SMAS At A Glance 

SMAS stands for the superficial musculoaponeurotic system, which is a layer of connective tissue and superficial muscle under the skin and superficial (subcutaneous) fat that overlays deeper facial structures. Some parts of the SMAS are mobile, and some are fixed.

In order to reposition the tissues of the face and restore youthful shape, certain fixed portions of the SMAS are released to facilitate the mobilization and repositioning.  This is a simple concept in theory, but one that requires advanced expertise in practice.  

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Unique Faces Deserve A Unique Facelift Approach 

There are various ways to perform a facelift, and each surgeon has their own specific set of techniques that they have developed and personalized, and apply as appropriate for each patient. There should never be a one-size-fits-all facelift. A facelift aims to re-sculpt the face, restoring youthful shape, in addition to redraping sagging skin. A facelift is never about pulling or tightening the skin but rather repositioning sagging skin to a youthful location and tailoring off any excess. 

Most facelifts performed today fall into one of two categories. SMAS lifts and deep plane lifts. The difference relates to how tissues under the skin are handled during the facelift and what technique is used to mobilize and reposition them to restore a youthful appearance. Both techniques have found favor with various esteemed facelift surgeons, meaning that there is not one “best” technique. Almost all surgeons vary their technique to suit the needs of their individual patients.  

What Is The Multiplanar SMAS Approach?

The deep plane technique releases attachments underneath the SMAS layer and repositions skin and deeper tissues as a single layer.  In the multiplanar SMAS technique the skin and SMAS layers are released from each other and deep fixation points over a portion of the face.  This mobilization can be performed to a greater or lesser degree as needed to adjust for features and the extent of aging changes in each individual.  Known retaining ligaments are released allowing adequate mobility to the skin and SMAS as separate layers.  

This allows maximum flexibility to redrape each component of the face in the direction and to the extent needed to regain a youthful contour.  Facial skin, neck skin, upper facial SMAS (cheek area), lower facial SMAS  (jowl area) and neck superficial muscles (platysma) can each be positioned independently  In distinction, these are all positioned as a single composite unit in the deep plane facelift.

During aging, facial tissue, particularly fat pads, shrink and descend.  Each fat pad does this to a different extent than the fat pads around it.  This explains why the graceful, confluent contours of the youthful face descend and shrink into individual sags and bags.  Dr. Bass believes that restoring confluence and balance can best be achieved by being able to adjust each area and layer to the extent necessary to undo the variable changes etched in over decades of aging.  Dr. Bass prefers the ability to customize the positioning and shaping restoration for each part of the face that the multiplanar SMAS technique affords.  
      
The exact ways that Dr. Bass manipulates the SMAS are determined by the patient’s desired look, the appearance of their face in youth as demonstrated by old photographs and their existing facial structure. He considers the degree of volume loss and flattening of the face (for example, in the cheeks), how much fat is present, and how the tissues respond during the procedure. Modern facelifts require shorter incisions and more focused dissection but yield a more complete and durable correction compared to older techniques. 

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Why Is Dr. Bass Unique?

Many surgeons rely on linear repositioning for facelifts, which pulls tissues and has a flattening effect. Dr. Bass has discovered that carefully rotating tissues into precise position –known as rotational vectors -is the most effective way to reposition facial tissue to its youthful location and configuration, helping to amplify projection and shape in the face which has been lost through aging.  He also prioritizes correction of the neck - both the neck’s contour and any muscle banding that may be occurring in the platysma. 

Dr. Bass operates by the principle that everyone has their own unique beauty, and the ideal in facial rejuvenation surgery is enhancement and preservation rather than change. Restored, not altered.  Looking better, not different.  For that reason, facelifts performed by Dr. Bass focus on restoring the youthful architecture of a patient’s face rather than restructuring it, producing natural-looking results that make the patient look like a younger, more rested version of themselves.

What Is Recovery Like For A SMAS Facelift?

Because of advances in modern facelifts like fewer incisions and less reliance on dissection, healing time is a great deal faster. Typically, patients are able to return to work and resume social activities in about a week. The complete effects of a facelift are apparent after three to six months. Dr. Bass is proficient in many methods to minimize bruising and swelling, which patients cite as the two most common impediments to resuming work and socializing. Some modalities Dr. Bass employs include tumescent fluid techniques, blunt tip infusion of fluid, and ultrasound treatments. To encourage incision marks to fade, laser treatments are utilized.

Dr. Bass Discusses Deep Plane VS. Multiplanar SMAS Facelifts

Dr. Bass created the Park Avenue Plastic Surgery Class Podcast to make the world of aesthetic plastic surgery accessible to more people. In this episode, he discusses different types of facelifts with a deep plane facelift expert. Listen as he summarizes key points about getting the best results in facelifting. Be sure to listen to all the episodes relating to facelifts for a comprehensive education on the topic.

Listen to the Podcast

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