SMAS facelift technique provides natural look that lasts

Chicago — For John Owsley, M.D., the key to a successful, long-lasting facelift lies in the underlying anatomical details of the face.

Dr. Owsley, an aesthetic plastic surgeon who practices in San Francisco and is clinical professor of plastic surgery at the University of California, San Francisco, pioneered the SMAS-platysma multi-vector facelift and malar fat pad lift technique. He discussed these procedures at Plastic Surgery 2005, the recent annual meeting of the American Society of Plastic Surgeons.

"If doctors can recognize what causes signs of aging underneath the skin, such as nasolabial folds and jowls, then they will be better able to recognize exactly how to go about correcting it in a way that is both effective and long-lasting."

Dr. Owsley tells Cosmetic Surgery Times that the skin of the cheek and anterior neck is made up of an interconnected three-layer unit. This facial skin unit is comprised of the superficial epidermal-dermal layer, the underlying subcutaneous fat, and a membrane composed of fibroelastic connective tissue and muscle.

This is the superficial musculoaponeurotic system, or SMAS, and it has multiple fibrous extensions that attach through the subcutaneous fat to the superficial epidermal-dermal portion of the skin, which causes the three layers to move together as a unit. The SMAS attachment to the epidermal-dermal layer is visible as the nasolabial crease.

Neck musculature

In the neck, the SMAS membrane incorporates the platysma muscle, which extends from the lower jaw area to the collarbone. The platysma functions in certain expressive movements involving the lower face and neck.

Constant contraction of the platysma muscle produces neck cords, which, with aging, can gradually create persistent vertical folds of skin beneath the chin and on the upper anterior neck.

Coordinating facelifts with aging

As facial skin ages, it loses its elasticity, as does the SMAS membrane. Gravity produces sagging of the cheek skin along the jaw, creating fleshy jowls, and often a double chin develops due to the drooping of the fatty portion of the lax skin unit along the anterior and lateral jaw area.

"Sagging of the subcutaneous fat and the gliding SMAS membrane contributes as much to the appearance of facial aging as the loss of elasticity in the superficial epidermal-dermal layer," Dr. Owsley says.

"Older facelift techniques pay more attention to the skin without repositioning all of the underlying muscles, facial fat and so on, so that when the skin is finally closed after a procedure, all the tension is on the skin and thus you get that tight look that indicates you've had a facelift. If the SMAS and malar fat pads are repositioned appropriately, that's where the tension should be, and then the skin can be draped over them and a more natural look is obtained."

Dr. Owsley says that follow-up observation indicates that the benefits of this surgery can last 10 to 15 years — significantly longer than the traditional facelift. And there's another benefit, he says.

"I've found that since this operation offers natural-looking results, we can offer it to patients at a younger age — say, the mid-40s as a maintenance facelift — so that a 45 to 50-year-old can look like they're in their mid-30s," Dr. Owsley says. "When that 45 or 50- year-old gets to the age of 60, they still look like they're middle-aged, and then we can redo a maintenance procedure if required. What we can achieve is a subtle, rather than a radical change in their appearance and a prolonged period of youthful appearance."

Dr. Owsley says the SMAS-platysma facelift and malar fat pad lift technique attain what he considers the chief goals for a facelift.

"Those goals are to provide a natural appearance while changing signs of aging, but leaving no stigmata, or signs that anything has been done," he says. "The other goal is that the procedure have longevity. This technique accomplishes both goals."