it good. Because this is a very limited dissection and has not freed up any real portion of the SMAS flap, other than a tiny bit, it has no real effect anatomically and has no real benefit, in my opinion. The other technique that is also used which is less effective than a full SMAS flap, in my opinion, is suturing. A number of surgeons suture the SMAS and pull it up and back. To me, there are a number of things unsatisfactory about this. I believe it bunches up the deep tissue in front of the ear which causes a characteristic fullness in this area that looks peculiar. I don't believe that the sutures cause any long term effect other than this bunching. In addition, I don't think you get a uniform lift or pull and, therefore, you may get distortion or contour irregularities.

The reason that so many surgeons are so reluctant to do a full SMAS is understandable. The fact is, the SMAS flap is only one thin film layer away from all of the nerves that supply the motion to all the facial muscles. Therefore, if you are on the wrong side of that filmy layer, your chances of ending up with an injured nerve are much greater than if you work only with the skin. The demands in regards to the preciseness that this technique requires, has prevented a lot of otherwise very capable surgeons from doing what I believe is the optimal surgery.

In spite of the increased potential risk to the facial nerves and the extra work and time involved, I strongly believe that a facelift doing a SMAS flap and a platysmaplasty are the gold standard. One of the things I was always asked is, "Can you do just my neck?" The answer for me was no. There are surgeons who feel they can, but my own personal opinion was that it is possible to do a lower face and neck lift, with a platysmaplasty without doing much of a SMAS and that would give you a good neck, but anything less than that would not. That is because if you're pulling up and back of the neck, you can't merely stop at the earlobe. You have to work out that extra skin somewhere and the earliest you can stop is to do a lower facelift, which starts at the upper level of the ear and allows the surgeon to work out the redundant skin in the preauricular area. By doing it this way, the result will end up with an improvement from the corner of the mouth down, with a good jawline and a good neck line, but no dramatic improvements in the cheek or face.

Learn more about SMAS facelifts at the website of a San Diego plastic surgeon - Dr. David Wolf

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