Before we begin, a piece of advice: Read the article on my blog titled "What is SMAS?"

SMAS is the name of an anatomical layer. This layer contains the facial connective tissues and superficial muscle structures. Just beneath it lie the facial nerves.

In facelift surgeries:

1. You can lift the skin by going over the SMAS layer.

2. You can lift both the SMAS layer and skin as a single unit by going beneath the SMAS layer.

3. You can lift the skin separately and the SMAS layer separately.

We call the first category subcutaneous facelift (also known as subcutaneous or classic facelift), The second category deep plane/composite facelift (also known as composite or deep plane facelift), And the third category lamellar facelift (also known as multi-layer facelift).

We in the scientific literature aren't fond of wordplay. On the other hand, traders and advertisers love wordplay. Things that appear as innocent differences in expression can lead individuals to receive a product or service completely different from their expectations. This also applies in the field of facelifts.

All surgeries referred to as SMAS lifts must involve a dissection beneath the SMAS layer and the separation of the SMAS from its anchor point. You can call the second and third categories SMAS lifts.

Lifting the SMAS from its anchor is challenging. It requires training, experience, microsurgical skills, and mastery of anatomical variations. You need to carefully separate all the retaining ligaments and, in the process, protect deep structures such as nerves, muscles, and salivary glands. This surgery isn't part of routine plastic surgery curriculum.

Unfortunately, surgeries performed without lifting the SMAS from its deep tissue anchor are incorrectly labeled as SMAS lifts by their practitioners. In the first category (non-SMAS lift) surgeries, when you lift the skin, the layer left at the anchor is the SMAS. You can manipulate this layer from its surface. You can fold the layer onto itself with stitches (plication), cut a thin strip from the layer and stitch its ends together (SMASectomy), gather the layer with purse-string sutures (purse-string), or support the layer with suspension sutures. All these techniques are effective to some extent. They all involve working on the SMAS layer from its surface. However, none of these techniques are SMAS lifts. They are superficial facelifts with superficial SMAS manipulation.

Especially in patients with advanced aging and a superficial aging pattern, superficial techniques might be more effective than deep techniques. I have developed a technique called "dual-level SMAS plication," which is a superficial category technique. I successfully apply it in patients with a superficial aging pattern. I'm not opposed to superficial lifts at all.

 

 

I'm against presenting superficial lifts as deep plane or lamellar techniques through wordplay.

Another misconception is that surgeries in the second category (deep plane/composite facelifts) are being portrayed as superior techniques through similar wordplay compared to surgeries in the third category (lamellar facelifts). High SMAS and Extended SMAS techniques in the third category are both complex surgeries that involve both superficial and deep SMAS dissections.

Some medical practitioners are trying to promote deep plane composite facelift techniques that have been around for 40 years. They are grouping the intricate sub-SMAS facelift methods in the third category (like highSMAS/extended SMAS, etc.) with simpler superficial facelift methods in the first category (such as SMAS plications, SMASectomy, SMAS suspension, etc.) under the term "SMAS lift." They're doing this mainly on social media, not in scientific literature or meetings. It's as if they're making the deep plane composite technique seem like an entirely new and special method. This is a tactic to attract business

People are confused. A patient to whom I suggested High SMAS once told me: "I don't want an SMAS lift, I want a deep plane technique." While saying this, the patient wasn't aware that High SMAS is quite similar to deep plane, following the same philosophy but slightly more comprehensive. Because they think an SMAS lift is one of the superficial techniques.

I'm also against portraying lamellar (multi-layer) surgical techniques through wordplay as mere superficial techniques.

In facelift surgeries, the choice of technique should be personalized for each patient. The same technique won't work for every patient. The aging pattern and facial morphology vary from patient to patient. A superficial technique might be a good choice for a patient with superficial aging, atrophic SMAS layer, and concurrent fat tissue transfer to deep compartments. However, selecting a superficial technique for a young, heavy-faced, or smoking patient would likely yield poor results.

In my practice: I perform facelift surgeries in all three categories. SMAS sublayer techniques are my subspecialty. I have published scientific articles and case series in this field in medical literature. However, I have never claimed that SMAS sublayer techniques are superior in every aspect compared to superficial techniques. On my Instagram account, you can find examples of superficial, deep plane/composite, and lamellar techniques. It's not right to impose a doctor's favorite technique on every patient in facial aesthetics. Technique selection should be individualized. Allowing a patient to decide on a technique also carries risks for them.

Know this: Doctor selection is more important than technique selection. Good results can also be achieved with both classic and superficial techniques. Each physician achieves the best result with the technique they are experienced in. Moreover, patient safety comes with experience. Don't push a physician to use a technique outside their expertise. Such insistence leads to complications.

To learn more about technique selection in facelift surgeries, you can contact us.

Stay with Love,

Stay Beautiful.

OB