This is prevented by supporting the SMAS layers to obtain the most natural results. Ramirez51 reported a similar rate of neuropraxia using a subperiosteal release and suture suspension technique. This is why the results have greater longevity. Current trends in facial rejuvenation: an assessment of ASPS members’ use of fat grafting during face lifting. 2013;131:1125–1136. Tel. Also, since we are not lifting under the muscles, the patients do not have as much bruising and swelling making recovery time a bit faster. While most surgeons can execute this procedure, Dr. Jacono does not suggest it because he believes facelifts should last 10 years or more, and this can be accomplished by lifting the SMAS. A retrospective cohort study was undertaken, clinically evaluating 225 consecutive patients treated from January 2009 to September 2019 with a sub-superficial musculoaponeurotic system uniplanar facelift, triple-vector platysmaplasty, and no temporal incision. (See Video 1, [online], which demonstrates the facelift dissection.) The SMAS dissection commences by first marking the path of the frontal branch of the facial nerve, keeping the SMAS dissection inferior to the line. This is the cranial-most extent of the SMAS dissection. You have a thicker flap that you’re working with, meaning the skin and the muscle all move together, and you’re moving all of that vasculature together instead of moving the muscle and then putting the skin over it. Reducing the risk of this complication is another advantage of eliminating a temporal incision. All rights reserved. Plast Reconstr Surg. Rohrich RJ, Ghavami A, Constantine FC, Unger J, Mojallal A. Lift-and-fill face lift: integrating the fat compartments. The Ultimate Guide to Soft Tissue Fillers Attempts to place these sutures through the muscular fascia should be made. Eliminating the temporal incision, where the scar may be exposed, may be more helpful than behind the ear, where the scar is usually well-concealed. 2002;110:1526–1536; discussion 1537. Different surgeons have a better comfort level with one of these procedures. Little JW. Plast Reconstr Surg. This is a simple procedure, but the suturing technique does not last as long, often creating results that last only 2 or three years. Dr. Jacono performed a SMAS face lift to correct these issues. New York Center for Facial Plastic Surgery. She was unhappy with the scar and was not comfortable wearing her hair up or back. She did not like her sagging cheeks and her very visible jowls. Plast Reconstr Surg. You may be trying to access this site from a secured browser on the server. This sequence allows no opportunity for subsequently opening the tissue plane and releasing fat. 64. 1989;83:11–16. to maintaining your privacy and will not share your personal information without Rejuvenation of the midface by elevating the malar fat pad: review of technique, cases, and complications. 2004.St. It is a layer of tissue that occurs under the skin of your face and provides facial elasticity and support. Swanson E. Does sub-SMAS buccal fat pad transposition augment malar volume in facelift patients? The term "SMAS facelift" simply means that something was done to the SMAS. You can see in her after photos how balanced her facial appearance is. 4. 2011;127:823–834. Evidence-based medicine: face lift. Patients provided written consent for the use of their images. Dr. Jacono performed a SMAS facelift which included his signature deep plane facelift to lift her drooping cheeks, nasolabial folds, and early signs of jowling. If you have questions? This depends on factors such as the surgeon's experience, the local economic market conditions, the facility and anesthesia fees, and the specific techniques involved. 52. Dr. Andrew Jacono, MD, FACS is considered the, Dr. Jacono Rated Top Plastic Surgeon – News, World Leading Expert in Facial Plastic Surgery, Innovator, and Philanthropist, Fat Transfer Correction with Facelift Surgery, Vertical lifting of the face and neck by repositioning the SMAS, Removal of Jowls, and Drooping/Turkey Neck, Removal of deep wrinkles with long-lasting results, Safe procedure with very few complications. The most frequent complication was a temporary neuropraxia (7.6%) (Table 3). 51. 1. The parietal branch is then identified and ligated at its takeoff. Jacono AA, Alemi AS, Russell JL. Our Surgical Team likes to make the analogy of the two facelift techniques for making your bed. Illustration of third vector. Facial aging, including slack facial skin, Facial fat descent with radial expansion of the fat away from the facial skeleton. Preservation of this tissue plane is only possible using a single vertical vector. 2002;110:1793–1796. This release allows greater mobility of the tissue and removes tension from the skin, placing it on the less-elastic SMAS layer instead. Fat (mean volume 32 ml) was injected into the undissected subcutaneous tissue plane. 44. This is done by inserting scissors in the plane between the malar fat pad and the elevators of the lip. The SMAS is then secured in this location with a soft absorbable suture, down to the underlying tissue and periosteum of the zygomatic arch (Figure 20.6). Doctor Jacono’s desire to become a facial plastic surgeon was solidified in grade school. After submental liposuction and conservative interplatysmal fat resection, the platysma is plicated in the midline with a running 4-0 Monocryl (Ethicon, Somerville, N.J.) suture. The horizontal incision was about 3 cm long. Find company research, competitor information, contact details & financial data for TECHNIFLEX of GIGEAN, OCCITANIE. Unfortunately you will continue to age but from a position of 10 to 20 years earlier. The sub-SMAS lift releases the SMAS from its ligamentous attachments, allowing it to be elevated along with the skin and fat sandwiched in between. Kids teased her and were cruel, and nobody would sit next to her on the bus, so he decided to sit with her. 2012;33:211–217. A SMAS, deep plane, lower facelift, neck lift, skin lift procedure can all be done through exactly the same skin incisions. Three-dimensional rejuvenation of the midface: volumetric resculpture by malar imbrication. No temporal incision was used. At this point, the platysma muscle can be visualized and may need to be repositioned and sutured together if it has splayed in the midline. In recent years, more and more patients prefer the SMAS technique when choosing a facelift. This is why he has gone on over twenty plastic surgery missions to poor countries around the world and provided free cleft lip and surgery for birth defects to over 500 children. The most frequent complication was a neuropraxia (7.6%), usually affecting a frontal nerve branch, and always temporary. You can see that her wrinkles are virtually all gone and her neckline looks amazing. Facelift techniques generally lift the skin of the face, but how the SMAS muscles under the facial skin are treated differs. Wan D, Small KH, Barton FE. Some people might want a touch up at that point, but some are fine with always looking 10 to 15 years younger than their age, even if they do experience some aging down the line. Get the latest business insights from Dun & Bradstreet. The mean follow-up time was 28 months. With the SMAS facelift, you’re actually just going on the top of it and moving it where you want it to be. SMAS Facelift New York – 59 Year old female patient of Dr. Jacono discusses her SMAS facelift procedure and her results. Preserving orbicularis branches of the zygomatic nerve with the orbicularis oculi muscle-superficial musculoaponeurotic system flap complex in facelift surgery. Plast Reconstr Surg. Malar projection is increased at 1 month, with no change at 6 months. Die Ergebnisse eines SMAS Liftings sind nicht nur besonders natürlich, sondern haben im Vergleich zu anderen Lifting-Methoden auch länger Bestand. Terms of Use. 2013:3rd ed. Finally, pouches beside the mouth could be due to a particular patient's anatomy or the particular technique used by the surgeon. This is would be very rare. 3). For SMAS facelift recovery photos, ask your nurse or Dr. Jacono, and he can show you the kind of bruising and swelling you can expect in your face. Dr. Sturm was named Texas Monthly’s Super Doctors Rising Star in 2016-2017, Texas Monthly’s Super Doctor in 2018-2019, H Texas Magazine’s Top Doc in 2013-2018, Top Doc by Houstonia magazine in 2016-2018, Houston Business Journal’s People on the Move and 40 under 40, Blazing Star Award by Texas Women’s Chamber of Commerce, Top Women in Business, one of the Top 30 Influential Women of Houston, Best Female Cosmetic Surgeon in Out Smart, and given the Patients’ Choice Award, On Time Doctor Award and Compassionate Doctor Award by Vitals.com. Under your skin you have fat and under that is a layer of muscle. There are countless variations of how the SMAS can be manipulated during this surgery. 1 Most people continue to look 10 to 15 years younger, but over time the results of aging gradually reappear about 10 to 15 years after the procedure. Dr. Sturm chose to focus her practice on only the face and neck to provide meticulous and thorough care in a very personal way. Undermining and lifting the SMAS allows the skin to re-drape smoothly thus avoiding any lumpiness and achieving natural results. • Contraindications • SMAS technique • Recovery • Risks and complications What is SMAS facelift? Normally for my Full facelift I will perform until SMAS layer, and it’s probably will last for 10 years, but some case will last for more than 10 years. It is equally important not to make the skin flaps too thin, lest they should be prone to venous congestion. The zygomatic7 and masseteric8 cutaneous retaining ligaments were released and the SMAS flap was transposed superiorly. 2013;132:57–64. 13. A deep plane lift works better on someone who has trouble healing. 2001;21:14–26. SMAS stands for sub muscular aponeurotic system, which is a very thin layer of muscle.. The surgeon is either going on top of the muscle or under the muscle to lift. Some error has occurred while processing your request. Avoiding tension on the skin layer is, in fact, the secret to a successful and natural appearing facelift. Tschüss Schwerkraft – hallo klare Gesichtskonturen! Of course, there is no external surgical option; an internal mechanism is needed to provide lift. 45. Furnas DW. The SMAS Facelift procedure is designed to restore a more youthful appearance to the face by repositioning muscles under the skin. These are most importantly placed into the SMAS layer of fibrous tissue that is very strong and does not tend to tear. One-way analysis of variance was used to compare means for continuously measured variables. The incisions have almost healed and are barely visible when her hair is pulled back, thanks to the incorporation of hyperbaric oxygen treatments that expedited the healing process. Answers ( 26) ASK A DOCTOR From board-certified doctors and trusted medical professionals Sort by Recommended VOTED MOST HELPFUL August 24, 2020 Answer: A SMAS Facelift can last a very long time A facelift will reverse 10 to 20 years of ageing from your face and neck. Aesthet Surg J. Omitting a medial platysmaplasty increases the risk of persistent platysmal bands.54 The author’s technique differs from a traditional sequence in that the facelift (Vector 1) is performed first, allowing unrestricted upward mobility of the SMAS, which is in continuity with the platysma.55. Now, an incision can be made that transects the medial portion of the platysma inferiorly. It is possible to have skin color or skin tone changes after a facelift. Swanson E. Does a deep-plane facelift restore malar volume without simultaneous fat injection? For one, the deep plane facelift also treats the neck, which the SMAS doesn’t. This supports the deeper layers of SMAS in both the Extended SMAS and High SMAS facelift, but they differ in that the Extended SMAS technique targets the jawline and neck, while the High SMAS technique can lift the cheeks that droop as well as the jowls and neck because the layers of SMAS in the upper face is also lifted. The authors performed a retrospective chart review of all patients who underwent triple-C SMAS plication facelift surgery performed by the senior author (K.S.) Wie viel Zeit sollten Sie für die Heilungsdauer nach einem SMAS Facelift einplanen? This dissection is continued caudally over the angle of the mandible and further down into the neck overlying the platysma. The patient’s activity increases with each passing day. A contemporaneous clinical study and laboratory study failed to support their efficacy.10,11 Patients were treated using total intravenous anesthesia without muscle relaxation. Plast Reconstr Surg. (See Video 4, [online], which demonstrates the endoscopic forehead lift.) A facelift should never actually fail it is simply that we cannot stop the facial tissues from continuing to age over the years. The facial retaining ligaments transmit through the SMAS to the overlying skin, either . He is committed to providing his surgical expertise in a caring, supportive environment with a professional staff that has you as their focus and concern. A value of P < 0.01 was considered significant. The skin is now redraped, and the amount to be resected is determined (Figure 20.8). From 2009 to 2019, 225 consecutive outpatients underwent a sub-SMAS facelift with a triple-vector (superior, lateral, medial) platysmaplasty, either alone or in combination with fat injection, laser resurfacing, blepharoplasties, endoscopic forehead lift, and other cosmetic procedures. How quick is the recovery from and SMAS facelift? Patients with a length of follow-up less than 100 days were excluded from the study. A secondary facelift may be indicated in some patients (7% in this series). Dr. Robert J. Knowling performs facelift surgery using the SMAS technique. Mit der von uns durchgeführten Methode können Sie sich auf einen Verjüngungseffekt von etwa zehn Jahren freuen. 41. 1993;17:43–47. 1992;89:441–449; discussion 450. Methods: A retrospective review was performed of patients undergoing the triple-C SMAS plication over a 1-year period. Placing the fat superficial to the SMAS avoids an overlying compressive force.48 The injected fat camouflages any flattening effect that may result from SMAS elevation and fixation.21 Although many operators inject fat at the beginning of the procedure,40 the author prefers to harvest and inject fat after the facelift. The SMAS facelift works by lifting things back up to where they used to be, rewinding time and making you look at least 10 years younger. 1992;90:601–607. Falls Sie einem Facelifting noch zurückhaltend gegenüberstehen, da Sie Angst vor einem maskenhaften Gesicht haben, können wir Sie beruhigen. Rohrich RJ, Ghavami A, Lemmon JA, et al. Dr. Jacono performed a SMAS facelift on her and the after photos show a defined jawline with a wrinkle-free and tighter neck. The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Hamra ST. 12. †Patients treated with a facelift, blepharoplasties, and a forehead lift were more likely to have simultaneous fat injection than patients having a facelift without these other procedures. While a SMAS facelift and a deep plane facelift are similar in the parts of the face that they work on (the lower two-thirds, approximately) and both address sagging skin, fat, and jowls, there are differences between the two. 2013;132:339–350. Lidocaine 0.5% with epinephrine is instilled along the incision lines and the planes of subcutaneous dissection. This line is then carried under the lobule, then up and behind the ear, in the vertical direction within the junction of the posterior concha and the postauricular skin (i.e., the conchal groove). The stitches in front are removed on the fifth day and those behind them around the eighth day. Fist the sutures don’t slice down  is possible that the different sutures use are absorbable or permanent but ones it heals what maintains the results is the quality of your  skin and what   the SMAS  really helps is the support of the deep tissues and reduction of the skin tension. The SMAS facelift works by lifting things back up to where they used to be, rewinding time and making you look at least 10 years younger.FULL ARTICLE: https://drangelasturm.com/how-long-does-a-smas-facelift-last/If you did just one facelift and you never did anything else again, you should always look about 10 to 15 years younger than your age. Facial fillers are either natural or synthetic substances that may be injected below the skin to eliminate the fine lines and wrinkles and restore lost volume. Fat is injected into the undisturbed plane between the skin and SMAS, providing outward (radial) expansion of the cheek. Another advantage of the SMAS facelift is that excessive tension is avoided on the skin layer since the SMAS lift will actually hoist up 60 to 70 % of the skin weight. Coleman SR. Terms of Use. If you are lazy and only pull the bedspread over the bedsheet, the bed will look lumpy. It’s is Doctor Jacono’s passion to help his patients achieve their facial aesthetic goals, creating natural appearing results to either enhance their beauty and proportion or rejuvenate their aging appearance. Comparisons of the procedure groups revealed no significant difference in age, follow-up time, sex, smoking status, secondary surgery, or body mass index (Table 1). McKinney P. Cervicoplasty: nonexcisional anterior approach. What that means is that you can lift the nasolabial folds and marionette lines better because when you do a deep plane facelift, you go under the muscles that control smiling, laughing, and moving your face. He also performed a lower eyelid lift with a temporal lift which opened up her eyes. Feldman JJ. Moreover, the ligamentous weakness is not at the sub-SMAS level, but at a level between the SMAS and skin. SMAS facelift is a relatively safe surgery. Their more superficial branches, which are fine terminal extensions that arborize in the superficial fibrofatty layer,29 have weakened, allowing tissue relaxation and descent.30 Skin tightening is inadequate to correct jowls because of its elasticity and its inability to provide much traction on the deeper tissues.30 Simply performing a SMAS plication without release of the retaining ligaments cannot be expected to provide much vertical movement of the superficial tissues,28,33 because these ligaments are quite strong (often making an audible snap when released). 1 Our early anatomic studies 2, 3 documented the benefit of leaving the skin and subcutaneous mass attached to the SMAS in facial rejuvenation. The lateral view demonstrates the temporary temple roll created by the vertical lift, which is still visible 10 days after surgery but has resolved well before her 3-month follow-up visit. Limitations of this study include its retrospective design and lack of a comparison with a control group treated with orbicularis redraping and a traditional temporal incision. Is a pink scalp normal after a hair transplant? Disclosure: Dr. Swanson receives royalties from Springer Nature (Cham, Switzerland). These are not suspension sutures, which are prone to cheese-wiring.27 The more distal the site of fixation from the tissue being elevated, the less reliable the lift and the greater the risk of relapse.12,28 Large-caliber, permanent sutures, featured in minilifts as compensation for lack of tissue mobilization,2 are unlikely to hold and can cause persistent tender lumps. All surgery was performed by the author at the Surgery Center of Leawood, Kans., a state-licensed ambulatory surgery center. 1983;10:543–562. Plast Reconstr Surg. This patient wanted to refresh her appearance while looking natural and younger. Ideal Candidate Recovery Side Effects Results Average Cost Pros Less Invasive Greater Improvement In Neck Skin Laxity Cons Visible Scars Longer Recovery Than Plicated SMAS Facelift Invasiveness Score mild moderate severe Invasiveness is graded based on factors such as anesthesia practices, incisions, and recovery notes common to this procedure.
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