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What are the important differences between the different types of facelift

Marketing and “spin” around the different types of facelift can make understanding the important differences very complicated. Here I explain the important differences very briefly.

The scar

This does not define anything other than the shape and length of a scar used by the surgeon. A scar should be as hidden and as neatly sutured as possible. For a facelift that includes the lower face you will always have a scar in front of the ear, which will either be straight or curved behind the tragus for part of its length. All surgeons will then extend this forwards into the hair or into the hairline depending on preference. There are pros and cons to both. Your surgeon may then also choose to extend the scar under and behind the ear and some even across behind the ear and into the hairline of the neck. Generally you can use a shorter scar the more vertical the vector of the lift. If the vector is posterior then a long scar is usually needed to excise skin behind the ear and on the neck.

Depth of the lift.

Traditional skin only face lifts will use long scars and posterior vectors. This often led to early relapse and a “pulled “ or tension look. Working on the SMAS layer (Superficial Musculo-Aponeurotic System) means the surgeon is working on a stronger and more structural layer. Results tend to last longer and be more natural.

Plane of Dissection.

Working on the SMAS layer gives a longer lasting and more natural result. Deep plane techniques separate the SMAS from the underlying tissues and reposition the SMAS higher up. This lifts the face. SMAS plication techniques reshape the SMAS by pleating it with sutures. Because the higher part of the SMAS in many people is relatively stable this can also achieve a lift.

The vector of the lift.

Pulling your skin backwards will correct some of the features seen in patients with baggy skin. All traditional  forms of skin only facelifts relied on this. They used long scars. As a hang over from this many forms of facelift still rely on a posterior “pull” to achieve correction of the jowel. Aging of the face however is far more than just correcting jowels, and many of these techniques have ignored obvious aging around the cheek and midface. These can only be corrected by concentrating on a much more vertical vector. After-all our faces have not fallen backwards as we have aged they have fallen down. Vertical vector techniques achieve much more natural results correcting the jawline but also address many of the concerns higher up in the face. They also completely avoid the windswept pulled “done” look.

In posterior vector techniques the SMAS can be either dissected in the deep plane and excised, known as a lateral SMASectomy or more simpler pleated with sutures.

In vertical vector techniques the SMAS can be dissected in the deep plane and elevated upwards or the SMAS can be pleated with sutures.


What is a sub-SMAS facelift

A sub-SMAS facelift is a type of facelift surgery that involves repositioning and tightening the underlying SMAS (superficial musculoaponeurotic system) layer of facial muscles and tissues. The SMAS layer is located beneath the skin and fat layers of the face and is responsible for providing the movement of facial expression, as well as support and structure to the face.

What happens during a sub-SMAS facelift?

During a sub-SMAS facelift, the surgeon makes an incision in the skin and separates the skin and fat layers from the SMAS layer. The SMAS layer is then lifted and repositioned to a more youthful position, and excess skin and fat are removed. Repositioning the SMAS allows for more significant improvements in facial sagging including the jowels compared to a traditional skin only facelift. A sub-SMAS varies from a SMAS plication, a plication does not dissect under the SMAS instead uses sutures to pleat the layer, thus also reshaping it. A sub-SMAS actually separates the SMAS from the underlying tissues and lifts  the whole layer to a higher position.

What is a high SMAS facelift?

To perform a sub-SMAS facelift the surgeon must decide where to divide or cut through the layer to get underneath it. In the majority of sub-SMAS procedures the SMAS is divided well below the cheek bone (zygoma) and lifting is done in the lower face. With a high SMAS the layer is divided directly over the cheek bone and the whole SMAS lifted which includes the midface (cheek). This gives a much more natural result highlighting a youthful triangular shaped face rather than an old square shape, emphasising health and wellness and avoiding a stretched look.

Can a sub-SMAS facelift be done under local anaesthetic?

Mr Lee offers a multitude of face lift techniques but is also highly experienced at performing  high SMAS facelifts under local aneasthesia, without sedation. You will be allowed a pre-med, so you will feel relaxed but will not be asleep.

What is the recovery time of a sub-SMAS facelift?

Mr Lee recommends that his patients refrain from sport and exercise for 4wks following a face lift under local aneasthetic, most are back working and socialising by 10 days.

How does a SMAS facelift differ from a deep plane facelift?

A SMAS lift just means the surgeon has targeted the SMAS layer of the face to achieve a lift. It is rather a vague term because it does not say how this lift has been achieved. The surgeon can choose to dissect under the SMAS  ( superficial-musculoaponeurotic system) separating it from the very deep structures of the face and then lifting and re-anchoring it higher up , this is the sub-SMAS approach, otherwise known as a deep plane facelift.

Alternatively the surgeon can simply pleat the SMAS with sutures without separating it from the deeper layers. This is known as a SMAS plication and is a simpler technique.

Repositioning the SMAS achieves a longer lasting and more natural result than traditional skin tightening procedures


What results can be achieved with a deep plane facelift?

The results of a deep plane facelift are typically longer-lasting than those of a traditional facelift, as the structural fibromuscular layer of the face is elevated and resuspended. SMAS plication techniques cannot quite emulate the results of a deep plane sub-SMAS lift particularly when compared to a high sub-SMAS technique that allows lifting of part  of the midface at the same time as well as augmentation of the cheek bone and temples. Reshaping of the face is now well recognised as one of the most important parts of creating  a more youthful and healthy appearance. However, the procedure is more complex and requires a highly skilled surgeon with extensive experience in deep plane facelift surgery. 


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