Optimal Asian Surgical Face Lift Techniques: Based on a 9-Year Study on 1,000 Asian Patients
- Admin
- 2 days ago
- 7 min read
Updated: 14 minutes ago
Face-lift surgery remains one of the most sought-after procedures in aesthetic plastic surgery, offering a powerful solution to reverse the visible signs of aging. For Asian patients, whose facial anatomy and aging patterns differ significantly from their Western counterparts, achieving natural, long-lasting results requires not only technical expertise but a personalized, evidence-based approach.
A pivotal study published in Annals of Plastic Surgery (August 2024) by Jung et al., titled "An Approach to Selection of Face-Lift Techniques for Different Types of Faces: An Analysis of 1000 Asian Patients Over 9 Years," offers new insights into this process. By analyzing a large cohort of patients, the study proposes a practical algorithm for customizing SMAS (Superficial Musculoaponeurotic System) manipulation techniques based on facial shape, aging pattern, and tissue laxity.
The Evolution of Face-Lift Surgery: A Brief History
Face-lift surgery has significantly evolved since its early 20th-century origins. Initially, techniques focused on addressing wrinkles and skin laxity through direct rhytidectomy. However, as the field advanced, the focus shifted toward deeper tissue layers, particularly the SMAS. This approach, introduced in 1974 by Skoog, enhanced the longevity of results by targeting the SMAS, and it has since become a cornerstone of modern face-lift techniques.
The Study at a Glance
Patient Demographics: 1000 consecutive patients who underwent high SMAS face-lifting over 9 years.
Surgeon Consistency: All procedures performed by the same experienced surgeon.
Objective: To determine the efficacy of different SMAS manipulation techniques—dissection, plication, and SMASectomy—tailored to patient-specific features.
Follow-up Period: Mean follow-up of 26 months.
The 3 Common Face-Lift Techniques
Three primary face-lift techniques are commonly used: SMAS Dissection, SMASectomy, and SMAS Plication. These techniques vary in the degree of tissue manipulation and the aesthetic goals they aim to achieve.
1. SMAS Dissection
Overview: This technique lifts both the skin and the SMAS layer, offering a more comprehensive approach to facial rejuvenation. By manipulating the SMAS layer, which is responsible for much of the facial sagging, it provides longer-lasting results.
Advantages:
Long-Lasting Results: By addressing deeper facial tissues, this technique ensures that the results are more durable compared to skin-only lifts.
Natural Appearance: The technique restores natural volume and contours to the face by repositioning the SMAS, reducing the risk of an unnatural or “pulled” look.
Effective for Moderate Sagging: Ideal for patients who have experienced moderate sagging or volume loss in the face.
Limitations:
Longer Recovery Time: As it involves deeper tissue manipulation, recovery takes longer, and there may be more swelling and bruising.
Increased Risk of Complications: Risks, such as hematomas, nerve damage, or skin necrosis, are higher compared to skin-only lifts.
Increased Cost and Complexity: Due to the complexity of the procedure, the associated costs and the time required for surgery are higher.
Suitable Patient Profile: Ideal for patients aged 50-70 with moderate to severe sagging, deep nasolabial folds, or volume loss.
2. SMASectomy
Overview: SMASectomy involves removing a portion of the SMAS layer to tighten the face and neck, particularly effective for patients with significant sagging or excess tissue.
Advantages:
Significant Lift: Provides a more dramatic lifting effect, especially in the lower face and neck areas, making it ideal for patients with substantial sagging.
Improved Jawline and Neck Contours: By removing a portion of the SMAS, it provides a significant contour improvement around the jawline and neck.
Effective for Severe Sagging: This technique is highly effective for patients with marked laxity and sagging, particularly in the lower third of the face.
Limitations:
Highly Invasive: The procedure involves significant tissue removal and dissection, making it more invasive than other techniques.
Risk of Over-Tightening: The potential for over-correction, which can lead to an unnatural or exaggerated result, is higher.
Not Suitable for Certain Facial Profiles: For patients with concave or flat facial profiles, SMASectomy may cause a hollow or sunken appearance.
Suitable Patient Profile: Ideal for patients over 60 with advanced sagging, particularly in the lower face and neck, and those who have significant excess skin or fat.
3. SMAS Plication
Overview: SMAS Plication involves folding and suturing the SMAS layer to create a tightening effect, without excising tissue. This approach offers a less invasive alternative to SMASectomy.
Advantages:
Less Invasive: Compared to SMASectomy, SMAS Plication is a less invasive procedure, making it easier for patients to recover.
Reduced Risk of Over-Correction: Since the technique involves folding rather than excising SMAS, the risk of over-tightening is minimized.
Effective for Moderate Sagging: Suitable for patients with moderate skin laxity, providing effective lifting without significant tissue removal.
Limitations:
Limited Lift for Severe Sagging: It may not provide sufficient lift for patients with significant tissue laxity, particularly in the lower face and neck.
Potential for Recurrence of Sagging: As SMAS Plication relies on folding rather than excising tissue, there may be a risk of recurrence of sagging over time, especially in patients with weak SMAS structures.
Less Dramatic Results: While effective, the results may not be as pronounced as those achieved with SMASectomy or deep SMAS dissection.
Suitable Patient Profile: Recommended for patients with moderate facial aging (ages 50-60) who experience mild to moderate jowling or mid-face volume loss.
Summary of Techniques
Technique | Description | Advantages | Limitations | Ideal Patient Profile |
SMAS Dissection | Lifting both skin and SMAS. | Long-lasting, natural appearance, effective for moderate sagging | Longer recovery, higher complication risk | Moderate to severe sagging, age 50-70 |
SMASectomy | Removal of a portion of the SMAS. | Dramatic lift, effective for severe sagging | Highly invasive, risk of over-tightening | Severe sagging, age 60+, with excess skin/fat in lower face and neck |
SMAS Plication | Folding and suturing the SMAS. | Less invasive, ideal for moderate sagging | Limited lift, potential for recurrence of sagging | Moderate aging signs, age 50-60 with mid-face volume loss |
Grading of Techniques Based on Severity of Aging
FIGURE: A) Grade 0: Lower face does not show any sagging. B) Grade I: Slight sagging of the lower face, with the appearance of marionette lines and nasojugal groove. C) Grade II: Pronounced marionette lines and nasojugal groove, accompanied by noticeable jowl descent. D) Grade III: Significant jowl sagging with an obscured jawline, marionette lines extending beyond the midpoint of the corner of the mouth and jawline, and nasojugal groove descending below the midpoint between the nasal tip and the corner of the mouth. The wrinkles have profound depth, and there is an abundance of skin extending beyond these lines.
Grade I (Mild Aging):
Primary Concern: Early signs of aging, mild skin laxity.
Ideal Technique: Skin-Only Lift.
Reason: Offers the least invasive option, addressing minimal laxity without the need for deep tissue manipulation.
Grade II (Moderate Aging):
Primary Concern: Noticeable sagging, especially around the jowls and mid-face.
Ideal Technique: SMAS Plication or SMAS Dissection.
Reason: Both techniques target deeper layers (SMAS) to provide longer-lasting results. SMAS Plication may be preferred for those who seek less invasive intervention.
Grade III (Advanced Aging):
Primary Concern: Pronounced sagging in the lower face and neck.
Ideal Technique: SMASectomy or SMAS Dissection.
Reason: These techniques can address significant sagging, particularly in patients with substantial tissue laxity.
Tailoring Techniques to Facial Features
FIGURE: A) Concave type: Protruding zygomatic bones with a depressed area below in a slender facial shape. B) Neutral type: Midpoint between the concave and convex profiles. C) Convex type: Greater volume below the zygomatic bones than the bones themselves in a plump face shape.
The study emphasizes the importance of a preoperative evaluation based on key factors such as sagging severity, facial profile, and SMAS mobility. This personalized approach helps in selecting the most suitable technique for each patient.
Concave Facial Profiles: Best treated with SMAS Plication, which adds volume to the lateral face for improved symmetry.
Convex Facial Profiles: SMASectomy works best, reducing excess volume and tightening the jawline.
Neutral Facial Profiles: SMAS Dissection offers a balanced lift without over-correction.
Additional Considerations
Age and Skin Quality: The younger the patient, the more likely a skin-only lift will be appropriate, as their skin may have greater elasticity. Older patients with more extensive skin laxity typically benefit more from SMAS-based procedures.
Volume Loss: The volume loss in the mid-face may require supplementary procedures such as fat grafting or dermal fillers to enhance the outcome.
Patient Expectations: Understanding the patient’s aesthetic goals is crucial. Those seeking a subtle rejuvenation might favor less invasive techniques, while those aiming for a more dramatic result may opt for deeper interventions.
Postoperative Outcomes
Patient satisfaction across all techniques was high, with an average FACE-Q score of 84.2, demonstrating that most patients were pleased with their overall appearance. The study also showed a perceived age reduction of approximately 11.2 years.
Outcome | Average Score |
Facial Appearance | 84.2/100 |
Social Confidence | 86.3/100 |
Psychological Wellbeing | 82.6/100 |
Surgical Satisfaction | 90.1/100 |
Perceived Age Reduction | 11.2 years younger |
Conclusion: A Personalized Approach
Face-lift surgery is not a one-size-fits-all solution. By considering facial profile, degree of sagging, SMAS mobility, and patient age, surgeons can select the best technique for each patient, ensuring optimal outcomes. Whether opting for a less invasive Skin-Only Lift for younger patients or a more dramatic SMASectomy for advanced sagging, personalized approaches are key to achieving long-lasting, natural-looking results.
Reference:
Kim, Do Gon MD; Lee, Sung Ha MD; Bae, Sung Gun MD. An Approach to Selection of Face-Lift Techniques for Different Types of Faces: An Analysis of 1000 Asian Patients Over 9 Years. Annals of Plastic Surgery 93(2):p 153-162, August 2024. | DOI: 10.1097/SAP.0000000000003982
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