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Can’t decide between two facelift methods. What is the difference?

Dr. Dean Kane Q & A. shutterstock_38139943Q. There were two types of facelifts offered by two different surgeons. One was sewing the cheek muscle only and another was loosening the cheek muscle and then sewing it back (called a high SMAS facelift). What is the difference ? A. There are two basic techniques in facelifting. They include:
  1. Lifting the lax, elongated skin and like a bed-spread, re-draping it upward and outwardly.
  2. ​Suspending the soft-tissues of the face, be it SMAS (the fascia component) and / or the muscles like lifting the top sheet of the bed.
For patients with excess skin laxity and redundancy, where you can “pinch an inch” or more along the jawline to the earlobe, a skin incision in front of and behind the ear to properly “hide” the scar is what we use to elevate the skin flap and lift it. The scar length will be determined by the quantity of skin laxity and the need to distribute this over a shorter or longer length of incision and subsequent scar line. ​ ​Those patients with descent of the cheeks and jowls will improve with a:
  1. ​SMAS lift variation: SMAS flap, SMAS imbrication or a SMAS lasso.
  2. ​deep flap, ie lifting the muscles as well.
​Patients with natural descent of both the skin and soft-tissues and no laxity of the skin or underlying muscles and fat may find improvement with a more specialized facelift technique called a sub-periosteal lift with imperceptible incisions. This is analogous to lifting and suspending the fitted sheet of your bed off the mattress and pulling up the above lying top sheet, pillows and bedspread. I, too, like the high SMAS imbrication technique in properly selected patients. In my hands, it best elevates the corner of the mouth and the sagging jowl while filling the medial and lateral aspects of the cheek. Sometimes you may need to supplement the surgical technique with fillers (including gels and / or fat) and skin firming techniques like lasers and peels or retinoids or Sculptra. It all depends on the training, talent and skills of your surgeon and the trust you have in him or her to achieve your goals.​Discuss these considerations with your surgeon to find the best approach for you. ​I hope this has been helpful. All the best!
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