Toronto Facelift: to SMAS or not to SMAS?

Toronto plastic surgeon, facelift, SMAS facelift, Toronto facelift

model – illustration

Facelift procedures are still very popular today in Toronto and in Canada but the techniques have evolved tremendously over the last 55 years when it was first performed.

The technical term is rhytidectomy or rhytidoplasty: from the Greek, ‘rhytid’ means wrinkles, ‘ectomy’ means excision and ‘plasty’, as seen in one of our first blog, means ‘shaping and molding’.

As you may know from reading my Curriculum Vitae, my biggest focus during my extracurricular training was in facelift, eyelid lift (blepharoplasty), forehead lift, necklift and rhinoplasty.  I had a chance to train with two outstanding facelift plastic surgeons: Dr Daniel Marchac in Paris and Dr. Bruce Connell in Laguna Beach, California.

A facelift surgery can involve various parts of the face and neck.  Although the forehead is part of the face, we normally refer to the rejuvenating part of the forehead as a forehead lift or browlift.

Not all facelift procedures are the same just as no one patient is the same.  Various variations of facelift and necklift exist; to name only a few names: short-scar, extensive, Hollywood, S-shape, mini, weekend, neck only, MACS, with or without fat grafting, etc… Some are smaller procedures with less downtime but with less longevity in results; some are more extensive procedures with slightly more downtime but with results that last longer.  The technique chosen is decided depending on the patient’s anatomy, her/his expectations of longevity of results and her/his desired recovery time.  The chosen facelift procedure also depends on whether the patient already had a previous facelift procedure or not.

One important concept though is the S.M.A.S. or the Superficial Musculo-Aponeurotic System, a complex facial layer below the skin comprising all the muscles of facial animation, interconnected by a thick collagenous layer of fascia (i.e. aponeurosis).  The SMAS also includes the loose hanging bands in the neck (so called turkey neck) commonly seen with aging.  The SMAS is also connected to the overlying skin with little fibrous bands so it is truly a system.

The SMAS can be plicated, excised, lifted, suspended and/or repositioned according to different vectors.  The aponeurosis component of the SMAS is a strong tissue that can bear tension a lot better than the skin alone and this is important for the final scars: a ‘no-tension’ skin closure favors finer scars.

Therefore, I commonly but selectively perform a SMAS procedure in my Toronto facelift patients.  I will commonly repair the hanging bands under the chin, then incise and create various SMAS flaps.  The SMAS flaps are then suspended behind each ear with strong sutures; this will act as a hammock and will also bear the tension of the repair, bringing along the skin with it (traction) without undue tension in the skin closure itself.  There is always some skin to be excised but the skin is rather elevated and redraped, not tensed, after which the excess of skin is tailored and gently sutured.

Think: French Haute-Couture by Toronto plastic surgeon French-Canadian Dr. Marc DuPéré!

In summary, the SMAS procedure will ensure more longevity in the facelift and necklift procedure and should lead to finer well-hidden and inconspicuous scars.

By Toronto Facelift plastic surgeon Dr. Marc DuPéré

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