SMAS Plication vs Removal in Facelifts

What an intriguing title for a blog, isn’t it?  Makes you want to dive right in…to bed and fall asleep.

Yes, I know, but it’s probably the most important subject when discussing a facelift – to keep fat or remove it.

The SMAS or superficial muscular aponeurotic system is the fancy acronym given to the deeper tissue of the face that contains fat and muscle.  It’s the tissue that starts up on our cheeks as children and ends up much lower as we age.  It’s really the workhorse of the modern facelift.  Without addressing it a facelift would just tighten skin.  A fine operation but not complete.

There are two schools of thought with this tissue.  First, many surgeons dissect deep to this plane of tissue then pull it in a superior and posterior direction, cut off the excess and resuture it down.  This moves the SMAS back up restoring it to its more youthful position.  The other school of thought elevates the tissue onto itself by grasping it, lifting it then suturing it to itself on the cheek bone.  No tissue is remove and the cheek is slightly augmented giving a more youthful and rejuvenated appearance.

I am a strong proponent of the second, or plication, method.  Facelifts and facial rejuvenation in general  is about reestablishing ratios. Whether it’s skin to fat, height to width, whatever.  By elevating the SMAS layer fat is retained and a more youthful outcome can be achieved.

If you’d like to discuss facelifts or any facial rejuvenation click here or call our office at 703.752.6608 for a complementary consultation with Dr. Christopher Hess.