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.
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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