Extended SMAS Facelift

Park, Dong Man

Abstract

In order to solve the problems related to aging faces, new techniques, including various kinds of barbed suture technique, are developing in present time. Although these several kinds of noninvasive or minimal invasive method for aging face have their own indication and barely complications, these procedures would be less effective than the extended SMAS technique used on those of Oriental person. In the face, there are some retaining ligaments, which support facial soft tissue against gravitational change. With aging, the cheek soft tissue anterior to the zygomatic ligament and posterior to the mandibular ligament descends into the plane between the superficial and deep fascia. However, the attached area by the zygomatic and mandibular retaining ligaments are almost unchanged because the ligaments that support facial soft tissue in normal anatomic position i.e, ligaments retain their integrity while the soft tissue around it relaxes. These changes lead to the formation of a nasolabial fold and jowl. I think the most important consideration factor before choosing a certain procedure is to decide which procedure could bring more predictable results, make longer lasting effect, and has minimal risk and morbidity. In my opinion, it is rationally impossible to say that one technique is better than the other. I always try to keep in mind that no two patients are the same, so whenever I do my technique, I try to adjust and adapt my technique according to individual specifications. Among the multiple problems related to aging, there are three distinctive features, which are wrinkles, volume loss, and drooping facial soft tissue. There is no single method for removing these problems. If the wrinkles are the main problem, we can get the best result by facial resurfacing. If somebody has deep wrinkles, fold, and drooping facial soft tissue, I usually perform the extended SMAS facelift. I always do it with local anesthesia. Under the intravenous sedation with ketamine, midazolam, and propofol, I infiltrate 2% lidocaine with 1:80,000 epinephrine along the proposed incision line. Next, the tumescent solution is infiltrated into the face and neck dissection area. A total of 300-400ml of tumescent solution is infiltrated on the both sides of the face and neck. After infiltration, I begin working on the neck area first and then try to solve the facial problems. Different problems require different amount of subcutaneous and SMAS dissection. If the patient has thick facial skin and his or her main problem is drooping, wide skin area and SMAS undermining beyond the retaining ligaments is required. If the patient has thick facial skin and the main problem is wrinkles, less skin area and wide SMAS dissection is needed.