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Which technique, high SMAS or lateral SMASectomy, provides the most improvement or lift of the cheeks?

Question from  North Carolina, NC: When choosing between two different surgeons, each with a different preferred surgical technique, which will provide the best lift of the cheeks: high SMAS or lateral SMASectomy? I am NOT interested in fillers or fat transfer to augment the cheek area but would rather have a lift that will address the cheeks. Thank you! Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:  ​I LOVE facelifts because of the uniqueness of every patient and the variation of the anatomy! ​ ​If fillers and fat grafting is left out of the equation, a Midface Lift is your best option to lift and fill the cheeks. As I perform them, a lower eyelid incision is made and depending on the tissues to be lifted, the cheek will be suspended straight up to the inferior orbital rim. ​ ​As you have found out there are different proponents for many SMAS lift variations. Some say imbricate at a medium or high cheek plane; some say lift and suspend in front and behind the ear; some say pull tight, cut off the excess and sew to the opposing edge. ​ ​For maximum advancement of the jowl to the cheek deficit, I find a high SMAS imbrication is very straight forward and best option to achieve a youthful appearance. It also lifts the jowl, the platysma and the attached neck soft tissues. ​ ​For maximum jowl and neck elevation from the facelift incision, a SMAS elevation and advancement in front of and behind the ear works well. ​ ​Lateral SMASectomy similarly lifts the jowl and tightens the soft tissue upward and outward but excises the redundant tissue which can be used to augment the cheek. ​ ​I find that SMAS lifting will not fully address the youthful medial upper cheek; ie., the nasal half of the cheek “apple” just below the eyes. I therefore perform fat grafting from any liposuctioned fat I have contoured from the jowls, jawline and neck. You may also consider fillers such as Voluma. ​ This of course only addresses one of many decisions made for customizing a facelift to the individual patients face and neck. ​ ​​This was a great question. I hope I was helpful.
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