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How platysma-SMAS plication lift differs from minimal access cranial suspension

Article-How platysma-SMAS plication lift differs from minimal access cranial suspension

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  • Due to differential vectors available, the PSP-lift can address different aspects of the face, allowing the ideal age range to extend up to and beyond 55 years of age.

International report — The traction forces resulting from the vectors used when performing a facelift can play a central role in the aesthetic outcome of the procedure. Several aspects differentiate the new platysma-SMAS plication (PSP) lift from the minimal access cranial suspension (MACS) lift, and, according to one expert, the PSP is superior to the MACS, as it can be used in a wider age group of patients and has a short learning curve.

Dr. Davies
"Today's facelifting techniques tend to be SMAS-based, and there is a continually increasing trend towards techniques that are minimally invasive, resulting in shorter downtimes and decreased risk of facial nerve injuries while achieving an enhanced youthful appearance. The PSP lift is an evolution from the MACS lift in that it balances procedural invasiveness with recovery time and aesthetic outcome," says Miles G. Berry, M.D., at the Institute of Cosmetic and Reconstructive Surgery, London.

Frontal view (left) of a 67-year-old female prior to surgery. Appearance 12 months later (right), following PSP-lift combined with upper and lower blepharoplasties and perioral CO2 laser. The strong platysmaplasty effect on the neck and jowl is clearly demonstrated, as is the restoration of malar projection. (ALL PHOTOS CREDIT: DAI DAVIES, M.D.)
PSP STUDY Dr. Berry and his colleague, Dai Davies, M.D., recently performed a study in which they used the PSP lift in 117 consecutive patients with a mean age of 55 years. Patients were evaluated at baseline, and at 12 and 18 months after the surgery. Using a 5-point assessment scale, the cosmetic outcome was graded 4.45 and 4.49 by patients and surgeon, respectively at initial follow-up. At the final follow-up, results showed that up to 82.2 percent of scores had either improved or remained the same, and overall grading was 4.43 and 4.45, respectively. None of the patients experienced any serious adverse events, and, importantly, there was no permanent nerve damage. SURGICAL STEPS The salient steps of the surgical procedure are as follows: After standard tumescent infiltration into the subcutaneous plane, the incision extends from the temporal area anterior to the ear, passes post-tragal, and into the post-auricular sulcus. A posterior extension is used only if required, and subcutaneous dissection is tailored to each patient sufficient for an acceptable vector of SMAS traction.

The anterior SMAS is tractioned in a postero-superior direction to provide a satisfactory effect on the jowl. Using 2.0 PDS, the SMAS is then attached to the relatively immobile pre-auricular parotidomasseteric fascia. Further sutures complete the platysma plication below the mandibular angle to the mastoid fascia, and any surface irregularities are addressed by SMAS imbrication with 3.0 vicryl sutures.

"The MACS is effective in younger patients who show early jowling, minimal neck ptosis and the desire for a minimal downtime. The PSP lift differs from the MACS in that it includes multiple sutures for a dual-layer SMAS plication, resection of excess infra-auricular SMAS, and it involves different vectors of traction, making the novel lift particularly useful for the mid-face. In our hands, we found the PSP lift of particular use in older patients, where more work typically needs to be done," Dr. Berry says.

According to Dr. Berry, the more prominent skin laxity commonly seen in older patients can be better addressed with the postero-superior vector used in the PSP lift. Additionally, pure vertical lifts are commonly associated with lateral canthal crowding, particularly pronounced with an extended MACS. Dr. Berry says that this "dog ear" does not always resolve satisfactorily, and though this excess tissue can be easily excised, not all patients require or desire an additional blepharoplasty incision.

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