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Choosing the Right Facelift Procedure: Exploring Various Methods for a Youthful Appearance

팔자주름없애기 성형상담

The purpose of a facelift is to treat wrinkled face for an aging face. Focusing on the SMAS technique, we will introduce various surgical methods and facelift costs, although it may vary among surgeons.


1. What is a Facelift?

When it comes to facelift surgery, it’s important to understand that the procedure primarily focuses on treating sagging tissues below the chin, resulting in a sharper jawline and neck. While the midface may also see some improvement, addressing facial lines above the eyes requires additional procedures rather than relying solely on facelift surgery.

2. Exploring the Facelift procedure

facelift procedure
Various surgical methods according to the dissecting layer(depth)

Facelift surgeries are categorized based on the depth of dissection, specifically whether they involve the skin layer only or also target the SMAS layer, which encompasses the muscles. Here are some surgical techniques worth considering:

1) Subcutaneous Facelift Surgery (skin layer only)

Because subcutaneous dissection is the most basic and fundamental, no doctor will tell to patients that they only do skin layer facelifts. However, accurately performing skin layer dissection is crucial for a successful SMAS facelift which will be described below. 
If only the skin layer is pulled and deeper tissue is not lifted, the result may be as shown in the image below, with only the lateral side being pulled while the sagging skin in the medial portion of the face not improved. This is called a lateral sweep. 
While this is a fundamental method, it’s important to note that performing accurate skin layer dissection is crucial for a successful SMAS facelift. Failing to lift the deeper tissues properly may result in a lateral sweep, where only the lateral sides of the face appear lifted while the sagging skin in the middle portion remains unchanged. 

lateral sweep
The lateral swept-up appearance is most noticeable in side views with the face looking down.
Ref : The Art of Aesthetic Surgery

When the subcutaneous layer around the mouth area is extensively dissected during a facelift, it can lead to a pulled appearance on the sides, creating an unnatural and surgical look. To avoid this, renowned expert Dr. Marten advises preserving the anterior platysma-cutaneous ligament.

2) SMAS plication

SMAS plication
SMAS plication

This technique involves pulling and suturing the SMAS layer after dissecting the skin layer. It is a less invasive method that can save on surgery time. It can be selected in situations where it is difficult to create an effective skin or SMAS flap.

MACS lift
MACS lift

A variation of this technique is the MACS facelift, which minimizes incisions and utilizes threading around the ear to the jowls. Many surgeons offer different methods of mini face lift, each with variations in incision placement and extent of dissection and fixation techniques. Regrets after a facelift are often related to mini lift and major reasons are discussed here.

3) Deep plane facelift (Composite facelift) 

This method lifts the skin and SMAS layers together without separating them. It is particularly suitable for patients who have undergone multiple procedures affecting the subcutaneous layer or for heavy smokers concerned about skin necrosis. While there are limitations to the direction of the lifting vectors, a deep plane facelift can be a safe option depending on the patient’s condition. 

Mendelson premasseter space
Illustration and intra-operative findings of middle premasseter space by Dr. Mendelson
Ref : Surgical Anatomy of the Middle Premasseter Space and Its Application in Sub–SMAS Face Lift Surgery

Dr. Mendelson and Dr. Hamra are notable surgeons who perform variations of this technique, which can be a safe option in specific situations. While some Korean plastic surgeons express skepticism regarding the suitability of this method for Asian faces, it can be considered as the preferred option in high-risk scenarios where there is a possibility of skin flap necrosis. This is particularly applicable to heavy smokers or patients who have undergone multiple skin-shrinking procedures.

4) SMASectomy

SMASectomy
SMASectomy

In this technique, the SMAS layer is cut out after lifting one layer of the skin and then carefully stitched back together. This requires expertise in designing the appropriate SMAS layer to cut without damaging nerves. Skilled surgeons can achieve excellent results with this method.

5) Extended SMAS Facelift

Extended SMAS Facelift
The key to the extended SMAS technique is to raise the SMAS flap more medially to improve mid face.

This is a surgical technique performed by many renowned experts known for achieving excellent facelift results. Also known as the “bi-lamellar technique” or “high SMAS,” this procedure involves dissecting each skin and SMAS layer. It focuses on raising the SMAS flap more medially to improve the midface area, such as nasolabial folds. Although it is a more technically demanding method, it has been associated with outstanding outcomes. Determining the position of the SMAS flap and releasing the retaining ligaments are critical factors in this technique. 
Due to various anatomical studies related to the retaining ligaments, many surgeons believe that the extended SMAS technique is the most fundamental solution for facial rejuvenation. This is why many academic lectures and studies on facelift surgery often highlight on the extended SMAS technique.

3. Conclusion

Since each individual’s facial aging is unique, there is no one-size-fits-all facelift technique. The ultimate goal is to achieve the desired results safely, regardless of the chosen method. In Korean plastic surgery clinics, procedures such as SMASectomy, SMAS plication, and high SMAS facelift are commonly performed. However, it is crucial for patients to develop a discerning eye and evaluate facelift before and after photos to make informed decisions about their desired outcomes.

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