We'll show you everything! Face and neck lift - photos and videos Before and After, report from the operating room, exhaustive frank story from the patient

Smas lifting of the lower third of the face and neck is a surgical method for eliminating age-related changes in the area of ​​the chin, lower jaw and neck. Unlike traditional lifting, this technique affects a deeper layer called the Superficial Musculo-Aponeurotic System (SMAS) - the superficial muscular-aponeurotic system.

With age-related changes in this layer, it is impossible to radically correct the situation with the help of various cosmetic procedures, including hardware tightening, since their action is aimed at the upper layers of the skin without affecting the underlying structures. With Smas lifting, the effect is on a kind of “framework” that keeps the skin from sagging, making it stable and durable. During the operation, the clear contour of the chin and lower jaw is restored, and the oval of the face is corrected. Excess fat tissue and sagging skin, which, by forming wrinkles, reveal age, are also eliminated.

Indications:

• the appearance of wrinkles around the lips;
• drooping corners of the mouth, more pronounced nasolabial folds;
• the oval of the face is unclear and saggy;
• double chin formation;
• neck skin - saggy and flabby;

Contraindications:

• presence of an infectious disease;
• some concomitant pathologies (heart disease, blood disease, diabetes, etc.);
• malignant tumors;
• psychical deviations.

Before/after photos of a neck lift

SMAS-lift

The abbreviation SMAS stands for “muscular aponeurotic layer.” SMAS is located under the skin and subcutaneous fat.

With this type of lift, an incision is made along the ear, the skin is peeled off along with the SMAS, moved and fixed in a new position, excess skin is excised and sutured.

The SMAS lift is dangerous because the facial nerve passes through this area, damage to which can lead to paralysis of the facial muscles. This is why only 6% of plastic surgeons undertake this type of lift.

Read more about the SMAS-lifting technique in my article.

How to remove a double chin and tighten your neck?

Popular questions

It is best to do a facelift after 35-40 years and before 50, with the exception of some techniques that allow you to remove even pronounced skin changes. The upper limit is quite arbitrary, because everything is decided on an individual basis. You can contact a plastic surgeon even at the age of 60, and he will decide how to help the patient. However, the younger the body, the easier the operations are tolerated, because regeneration processes occur faster.

Most often, general anesthesia is used, but some procedures can be performed under local anesthesia. If necessary and at the request of the patient, local anesthesia can be supplemented with medicinal sleep or mild sedation.

Incisions are made behind the ear, 2/3 of the length of the auricle, or along the scalp. Therefore, they will not be noticeable after the intervention, and will completely resolve over time.

Lifting the lower zone of the face and neck according to Mendelssohn in Dikarev’s modification

Lifting the lower zone of the face and neck according to Mendelssohn as modified by Dikarev is an evolutionary development of the SMAS lift.

With a SMAS lift, the entire muscular aponeurotic layer is stretched and moved entirely to one side. But this layer consists of multidirectional muscles, and it would be more logical to move each muscle in isolation.

This is precisely why this approach is good: the surgeon does not work with all SMAS at once, but with each component individually, moving it in different directions, attaching it in different places.

At the moment, a comprehensive lift of the lower area of ​​the face and neck according to Mendelssohn as modified by Dikarev gives the most effective and long-term result.

Read more about the technique in my article.

How to get rid of jowls? Lifting, SMAS-lifting, MACS-lift.

Preparing for surgery

For two weeks, it is recommended to quit smoking or at least halve the number of cigarettes you smoke, and also eliminate blood thinning medications. A few days before the intervention you need to undergo an examination. It includes:

• general urine analysis;
• blood tests - clinical, biochemical, coagulogram, HIV, syphilis, hepatitis B and C;
• fluorography;
• ECG;
• other examinations, depending on the scope of the operation and the doctor’s individual recommendations.

With the results, the patient needs to go to a therapist who, in the absence of contraindications, will give permission for surgical intervention. After this, you need to consult with an anesthesiologist.

Memo for preparing for facial plastic surgery: tests, prohibitions, recommendations

MACS-lift

MAX-lift is an evolutionary development of skin tightening in the lower third of the face.

The skin is peeled away from the SMAS, the SMAS is pierced with a running stitch and tightened.

Excess skin is then excised and a suture is applied.

At first glance, it seems like this is the ideal skin tightening: simple, low-traumatic, with good results. However, this only seems: the effect lasts for a year or two, then SMAS begins to cut through the thread, sink, stretch the skin, and the wrinkles return.

Read more about the MACS-lift technique in my article.

The essence of MAX-lift

Facial plastic surgery Lower third

Anton Zakharov: Hello, dear viewers! In this video we continue to analyze the face in thirds. We have already discussed the upper third, the middle third, and now we will talk, respectively, about the lower third of the face.

The lower third of the face is what is located between the base of the nose and the neck. Most often, the group of operations included in this section also includes the neck, which is why we usually say “lower third of the face and neck.”

What complaints does the patient have if something bothers him in this anatomical area? Most often these are violations of the oval of the face: the so-called jowls - sagging tissue in the lateral parts of the face and drooping tissue of the cheeks; these are the oromental folds, these are the nasolabial folds, the lateral section; violations of the cervical-mental angle, excess local fat deposits in the neck and chin and, in general, prolapse of soft tissues in the lower third of the face and neck. These are the main complaints that our patients present.

What operations do we have in our arsenal to work with this zone? These are four groups.

The first group is facial plastic surgery itself, which includes superficial lifts and deep lifts.

This is neck plastic surgery, also known as platysmoplasty. It can be lateral, that is, lateral (in our terminology) and central, that is, medial (in our terminology).

This is a chin augmentation. Most often we say augmentation with implants, but there are also techniques for augmentation with bone grafting.

And the last, fourth group of operations is liposuction and work with subcutaneous fat in the neck and chin area.

Let's take a closer look at these groups of operations.

The first group of operations is face lifts. They are superficial and deep. Superficial lifting is an operation that has been known for a very long time. She is about 15 years old, she has already been worked out in detail, all her nuances have been well studied by plastic surgery.

And, in general, the point of the operation is that the skin of the integumentary tissues is widely mobilized. They move in the required direction to straighten wrinkles and folds or eliminate sagging. At the same time, excess skin is removed, and, in fact, the whole operation is completed, and it is all sutured.

The biomechanical meaning of such manipulation is that the cover is simply tightened. No work is done with the frame or with the deeper structures of the face, that is, the volume of integumentary tissue is simply reduced. From this, accordingly, all the disadvantages that exist in dermal face lifting follow. Stretched mouths, elongated lobes on the face, tension lines on the skin of the face - these are all a consequence of skin superficial lifting. That is, when you see such unaesthetic manifestations somewhere in the society around us, you need to understand that it is skin lifting that was performed here, because deep lifts do not lead to such moments, and this is a consequence of the load on the integumentary tissue, since the volume of the cover has decreased , and the volume of internal structures has not changed.

It's like stuffing a pillow that was in a pillowcase of its size into a smaller pillowcase, roughly speaking. Good analogy.

The second group of interventions is SMAS - these are deep face lifts. SMAS is an English acronym that stands for superficial musculoaponeurotic system of the face. And the meaning of these operations is completely different in relation to biomechanics. That is, they begin in exactly the same way - the integumentary tissues are lifted, but the next stage of this intervention is the deep mobilization of the underlying tissues, which includes everything in the structure of the muscular aponeurotic system of the face, including facial muscles.

In order to widely mobilize this layer, you need precise knowledge of anatomy: bypass all important anatomical formations that are significant for human life, move the superficial muscular aponeurotic system to the correct position, that is, create a new facial frame and only then drape this frame with freely lying integumentary tissues .

That is, in these operations - skin lifting and SMAS lifting - there is a huge biomechanical difference. In the first option, the skin is simply tightened, and in the second option, the deeper layers of the face are moved, and thereby a new frame of a new oval is formed, and the skin, without any load, simply freely covers this entire structure.

It is important to note: both of these operations have a common approach - most often we are talking about the periootic-behind-the-ear access - and they have absolutely general rehabilitation for the first few weeks. That is, an untrained person and even, in general, just another plastic surgeon who did not participate in the operation, for the first few weeks cannot distinguish whether a skin lifting was performed or a really deep SMAS lifting, based on what is happening. This simply creates a huge field for fraud, and very often it is declared that SMAS lifting is being done, but in fact, a simple skin lifting is being performed, which is already 150 years old, in fact.

The difference becomes visible later, and it increases over time, because skin lifting leads to what I said - to tension lines, elongated lobes, and deformation of the mouth. And it is ineffective: all deep-lying layers, since no work was done in them, quickly begin to sag and sag again, pulling back the displaced volume of integumentary tissue that was involved in the operation, and causes both deformation and a relapse of those aesthetic defects. who brought the person to the operation.

With SMAS lifting, the opposite is true - the frame is stable. There is no load on the skin, therefore, mouths and earlobes do not stretch. The oval lasts a long time. Early relapses most often do not occur with this operation, and the appearance is completely different - everything is more natural and not overtightened, but much more radical in its effectiveness.

So why is it that they perform skin lifting instead of deep lifting? It’s simple: these operations are of completely different levels of complexity. Even a novice surgeon can perform skin lifting. This does not require any super complex knowledge or total preparation. To do this, it is enough to have basic surgical skills.

To perform a deep face lift, also known as SMAS lift, you need to spend a lot of time working both in the section room and working in the operating room with more experienced surgeons, know the topographic anatomy in detail and have a good understanding of all the nuances of work in the lower third of the face and neck, because there are a huge number of anatomical formations important for our life. There are great vessels that provide blood supply to the head and neck, there are nerves that provide facial expressions. First of all, the facial nerve is located in the dissection area during SMAS lifting, and SMAS lifting requires perfect knowledge of the anatomy, bypassing its branches, often in radical variants of this operation, and requires a completely different level of training and experience from the operating surgeon. If a surgeon of insufficient training tries to perform this operation, most often it ends with disturbances in facial expressions and conduction disturbances along the facial nerve. As we know, to my deep regret, they are most often permanent, because surgical trauma is very rarely fully restored in patients with injuries to the branches of the facial nerve. And this leads to very serious visual aesthetic problems, impaired facial expressions, and functional disorders - the inability to retain fluid in the oral cavity, for example, when the marginal branch is damaged. Well, and a host of all sorts of troubles that seriously complicate the patient’s life.

Skin tightening

Skin tightening is the simplest facial rejuvenation surgery. In this operation, the surgeon works only with the skin and subcutaneous fat, without affecting the deeper structures. This is both good and bad. It’s good because there is minimal trauma and quick rehabilitation. It’s bad because the effect is short-lived: after six months or a year, the wrinkles will return.

They say that some surgeons manage to sell a SMAS lift, but only do skin tightening: for the first six months there is no noticeable difference, and then the surgeon just shrugs his shoulders. But I don’t want to believe it.

Recovery

After surgery, the patient spends several days in the hospital. The first dressing is done on days 3-5. To prevent infection, the doctor prescribes a course of antibiotics.

For 10 days after surgery, you should not use cosmetics or wash your hair. The swelling subsides after 2-3 weeks, by which time the patient will be able to return to his normal lifestyle, but full recovery will take at least 2 months. During this time, the patient is prohibited from visiting the pool, bathhouse, solarium, playing sports, dyeing hair, smoking and drinking alcohol.

To speed up recovery, doctors recommend physiotherapeutic procedures and massage, but not earlier than a month after surgery.

As with any surgical procedure, complications are possible after a facelift. You can minimize the likelihood of negative consequences by contacting an experienced plastic surgeon. Medical specialists will provide a full range of services related to the preparation, conduct of the operation and the recovery period.

A facelift allows you to look 5-10 years younger, remove folds and wrinkles on the forehead, bags and circles under the eyes, as well as correct other age-related imperfections common among men and women. The effect remains for many years.

Yakimov Dmitry Konstantinovich

Doctor of the highest category. Candidate of Medical Sciences. Member of the Society of Plastic Surgeons. Author of more than 30 works in the field of surgery, teacher at the Military Medical Academy.

Anterior platysmoplasty

Platysma are the muscles of the neck. Platysmoplasty - suturing of the neck muscles:

Anterior platysmaplasty - diagram

The operation, together with neck liposuction, SMAS lift or modified Mendelssohn lift, allows you to remove a double chin, tighten your neck and eliminate wrinkles.

Read more about platysmaplasty in the article.

How to remove a double chin and tighten your neck?

Indications for the procedure

Most of the changes that patients want to correct with the help of SMAS lifting are age-related. They can be of varying degrees of depth and can manifest themselves in different ways. But in one thing they are all the same: they spoil our reflection in the mirror.

Such changes include:

• Soft tissue ptosis
• Skin laxity
• Sagging cheeks
• Loss of clear facial contours
• Double chin
• Folds on the neck
• Deep folds in the nose and lips
• Drooping of the corners of the lips.

All this can be eliminated with the help of SMAS lifting.

Prices

Benefits of a facelift at the Swiss University Hospital

• The plastic surgery department in our clinic is equipped with modern expert-class equipment.
• The clinic employs plastic surgeons of the highest category with many years of experience, also specializing in the field of maxillofacial surgery, who perform more than 600 operations annually.
• We offer preoperative examinations and offer patients all the necessary diagnostic methods, including high-tech techniques.
• The clinic has its own intensive care unit, each operated patient is under the supervision of experienced staff, and the intensive care wards are equipped with highly sensitive equipment.
• We also host doctors from more than 15 specializations; if necessary, assistance from any specialist is available.
• We also carry out simultaneous interventions: during one anesthesia it is possible to combine Smas face lifting with plastic surgery (mammoplasty, abdominoplasty, blepharoplasty, etc.) or with surgical treatment (removal of hernias, cysts, tumors, surgical treatment of cholelithiasis, etc.).

Reviews

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Video reviews

What results can be expected after surgery and how long does it last?

After the operation, it is possible to restore the clarity of the oval contours of the face, tighten the tissues, and reduce the appearance of jowls and wrinkles. This effect can please patients for 7-10 years with accompanying cosmetic care for their skin condition.

Hardware techniques will also help prolong the effect after surgery - for example, Liftera ultrasonic lifting, which stimulates collagen production, increasing skin elasticity.
With competent and professional care for your beauty, the result of plastic surgery will delight you for a long time. Make an appointment