Extended SMAS & High SMAS facelift

The extended SMAS facelift and the high SMAS facelift are among the advanced SMAS flap techniques of modern facelift surgery. They go beyond simple SMAS plication and allow a considerably more effective mobilisation and repositioning of sagging facial soft tissue. The aim is a natural, long-lasting facial rejuvenation – adapted individually to the anatomy and the mechanisms of ageing.

Appointment with Dr. Kuzbari    Appointment with Dr. Arafat

Technique	Extended variants of the classic SMAS facelift
Principle	Greater mobilisation of the SMAS for more effective repositioning
Effect	Improvement of the mid-face, cheek contour and jawline
Naturalness	Low skin tension, harmonious proportions
Positioning	Between the classic SMAS and the deep plane facelift

Quick facts

What is an extended SMAS facelift?

A SMAS flap technique with further medial dissection for improved mobilisation of the fatty tissue of the cheek.

What does high SMAS mean?

A technique in which the SMAS is dissected further cranially, in order to lift the mid-face in a targeted way.

Where does the advantage lie?

More depth of repositioning than with simple SMAS plication, without necessarily reaching the extent of the extensive dissection of the deep plane facelift.

Who is it suitable for?

For patients with moderate to marked sagging of the soft tissue of the face.

Why classic SMAS techniques are often not enough

The limits of SMAS plication

Simple SMAS plication does allow a tightening of the lower cheek, but it frequently does not reach the sagging tissue of the malar region. The effect therefore remains limited and can be less lasting than with more far-reaching techniques.

The decisive factor: mobilisation of the SMAS

Both extended SMAS and high SMAS techniques are what are known as SMAS flap techniques, in which the SMAS is released and repositioned in order to achieve a better repositioning of the sagging cheek fat. The boundaries with the deep plane facelift are fluid, depending on how far the dissection of the SMAS reaches towards the central face.

Appointment with Dr. Kuzbari    Appointment with Dr. Arafat

Extended SMAS facelift – when more mobilisation is necessary

What distinguishes the extended SMAS facelift?

With the extended SMAS facelift, connective tissue attachments are released as far as the region of the nasolabial fold, in order to mobilise the sagging tissue effectively. With the classic technique the dissection reaches somewhat less far medially than with the deep plane facelift. Skin and SMAS are also dissected separately.

Which areas benefit particularly?

• The mid-face and the malar region
• Nasolabial folds
• Jowls
• An undefined jaw contour

The biomechanical advantage

Thanks to the greater mobilisation, the SMAS can be fixed with little tension along an individually defined vector. This relieves the skin, which supports the naturalness of the result. The fixation of the SMAS is located further from the site of action than with the deep plane facelift, which is biomechanically somewhat less effective.

High SMAS facelift – a focus on the mid-face

What does ‘high SMAS’ mean?

With the high SMAS facelift the SMAS is dissected further upwards (cranially). The aim is to lift the mid-face in particular more effectively and to restore the youthful projection of the cheek region.

When does high SMAS make sense?

As an effective facelift method, a high SMAS is suitable for all patients in whom the slackening of the face can no longer be corrected satisfactorily with minimally invasive methods. As with the extended SMAS lift, the fixation of the SMAS is located further from the site of action than with the deep plane facelift, which is biomechanically somewhat less effective.

Extended / high SMAS vs. deep plane facelift

What they have in common

• SMAS-based repositioning instead of SMAS gathering and instead of pure skin tightening
• Natural results with little tension
• Longer-lasting effect than simple techniques

Differences

While extended and high SMAS techniques allow an extended mobilisation of the SMAS, in the classic variant of these procedures it is less extensive than with the deep plane facelift. With the deep plane facelift, skin, SMAS and fatty tissue are mobilised together as a composite flap, which has biomechanical advantages. Fixation closer to the site of the tissue slackening of the central face is also an advantage of the deep plane facelift. A correctly performed deep plane facelift with sufficient dissection makes greater surgical demands.

Tension-free skin closure – a central mark of quality

As with all modern facelift procedures, after extended or high SMAS facelifts the skin is closed free of tension. This supports inconspicuous scar healing and prevents visible signs of surgery.

Combinations for a harmonious result

Extended / high SMAS & neck lift

As the sagging of the facial soft tissue frequently goes together with changes in the neck area, the technique is often combined with a neck lift in order to achieve a clear jaw and neck contour.

Extended / high SMAS & fat transfer

With an additional loss of volume, a targeted fat transfer can be sensible in order to complement the repositioning and to achieve a balanced overall picture.

Who are extended and high SMAS facelifts particularly suitable for?

• When the age-related changes to the face caused by the slackening of the tissue are troublesome, for example jowls, marionette lines, loss of contour of the jawline.
• When other, less invasive procedures cannot achieve a satisfactory facial rejuvenation.

Which method is the right one for me?

Extended SMAS, high SMAS or deep plane – no technique is ‘better’ in an absolute sense. Satisfactory results can be achieved with all these techniques. What matters is not what the technique is called but how it is carried out during the operation. With all these techniques the mobilisation and tension-free repositioning of the slackened tissue is the decisive factor. This is time-consuming and requires a high degree of surgical expertise. Overall the deep plane facelift, when carried out correctly, has certain biomechanical advantages. But only when carried out correctly.

Summary

Extended SMAS and high SMAS facelifts represent important further developments of the classic SMAS technique. They allow a more effective repositioning of sagging soft tissue and deliver natural, long-lasting results – with a balanced relationship between depth of effect and invasiveness.