Facelift High SMAS technology? Questions to PD Dr. Mathias Tremp

The traditional techniques of face lifting by means of primary skin removal have a short duration of action and poor wound healing with visible scarring. The problem is the high elasticity during wound healing. Studies show that with the so-called SMAS technique (= superficial musculoaponeurotic system), in which the midface is also treated, a more natural result with long-term effect can be achieved.

Read also: Plastic and aesthetic facial treatments, plastic facial surgery, technique for facelift?

How does the "High SMAS technique" work?

If the SMAS flap is tightened below the zygomatic arch, the effect on the midface and eye region is missing. Only the lower half of the cheek is lifted. With the "High SMAS technique", the SMAS flap is raised higher, above the zygomatic arch. This allows a simultaneous tightening of the midface, cheek area and jaw area.

Skin flap dissections:

A) Minimal B) Limited C) Extended

What are the benefits of the self fat treatment in combination with the "High SMAS technique"?

The self fat treatment ("micro fat") is very often combined with the "High SMAS technique" to restore the volume loss in the midface and eye area.

When is the self fat treatment applied?

As a rule, the patient's own fat treatment is carried out before the facelift.

What are the risks of nerve injury?

There were initial concerns that this technique poses an increased risk of injury to the so-called frontal branch of the facial nerve (ramus frontalis of the facial nerve). However, anatomical studies have shown that the High SMAS technique is safe for the forehead region.

What is the "lamellar" preparation technique?

There are different preparation techniques to raise the SMAS. The SMAS can be lifted and tightened together with the skin (so-called "composite" preparation technique). However, the skin and the SMAS age differently, and the lifting of the two layers should be done in different directions. With the "lamellar" preparation technique, the skin and SMAS are approached and tightened separately, the result is more natural.

What is the cut in front of the ear?

The incision in front of the ear can be made intratragal/post-tragal (= behind the tragus (tragus = cartilage attachment of the outer auricle)) or pre-tragal ( = in front of the tragus). The intratragal/post-tragal incision is performed more often because the scar is not visible. The pre-tragal incision is more visible and can be used if the skin colour varies between the cheek area and the tragus or if the tragus cartilage is very prominent.

Can the "High SMAS technique" be used to tighten your neck at the same time?

A simultaneous face lift and neck lift is almost always the best treatment to achieve a natural and harmonious result. It is unusual to have only excess skin on the face without excess skin on the neck. A neck lift often requires an additional incision under the chin (so-called submental incision).

What kind of anesthesia is necessary?

As a rule, the procedure is performed in deep sedation (so-called twilight sleep) with larynx mask. This type of anesthesia is gentler than the endotracheal tube and allows spontaneous breathing.

What do I have to consider after the operation?

After the operation you should lie flat without pillows. You should rest on salty, acidic, hard food or alcohol for 2 weeks. Showering with shampoo is allowed after 3 days. The stitches are removed after 5 - 7 days. After approx. 4 weeks unrestricted sporting activity is possible. The scar must be protected for up to one year with a sunscreen SPF 50 and regularly treated with a fatty ointment.

Do you have questions about facelifting and facial surgery?

Contact PD Dr. med. Mathias Tremp (specialist for plastic, reconstructive and aesthetic surgery) for a consultation.

PD Dr med Mathias Tremp Surgery

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