Many believe that the main and almost the only external sign of aging is the appearance of wrinkles. In fact, everything is much more complicated and only smoothing the annoying folds of a high-quality anti-aging effect is not achieved.
SMAS lifting – This is a special kind of face lift. Its main difference from the classical operation is that the work is carried out not with the superficial layers of the skin, but with deeper tissues. What are the advantages of this technique and what are its disadvantages? At what age will it help, and at what time it will be useless? What to prepare for in the rehabilitation period and how long will the result last? Are there any complications and side effects?
The term SMAS stands for “superficial muscular aponeurotic system”, which is translated from English as a superficial muscular aponeurotic system (Russian abbreviation – PMAC). This layer is located directly under the skin and fatty tissue and acts as a framework for the soft tissues of the face. With age, it inevitably degrades: initially, the elastic fibers weaken and stretch, the production of collagen and elastin decreases, and the SMAC structures gradually slide down, carrying the surface layers of the dermis. As a result, deformations characteristic of older and older age appear on the face:
- skin looks flabby, it appears deep,
In order to fully solve this complex of problems, it is necessary to move the fibers of the muscular aponeurotic layer to its former position – where they were 10-15 years ago, before they began to stretch and sag. If this is not done and work only with the skin (as it happens with normal surface lifting of the face), then firstly, the rejuvenating effect will be minimal, and secondly, there is a high probability of distortion of the mouth line, submental area and eye incision.
At what age should a SMAS tightening be done?
- Plastic surgeons rarely focus on the passport data of patients: each person is aging in his own way, and even women of the same age can have completely different aesthetic problems. On average, the period from 35 to 55 years is considered optimal for the correction of SMAS structures.
- For girls under 30, this operation is unnecessary (without exceptional indications) – their face carcass performs its functions almost flawlessly, the tissues confidently resist gravitational ptosis, and the dermis retains its natural elasticity. As a preventive measure, they, as a rule, have enough cosmetic facelift and beauty treatments.
- But the ladies over 60, who have strong wrinkles and folds, isolated SMAS-lift will not bring the desired result. For high-quality rejuvenation, it will be necessary to supplement it with a classic circular facelift, during which all excess loose skin is excised.
Types of surgery: which is better for the patient?
Plastic surgeons have two main ways of working with the superficial musculoaponeurotic system, and another alternative method is available to cosmetologists:
- Basic technique
It resembles a circular lifting, but is considered much more benign and less traumatic. Cuts are made above the ear in the scalp, then the surgeon leads the scalpel along the front edge of the auricle and around the lobe – such a long access is necessary to separate the tissues and highlight the SMAS.
Detachment of the skin and muscle aponeurotic layer is performed in a different volume for each patient. The standard separation zone is limited to the following reference points: the outer part of the eye > line above the cheekbone > nasolabial fold. The zone around the lower jaw and the neck area are peeled off at the bottom. The selected layer is fixed with clips, after which the doctor pulls it in the right direction and secures it in a new position with sutures. If necessary, excess skin is excised – but only in a very small volume.
The lower third of the face is also corrected in the same way – here lifting the supporting layer allows normalizing the neck-chin angle and smoothing the neck. Next, cosmetic seams are applied, which are hidden either in the hair or in natural tissue folds. At the end of the patient’s face bandage tight bandage-fixer.
- Endoscopic surgery
It assumes all the same manipulations with tissues as with the base SMAS-lifting technique. The difference is that there is no need to make long cuts: the surgeon uses the finest endoscopic equipment with which you can work through small (up to 1 cm) punctures. The micro video camera transmits the working field to the monitor, and, focusing on the resulting image, the doctor first isolates the musculoaponeurotic layer, and then conducts its deep tightening along with the adjacent skin flaps.
The result is a complex rejuvenation, almost invisible stitches and a relatively fast recovery period. The main disadvantage of this technique is that it is impossible to excise excess skin, so endoscopic surgery, with all its advantages, will not give the desired effect to patients with pronounced deep wrinkles.
- Hardware non-invasive technique (Altera)
Recently, it has become possible to work with deep facial tissues without surgery – using special ultrasound equipment. Waves are directed through the surface layers of the dermis and focus on SMAS structures. Local heating of tissues occurs, as a result of which the stretched fibers contract, tighten the support layer and smooth out all upstream tissues. The process is quite painful, but it is quite possible to do without general anesthesia, on local anesthetics. For details, see the article “Altera Systems – deep lifting without surgery.”
The recovery period is minimal – only a few days – but the result will be much less noticeable than in the case of plastic, and its duration is only 2-3 years against 10-15 years, which is guaranteed by the classic SMAS-lift. According to experts who have mastered both techniques, there is no great sense in comparing them directly: a full surgical intervention in all respects is much more effective than a hardware procedure. The latter, given its high cost, can be recommended only to those who have direct contraindications to plastic surgery.
How is the operation performed?
SMAS-lifting begins with a face-to-face consultation, in which the surgeon examines the patient, identifies specific aesthetic problems and suggests one or more ways to solve them. Next, you must pass the standard preoperative tests (their list can be expanded) and talk with the anesthesiologist. In the absence of contraindications, a convenient date for the intervention is appointed. A further diagram of the surgical team’s actions is as follows:
- The anesthesiologist puts the patient to sleep with general inhalation or intravenous anesthesia.
- The surgeon forms an access through incisions in the parotid region. With endoscopic SMAS lifting, punctures are made in the scalp for insertion of instruments and the camera.
- The muscular aponeurotic layer is separated from the underlying facial structures, moves in the right direction and is fixed by internal sutures.
- If necessary, excess skin and soft tissue are excised.
- All cuts are sutured with cosmetic seams, drainage tubes are placed, and a fixing bandage is applied on the face. The patient is sent to the ward, gently removed from anesthesia and kept under constant surveillance.
The operation lasts about 2-3 hours, in the most difficult cases – up to 4-5. Then another day will need to be spent in the hospital under the supervision of doctors, after which, in the absence of complications, you can go home.
How is rehabilitation going?
The severity and duration of the recovery period depends mainly on how the lift was performed: after ultrasound it takes no more than a week, after endoscopy – about a month. The body comes to life the longest after a classic operation with full-length cuts. The main changes in the patient’s condition by day will look like this:
At the exit of anesthesia, weakness, dizziness, nausea can be felt – when using modern anesthetics of the last generation these unpleasant symptoms will be minimal. After a few hours, pain arises (they are stopped by pharmacological preparations), postoperative edemas and hematomas appear.
During this period, complete rest is shown. It is strictly forbidden to wash the face or head, as well as remove the bandage. Puffiness will increase, to reduce it you need to keep your head higher, sleep on a high pillow, face up. In parallel, you will need to continue taking painkillers.
Rules for the fastest possible recovery. In the first three weeks:
- no aspirin and other drugs that worsen blood clotting;
- alcohol and cigarettes are also banned – they lead to increased edema, can cause vascular disorders and negatively affect healing;
- Be especially attentive to your well-being: severe pain, fever or any other health trouble – a reason to immediately consult a doctor.
For the next three months, do not:
- Visiting saunas, solarium, sunbathing – heating tissues increases swelling, negatively affects fragile vessels and provokes inflammation, and ultraviolet increases the risk of pigment spots.
- To lift weights, physically load yourself in the gym or at work – SMAS structures should be fixed in the new position, any sudden movement or muscle strain can disrupt the geometry of the face.
- To do an intensive massage in the operated area and around it – such an impact can displace not yet fully grown layers of tissue or, at a minimum, cause the appearance of hematomas.
- Before signing up for any salon procedures during this period, get approval from your surgeon. Most likely, he himself will appoint a course of physiotherapy and cosmetology manipulations, accelerating the healing and removal of edema.
How long does the effect hold, can it be strengthened and extended?
The total duration of the result after the SMAS-lifting is up to 15 years. As a rule, this operation is performed once in a lifetime and does not require repetition: even years later, patients who have done a deep tightening look much younger than their peers. And then everything will depend on skin care: regular peeling courses, mesotherapy and biorevitalization will allow you to keep the youth and freshness for a long time.
For maximum effect, deep lifting can be combined with light rejuvenating operations: liposuction of the chin, endoscopic plastic of the forehead or blepharoplasty. Also, surgeons sometimes supplement SMAS-tightening with liposuction in the cheek area to simulate the perfect facial contour, make it more expressive and more sculptural. For the same purpose, implants are sometimes placed in the cheek or chin area. However, the possibility and expediency of carrying out any additional manipulations can be determined only in person: it all depends on their overall complexity and resources of the body.
Contraindications, possible complications and side effects
Restrictions for such an operation are quite standard:
- pregnancy and lactation;
- diabetes, oncological diseases;
- dermatological problems, inflammation in the face;
- propensity to form keloids;
- the presence of any acute illness or exacerbation of chronic;
- violation of blood clotting;
- heart diseases.
The main and relatively harmless side effect of SMAS-lifting is edema and hematomas. You should not be afraid of them – they happen to absolutely all patients and normally in a few days they decline, and by the end of the first week they stop bothering at all. But sometimes there are much more serious troubles: