About Face

About Face

It must be very confusing to read a variety of articles in the lay press presenting different operations for Facelifting. People reading these articles, I am sure find them informative but sometimes confusing.

It was my recent pleasure to attend a major Aesthetic Plastic Surgery Conference in Melbourne where the guest speakers spoke specifically about Facelifting.

One was a guest from Paris. He was instrumental in working out the anatomy of the planes of the face and designed some of the major Facelifts which are currently performed. Most specifically he was instrumental in developing the SMAS lift and the Dual Plane Lift.

The other speaker was somewhat younger and had taken his understanding of anatomy to develop a different style of facelift. This is called the MACS lift.

What do all these abbreviations mean and what is all this anatomy that we as surgeons interfere with in an attempt to rejuvenate faces.

The Mini Facelift is a facelift with reduced dissection of skin and tissues. It involves excision of some skin from in front of and occasionally behind the ear.

More recently a variation of this has become popularised as the S lift. This is quite simply a variation where there is an incision placed in front of the ear but then extending along the lower border of the hairline onto the face.

The skin is dissected up and then excess skin is excised.

The SMAS layer is the next layer of tissue underneath the skin. I guess you could compare it a little to a foundation garment. It is underneath your clothing and it supports the tissues.

Various procedures have been described to rearrange the deeper layers. They include extensive dissection and even excision of some of the SMAS layer from the region of the cheek in front of the ear and extending down into the neck. The layer is then pulled up and back and repaired in an attempt to relift the deeper tissues of the face. These are the many varieties of Dual Plane and SMAS lift procedures.

They have been popular and used extensively over the last 25 to 30 years.

Surgeons will vary in the extent to which they lift up this layer. There is no doubt that as the layer comes forward on the face, there is perhaps an increased chance of damage to the nerves to the face. There is a feeling however that in some cases, particularly where there are problems in the neck, it is important to carryout this dissection and even divide the layers of the SMAS to obtain an optimal result.

The MACS lift is really something of a combination of a very extended S lift with a superficial SMAS lift. The incision is much the same as for an S lift but the dissection of tissue carried out is certainly more extensive.

The SMAS is lifted but is not cut. It is lifted by a series of sutures that are quite simply used to “pleat” the layer up.

With the extended SMAS lifts and with the MACS lift there is also a lifting and excision of the skin.

So what does all this mean? It means that for any given individual there are a variety of combinations of surgeries operating on both the deeper layer of tissue and or the skin layer of tissue to provide an optimal result. An understanding of these procedures, an understanding of the individual needs of patients and a balance of the risks and the safety involved, are what we as surgeons need to consider.