Goals/Purpose:
The competitive efficacy of the SMASectomy approach in facelifting has been well established. (1,2). And the successful application of the concept of treating tissue excess without direct undermining has been equally demonstrated both in the pinch blepharoplasty and high tension abdominoplasty techniques.
The purpose of this paper is to present a uniquely longer-term clinical study of a variation on the traditional facelift which combines these concepts with the use of an exclusively laterally-based SMASectomy approach. This technique has proven to be safer and less invasive while still delivering a most effective, long lasting, natural looking correction.
Methods/Technique:
Over the last 10 years this lateral-based facialplasty has fully usurped the traditional, more limited SMASectomy with a central direct neckplasty. The key elements of this technique are the following:
1. The facialplasty is accomplished entirely from a lateral approach. (The central neck is liposuctioned whenever necessary).
2. The SMAS manipulation is designed in a more extensive boomerang shaped construct: from above the malar to below the neckbands, running parallel to the nasolabial/marionette folds and neck bands.
3. The SMAS excision/plication is performed more aggressively, both at the face and neck, in order to realize a complete repair from this lateral approach.
4. The fascial treatment is so designed that the mobile SMAS component is both maximally trimmed and firmly sutured to the immobile SMAS.
5. The skin need be undermined laterally only as much as is necessary to accomplish the SMAS repair.
With these elements united, the SMAS repair becomes decidedly more powerful: “higher, lower, wider and tighter”.
Results/Complications:
The results of more than 300 cases over 10 years, with at least a year follow-up, were evaluated. Uniquely, the author utilized self-imposed “benchmark” criteria to measure results. On account of the conservative skin undermining, immediate postoperative swelling was much reduced and overall recovery time significantly accelerated. Most importantly the results remained predictably and satisfyingly natural looking. And the longer-term results were stable with only about a 3 % recurrence rate of modest and generally acceptable neckbands. However, if necessary, in a small subset of these cases, the bands were corrected relatively easily, under local anesthesia, by either excision or plication. There were no significant complications such as motor nerve injuries, skin sloughs, or areas of poor scarring.
Conclusion:
The essence of this facelift approach is the power of the laterally based SMASectomy. And the principal driving this technique is that the SMAS and the overlying skin do not necessarily have to be undermined or otherwise mobilized in order to be tightened and manipulated respectively. Therefore,
1. The midface ptosis correction does not require an aggressive subSMAS and skin dissection with direct release of retaining ligaments but rather a well-designed and executed SMAS tightening.
2. The vertical neckbands do not have to be approached from the midline with an expansive skin elevation and complete plastysmaplasty but instead can be repaired with a strong, laterally driven SMAS / platysma tightening.
As a result, the patients enjoy a swifter recovery, with less risk of neck hematoma, flap ischemia, nerve injury and poor scars. And this approach realizes a very natural, long-term result with a more complete neck repair, fully to the chest, as well as a very effective correction of the midface/cheek and jowl deformities.
References:
1. Lateral Smasectomy
Baker, Daniel C.
Plastic & Reconstructive Surgery. 100(2):509-513, August 1997.
2. Identical Twin Face Lifts with Differing Techniques: A 10-Year Follow-up
Alpert, Bernard S.; Baker, Daniel C.; Hamra, Sam T.; Owsley, John Q.; Ramirez, Oscar
Plastic & Reconstructive Surgery. 123(3):1025-1033, March 2009.
