Overview of the “Super High SMAS” Facelift and Neck Lift
During the past two decades, many techniques for facial rejuvenation have been discussed. Dr. Miramontes’s practice in Guadalajara, Mexico has been performing, almost exclusively, face and neck lift surgery for the past 20 years. This specialization enables concentrated evaluation of both primary and secondary results. Dr. Miramontes exclusively performs the “Super High SMAS” facelift, using the deep plane approach, as this is the only technique that will ensure natural and longer-lasting results for his patients.
Lifting and repositioning the SMAS (a muscular-fibrous layer of the face attached to the skin and subcutaneous fat) is paramount in achieving optimal facelift results. Although the more common or traditional facelifts address the SMAS layer, they are limited in their ability to produce optimal results.
Why Is This?
In a traditional facelift, the SMAS layer is not completely freed from the deeper tissues and therefore can only be lifted and repositioned to a minimal degree.
Severe tension on the skin, resulting in delayed wound healing and a higher risk of complications. This can lead to stretched scars, pixie ears, loss of sideburn hair and the horrible “windblown” look.
Ultimately, the lift does not last long, and early revision is sought.
Dr. Bruce Connell, the Father of the Postmodern Facelift, did not like the problems associated with the traditional facelift and approximately 50 years ago offered the best solution to many of these problems:
The Deep Plane Facelift
Trained by Dr. Connell, Dr. Miramontes dissects below the SMAS layer releasing it completely from the underlying muscles and ligamentous structures. This, in turn, allows the newly released or mobile SMAS layer to be repositioned higher up on the face. This frees the whole face to be lifted ensuring deep tissue support.
Since the whole face is evenly lifted, there is no need to pull the skin. The skin is merely draped over the newly repositioned SMAS layer (excess skin is cut) eliminating needless tension on the skin.
The Deep Plane lift is more secure, providing a strong foundation and long-lasting improvement to the cheekbones, jawline, and neckline.
Once the SMAS is repositioned, it “fills in” the lost volume, especially to the midface or cheekbone area, eliminating the need for facial fillers and fat injections.
There is absolutely no tension on the skin. The incisions heal quickly; thus, the appearance of stretched scarring and other unsightly facelift “giveaways” are extremely unlikely.
The Deep Plane approach gives rise to the development of the “Super High SMAS” lift.
Dr. Miramontes takes the extra time and precision needed to reposition the SMAS layer above the cheekbone area, the zygomatic arch; thus, coining the term the “Super High SMAS” facelift. This is opposed to the “Low SMAS” facelift that repositions the SMAS below the Zygomatic arch. The advantages to the “Super High SMAS” lift are powerful, and include:
- Improved cheek volume leading to better contour
- Enhanced volume of the infraorbital region
- Greater improvement to the corners of the eyes, smoothing out “crow’s feet”
- Increased support of the lower eyelid
- Greater improvement of the nasolabial fold
- Lift of the jawline
Dissection of the SMAS in Two Planes
As we have noted previously, which bears repeating, Dr. Miramontes dissects below the SMAS layer releasing it completely from the underlying muscles and ligamentous structures. However, it’s extremely important to note that he also mobilizes the SMAS layer from its overlying skin, as well.
This dissection of the SMAS in two planes is called the lamellar dissection.
Why does Dr. Miramontes dissect the SMAS in two planes?
Because then the SMAS layer and skin are free to advance along different and distinct vectors (insert diagram) and with different amounts of tension.
The SMAS layer is generally lifted more vertically, while the skin layer is generally lifted more horizontally.
Dr. Miramontes takes the extra step to dissect the SMAS in two different planes because he has surmised through his many years of observation that the lamellar dissection ensures a natural looking facelift result. More than anything else the majority of his patients want to ensure a natural-looking rejuvenated facelift. They want to eliminate the worry of looking funny or artificial or ever even had a facelift. Thus, the lamellar dissection is a fundamental step in providing this natural appearance.
The “Super High SMAS” facelift, using the deep plane approach, face and neck lift surgery is technically more difficult to perform, and most surgeons lack the expertise and experience. Dr. Miramontes, with his advanced training background in California with Dr. Bruce Connell and further facial plastic surgery fellowship training, has the understanding of the facial anatomy required for such surgery.