Mini-Lifting, Mini-Rhytidectomy, Minimal Incision Rhytidectomy (Short Scar Face Lift) with Lateral SMASectomy I

This is a paper by Daniel C. Baker, MD, from New York University Medical School, on mini-lifting.

The core idea is minimal SMAS dissection and fixing the mobile SMAS to the immobile SMAS.

Minimal Incision Rhytidectomy

(Short Scar Face Lift) with Lateral

SMASectomy: Evolution and Application

Daniel C. Baker, MD

‘I saw little difference in overall facial contour regardless of whether I had performed a lateral SMAS dissection...’ It seems he questioned the necessity of extensive SMAS dissection.

As experience with SMAS anatomy increased... ‘it was necessary to elevate the mobile SMAS anterior to the parotid gland.’

The author, through extensive experience with SMAS (the thin fascial tissue beneath the facial skin) dissection, realized that to change the facial contour, the SMAS needed to be lifted anterior to the parotid gland for effectiveness.

Problems Discovered

However, the wider the SMAS was lifted, the greater the risk of injury to facial nerve branches.

Also, the further anteriorly the SMAS was dissected, the thinner the tissue became, making it prone to tearing.

In practice, lifting the SMAS often resulted in thinning or tearing.

Applying tension during SMAS suturing made it even more susceptible to tearing.

Conclusion

For these reasons, the author concluded that extensive SMAS dissection is unnecessary for most patients and offers no significant long-term benefits.

Extensive SMAS dissection increases the risk of nerve damage and tissue tearing, and does not provide significant long-term benefits, so it is not necessary for most patients.Intention: Let's adhere to a safe and appropriate surgical scope!

The 1980s

With the introduction of lipoplasty in the 1980s, the author was able to improve the appearance of the neck.

Method:

Performed strong lateral suturing of the platysma (neck muscle) in conjunction with lipoplasty.

Advantages:

This method largely eliminated the need for submental incisions and extensive undermining.

Incisions and undermining were only necessary in very challenging cases (when the neck condition was very poor).

Reduced medial platysma work:

Surgery involving the anterior (medial) neck muscles also became largely unnecessary.

However, platysmaplasty was exceptionally performed in cases where prominent vertical neck bands appeared clearly during movement.

Effect:

Strong lateral traction of the platysma (sutured to the mastoid periosteum) significantly improved the neck contour.

By using only liposuction and strong lateral fixation of the neck muscles, a beautiful neck contour can be achieved without the need for unnecessarily wide incisions or undermining.Intention: Achieve good results with a simpler and safer surgery!

The 1990s

In the 1990s (especially 1992), the author tried a new method:

- Instead of lifting the SMAS, a method called lateral SMASectomy was used.

- Nasolabial folds and jowls were naturally improved.

Neck surgery methods were also performed differently:

- Lateral platysmaplasty: The platysma neck muscle was pulled laterally and fixed to the firm mastoid area behind the ear.

- The jawline contour was significantly improved.

Many new methods emerged, but ultimately, it's important to consider:

(1) What are the indications for these new techniques?

(2) How great are the risks and complications?

(3) Most important, do the benefits of these techniques outweigh their risks significantly enough to justify using them routinely?

Indications: For which patients should this technique be used?

Risks: What are the side effects and complications?

Efficacy: Do the benefits sufficiently outweigh the risks? (Enough to justify routine use?)

Considering these points is crucial!!!

‘The ultimate success of any rhytidectomy operation is a happy patient. That is where the best new referrals originate. Therefore each surgeon must adapt a technique that works best for his or her patients.’

New methods involving excising and reattaching parts of the SMAS can create a more beautiful face and neck, and while surgical techniques continue to evolve, it is important to choose the method that best suits the patient.Intention: Patient satisfaction is paramount, and while surgical methods continue to evolve, choose them carefully!

Frequently Asked Questions

What is the appropriate extent of SMAS dissection during a mini-lifting procedure?

Excessively wide dissection of the SMAS is generally not necessary for most patients. Extensive dissection increases the risk of nerve damage and tissue tearing, and does not offer significant long-term benefits. Therefore, it is important to perform surgery within a safe and appropriate scope.

What are the risks of wide SMAS dissection?

The wider the SMAS is dissected, the greater the risk of injury to facial nerve branches. Additionally, the tissue can become thin and easily tear, and in practice, tearing often occurs when the SMAS is lifted or sutured.

Can a mini-lifting procedure also improve the neck contour?

Yes, it can. By combining liposuction with strong lateral suturing of the platysma (neck muscle), a significant improvement in neck contour can be achieved, yielding good results without the need for unnecessarily wide incisions or undermining.

How did mini-lifting surgical techniques evolve in the 1990s?

In the 1990s, instead of lifting the SMAS, lateral SMASectomy was used to improve nasolabial folds and jowls. For the neck area, lateral platysmaplasty was attempted to significantly improve the jawline contour.

What is the most important consideration for a mini-lifting procedure?

Patient satisfaction is the most important consideration. It is crucial to carefully consider the indications, risks, and whether the benefits significantly outweigh the risks of new techniques, in order to choose the most suitable surgical method for each patient.