Facelift High SMAS technique? Questions for PD Dr. Mathias Tremp

The traditional techniques of face lifting, which primarily involve removing skin, have a short duration of effect and poor wound healing with visible scarring. The problem is the high elasticity during wound healing. Studies show that the so-called SMAS technique (= superficial musculoaponeurotic system), in which the midface is also treated, can achieve a more natural result with long-term effects.

How does the “High SMAS Technique” work?

If the SMAS flap is tightened below the zygomatic arch, the effect on the mid-face and eye region is lost. Only the lower half of the cheek is lifted. With the “High SMAS technique”, the SMAS flap is lifted higher, above the zygomatic arch. This allows simultaneous tightening of the mid-face, cheek area and jaw area.

Skin flap dissections:

A) Minimal B) Limited C) Extensive

What are the benefits of autologous fat treatment in combination with the “High SMAS technique”?

Autologous fat treatment («microfat») is very often combined with the «High SMAS technique» to restore volume loss in the midface and eye region. Nanofat treatment can also improve skin quality.

When is autologous fat treatment used?

As a rule, the autologous fat treatment takes place before the face lift.

What are the risks of nerve injury?

There were initial concerns that this technique posed an increased risk of injury to the so-called frontal branch of the facial nerve (ramus frontalis of the facial nerve). However, anatomical studies have shown that the “High SMAS technique” is safe with regard to the frontal branch.

What is the “lamellar” preparation technique?

There are different preparation techniques for lifting the SMAS. The SMAS can be lifted and tightened together with the skin (so-called “composite” preparation technique). However, the skin and the SMAS age differently and the tightening of the two layers should be done in different directions. With the “lamellar” preparation technique, the skin and SMAS are approached and tightened separately, the result is more natural.

How is the incision made in front of the ear?

The incision in front of the ear can be made intratragally/posttragally (= behind the tragus (tragus = cartilage attachment of the outer ear)) or pretragally (= in front of the tragus). The intratragally/posttragally incision is performed more frequently because the scar is not visible. The pretragal incision is more visible and can be used when there is a difference in skin color between the cheek area and the tragus or when the tragus cartilage is very prominent.

Can a neck lift be performed at the same time as the “High SMAS Technique”?

A simultaneous face lift and neck lift is almost always the best treatment to achieve a natural and harmonious result. It is unusual to have excess skin on the face without any excess skin in the neck region. A neck lift often requires an additional incision under the chin (so-called submental incision).

What kind of anesthesia is necessary?

The procedure is usually carried out under deep sedation (so-called twilight sleep) with a laryngeal mask. This type of anesthesia is gentler than the endotracheal tube and allows spontaneous breathing. However, a consultation with the anesthetist always takes place before the operation.

What should be taken into account after the operation?

After the procedure, you should lie flat without a pillow. You should avoid salty, acidic foods, hard food and alcohol for 2 weeks. Showering with shampoo is permitted after 3 days. The stitches are removed after 5 – 7 days. After about 4 weeks, unrestricted sporting activities are possible. The scar must be protected with a sunscreen SPF 50 for up to a year or regularly treated with a fatty ointment.

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Do you have any questions about the SMAS facelift?

The best time for a facelift is very individual for each patient. The facelift is suitable for patients who suffer from very severe skin changes, with deep wrinkles and extensive sagging skin.

A facelift is one of the most difficult procedures in the field of plastic surgery and must be performed by an experienced surgeon. Most patients have thought carefully about the step of having a facelift.

During a consultation, PD Dr. Mathias Tremp will provide you with complete information about the procedure, possible complications and the feasibility of the desired facial correction.

Non-surgical facial and wrinkle treatments
The big advantage of so-called minimally invasive facial treatments is the immediate effect. You are usually able to go out in public straight away after the treatment. For example, important facial areas (forehead, frown lines, cheeks, nasolabial folds and chin line) can be treated and corrected very effectively using just a few fine needles.
Liquid face lift
Various liquid injection materials are used for a liquid facelift. These can be injected with hyaluronic acid, your own blood or fat, or even calcium hydroxyapatite. The body’s own fat is injected into the face to achieve a natural-looking plumping effect, for example of the cheeks.
Mini faclift
The mini facelift is particularly suitable for patients who tend to have very thin, wrinkled skin and without any significant sagging of the soft tissue. A mini-lift procedure involves tightening the skin on the side of the cheek, while a classic facelift tightens the entire cheek area and the neck. The incisions are always made in places that are as inconspicuous as possible, such as behind the ears.
SMAS Facelift (Superficial Musculo Aponeurotic System)
The SMAS facelift tightens not only the skin, but also the underlying fatty tissue and muscles. The SMAS method lifts the sagging tissue and simultaneously smoothes out deep wrinkles. A SMAS facelift is performed on an inpatient basis and is carried out under sedation or general anesthesia.
Intervention, ability to work, risks and aftercare
As with any surgical procedure, general complications such as impaired wound healing, infections or postoperative bleeding can occur. In smokers, the healing process can be delayed and blood circulation reduced. The aftereffects of a facelift, such as swelling or bruising, usually subside within 14 to 21 days after surgery. Patients can then return to normal daily activities. The feeling of tension or sensitivity of the facial skin will completely disappear within a few weeks. Proper skin care is very important during this time. Depending on your skin type and lifestyle, the results of your facelift will last for several years or even decades.
Cost
The costs vary depending on the effort involved and are discussed and defined individually with the patient in advance. The costs include all measures such as preliminary discussion, surgery, anesthesia and follow-up checks, excluding overnight accommodation. Contact us for a non-binding consultation.
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