Q. Why would a Surgeon choose a SMAS-imbrication over a SMAS-ectomy, where is the logic in keeping excess SMAS in the face? Also, wouldn’t it be counterproductive to dissect and re-suture SMAS to a face that is seeking to Lift a droopy jowl look? Just like the outer most layer excessive human skin is dissected and disposed of, why wouldn’t you wanna dissect and disposed of excess SMAS?
A. Good question and one dependent on the skills and creative process of your surgeon. Having done both, I have found the thickness and the adherence of the SMAS to vary in individuals making the SMAS flap more difficult to lift in order to pull, reposition and suture.
I am in the camp of redistributing volume from the jowls up the mid-face and imbricating the SMAS along the lateral cheek and zygoma. This provides a smoother transition from the jawline upward and adds the extra well vascularized tissue to the cheek from where it descended from. In addition, the lipo-contoured jowl fat maybe grafted into the medial and lateral cheek for a fuller cheek mound.
These a issues to discuss with your surgeon. Consult with a Board Certified and experienced Plastic Surgeon.
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