SMAS lifting. The essence of the technique and what are its advantages.

REJUVENATION / HARDWARE COSMETOLOGY

ULTRASONIC SMAS LIFTING

Duration of the procedure:

40-90 min.

Number of procedures:

1-3

Price:

from 14,785 rub.

Recovery period: no

Equipment: Liftera-A apparatus with various cartridges

SMAS lifting is a modern, effective cosmetic procedure that allows you to rejuvenate the skin and improve the shape of the face. SMAS face lift is ideal for those who do not want to lie on the operating table. The big advantage of this procedure is that it does not require surgery.

What is SMAS lifting

Despite the fact that doctors have thoroughly studied the structure and anatomy of the skin for a long time, contouring technology such as SMAS lifting in cosmetology and aesthetic surgery is a relatively new direction. The abbreviation SMAS stands for SMAS lifting in the cosmetology field, which began recently. In 1980, cosmetologists developed the Superficial Musculo-Aponeurotic System - the subcutaneous superficial muscular-aponeurotic system. Its full description became available to specialists only in 1980.

According to research, the localization of the system occurs in the subcutaneous tissue, responsible for the connection of muscles and skin. The SMAS is located in the area of ​​the ears, cheeks and neck and is responsible for the functioning of the facial muscles, as well as its tone. As soon as the system weakens, the natural tension of the skin and muscle tone disappears, signs of aging appear on the face - wrinkles around the lips, folds on the neck, swelling under the eyes, double chin, drooping upper eyelids.

In 1987, the first successful plastic surgery to tighten the skin was performed, preserving the integrity of the musculocutaneous joints and minimal traces of surgical intervention. Over time, the technique became less traumatic, despite its extensiveness, rehabilitation time decreased, and the procedure became even more popular. Unlike other surgical techniques, SMAS lifting allows you to preserve natural facial features, the skin does not look overtightened, the shape of the eyes and the shape of the lips are preserved.

What effect will be from SMAS lifting?

Compaction of SMAS and strengthening of ligaments is a lifting effect. Targeted reduction of adipose tissue - lipolytic, to reduce fat bags. On the skin area - increasing tone, eliminating sagging. The visible effect is that the face becomes more compact, there is less swelling in the eyelid area and sagging of the subeyebrow area, the jowls are reduced in volume, and the cheeks creep less into the nasolabial area. The face looks younger and fresher. In general, the word “compactization” very accurately describes the essence of the procedure.

When this procedure is carried out on the body, it reduces local fat deposits and eliminates sagging skin.

Types of SMAS lifting: time-tested classics

Since the scope of application of the technology is quite large, the general concept of SMAS lifting can be defined as a combination of several types of procedures:

• classic lift;
• endoscopic rejuvenation method;
• ultrasonic lifting.

Each type should be described separately. What is SMAS classic face lifting? This is the most traumatic and expensive method. The operation requires careful preparation of the patient, and the time spent on the operating table under general anesthesia can range from 2 to 3 hours. After surgery, enough time is needed for the face to fully recover and acquire the expected attractiveness. But this technique is the most effective, since one procedure is enough to not think about age for another 10-15 years. The classic method is recommended for people over 40 years old, since it is at this age that changes on the face become noticeable to others.

SMAS lifting: what is it and how is the procedure performed?

• After the patient is put under anesthesia, the doctor makes an incision from the area behind one ear in the temple area, around through the anterior facial area to the area behind the second ear. The top layer of skin is peeled off in order to tighten the SMAS system to the desired level.
• Excess (redundant) tissue is excised.
• If necessary, liposuction is performed to reshape the position of the upper layer of skin.
• In the correct position, the skin is carefully fixed until complete healing.
• Cosmetic sutures are placed along the hairline and are removed no earlier than two weeks after the operation.

During the recovery period, the patient should be observed by a doctor to monitor the condition. The bandage can be removed after 3-4 days. In total, rehabilitation takes at least one and a half months. During this time, tissues and muscles have time to recover, postoperative hematomas finally resolve, and swelling subsides.

It is important to follow the doctor’s recommendations: apply cooling compresses in a timely manner, take antibiotics, and do not bend over.

Attention! Even at the stage of preparation for surgery, you should give up cigarettes and alcohol. After the operation, it is strictly forbidden to visit baths and saunas.

What is endoscopic SMAS lifting?

Another type of lifting is endoscopic. It is much less traumatic, since it does not require incisions, and therefore no stitches. True, this is still an operation and it is performed under general anesthesia. The duration of this procedure is about 3 hours.

The endoscopic method is recommended for people under forty, since its results last only five years. In addition to a more gentle procedure, this method of restoring youth is affordable, especially compared to the classical procedure, the cost of which can reach many hundreds of thousands of rubles.

Despite the absence of incisions, the operation is performed with violation of the integrity of the skin; the endoscope is inserted through pinhole punctures in the temple area on the scalp. Recovery after surgery also requires at least 1.5-2 months, but the likelihood of damage to nerve tissue is minimal. And there will be no significant swelling after the operation.

Ultrasonic thread technique

The ultrasonic thread technique is a method that is suitable for optimal patients with a high level of connective tissue and preserved tissue tone. Advantages of the protocol: lasting results, pronounced effect, and fewer lines (30–40% compared to the classic uniform treatment protocol).

For example: if in the standard Doublo protocol up to 150–200 lines can be used for the middle and lower third, then in the ultrasound thread technique 80–120 lines will be used for the same area (depending on the morphotype of the patient’s aging and tissue structure).

Clinical case 1

Patient, 58 years old.

No contraindications have been identified. She had not previously applied for cosmetological care and had not undergone any medical procedures. On examination: deformation type of aging. Tissue tone is slightly reduced.

Rice. 2. The scanogram reveals pronounced connective tissue in the area of ​​subcutaneous fat (starts at a depth of 3 mm), the connective tissue covering the SMAS layer is clearly differentiated (depth 4.6 mm). There were no contraindications to the area where the procedure was performed. The main working sensors for obtaining lifting will be D4 - 4.5 mm and M7 - 3 mm on the Doublo device.

At the first stage

Anamnesis is collected, indications and contraindications for the procedure are identified, as well as examination and palpation of the patient’s tissues.

At the second stage

– high-resolution ultrasound diagnostics using the Doublo HIFU device. It is necessary to scan all areas where treatment will be carried out, determine the depth of bone structures, deep fat packets, SMAS, subcutaneous fat, and skin thickness. Determine the depth of the connective tissue for selecting sensors. The patient must also be examined for possible contraindications to the procedure area.

At the third stage

Markings are made on the patient's skin. All “taboo” areas that cannot be entered during the procedure are marked.

The zygomatic arch is highlighted with a rectangle (in it, the treatment will proceed as standard, line by line, since otherwise there will be multiple overlaps of coagulation points in this area when the ultrasonic threads converge); the direction of the HIFU lines themselves will depend on the area of ​​maximum sagging. Next, guide lines are drawn in an obliquely downward direction. After this, segments are marked on each guide that coincide with the length of the line itself, 25 mm (you can use a sensor for this, since the standard line length of 25 mm is marked on it). Since the procedure will be carried out in two layers, guides for the first layer are applied on the markings, and the lines of the second layer will be applied in the intervals.

Rice. 3. Marking on the patient’s skin before Doublo HIFU SMAS lifting.

Video demonstration of marking before the Doublo HIFU ultrasonic SMAS lifting procedure

At the fourth stage

The procedure is carried out directly on the markings applied earlier, in compliance with safety precautions and all rules for working on the device.

Photographing of the result in this patient was carried out 1.5 years after the procedure itself, while preparing material for the article. The effect developed within 4 months after the procedure and the result remained stable. The patient did not undergo any other procedures; home skin care was additionally normalized.

Rice. 4. Results before and after the Doublo HIFU SMAS lifting procedure

Hardware SMAS lifting: getting younger with ultrasound

The most comfortable, safe and painless procedure: facial lifting using ultrasonic waves. The Ultraformer apparatus is widely used for this purpose. The technique does not require the use of general anesthesia - local anesthesia is sufficient, and it is also shorter and takes only about an hour and a half.

How is such an operation performed?

• Before the procedure is scheduled, the patient must undergo a thorough preoperative examination.
• Preparation includes drawing lines on the skin along which the lifting will be carried out.
• A special gel-like texture is applied to the skin in the treatment area.
• The specialist acts on selected areas with a special manipulator of an ultrasonic device. No pain. There may only be a slight tingling sensation

The effectiveness of the method is noticeable much earlier than after classical or endoscopic methods. Within a week, an improvement in facial contours and skin structure becomes noticeable. And the maximum effect will become obvious 3 months after the procedure. The result does not last long - about two years, after which the ultrasound facelift can be repeated. This technique is designed to eliminate age-related changes that appear at the age of 35-45 years.

Interesting clinical cases from experts in ultrasonic SMAS lifting Doublo HIFU

Irina Alekseevna Baranova

Candidate of Medical Sciences, dermatovenerologist, cosmetologist.
Network of clinics of topical medicine LE BAR CLINIC, Novorossiysk.

Clinical case 3

Patient, 49 years old.

Complaints about drooping facial tissues, a sharp decrease in tone and turgor, deterioration in overall appearance. The patient is perimenopausal, the medical history is without specific features. Previously, botulinum therapy and biorevitalization were performed.

There are no contraindications to the hardware SMAS lifting procedure.

A rejuvenation procedure was performed using high-intensity focused ultrasound Doublo HIFU (Fig. 9)

.

Impact areas: face, neck, décolleté.

Cartridges: D4 (4.5 mm), M7 (3 mm), D7 (1.5 mm). The standard protocol of uniform development was reinforced with additional cross lines in the areas of the painters, the fixed upper eyelid and eyebrow, and the “rings of Venus.”

Total number of lines on the face, neck and décolleté: 500.

During the rehabilitation period, the patient received vitamin C, organic silicon preparations, and vitamin D to stimulate the synthesis and assembly of collagen.

Rice. 9. Results before and after using Doublo HIFU high-intensity focused ultrasound.

Expert conclusion:

In the Le Bar Clinic network, we have been using devices from the Doublo HIFU line since 2022. I note high efficiency, high patient satisfaction, and good tolerability of the procedure. For me, an important factor is the return of patients for the procedure. I note that on Doublo it is very high! We are committed to long-term cooperation with our patients, are interested in long-lasting results and carefully approach the selection and purchase of equipment. Regarding Doublo HIFU, I only regret one thing – that I didn’t buy it earlier!

Rakhat Dzhumaeva

Dermatovenerologist, cosmetologist.
Melissa Medical Clinic, St. Petersburg.

Clinical case 4

Patient, 43 years old.

From the medical history: a thread lifting procedure and botulinum therapy were performed more than a year ago. No contraindications have been identified, she is practically healthy. Tired type of aging. Doublo HIFU high-resolution ultrasound scanning revealed a moderate amount of connective tissue in the subcutaneous fat and on the SMAS layer. The SMAS lifting procedure was carried out in the classic protocol of uniform treatment using three sensors: D4 – 4.5 mm, M7 – 3 mm, D7 – 1.5 mm, with a follow-up examination after 3 months (Fig. 10)

.

Rice. 10. Result before and after using Doublo HIFU high-intensity focused ultrasound.

Expert conclusion:

We have been performing procedures using the Doublo HIFU device at the clinic since 2017. With its advent, the need for thread lifting has significantly decreased, and in complex categories of patients, procedures can be combined to obtain even more pronounced results and a lasting effect from the threads themselves. I really like combining the technique in the course treatment of patients with botulinum therapy for platysma bands - we get ideal oval contours.

Ekaterina Andreevna Nazarova

Dermatovenerologist, cosmetologist.
Aesthetic, Arkhangelsk.

Clinical case 5

Patient, 34 years old.

No contraindications to the procedure were identified. Complaints about drooping eyebrows, “heavy” upper eyelid. The procedure was performed using the “anchor point” technique (Fig. 11)

.

The “anchor” point is the intersection of the midpupillary line and the anterior border of the scalp. To this point there are three rows of lines using sensors: D7 – 1.5 mm and M7 – 3 mm (where the depth allowed according to the results of ultrasound diagnostics of the skin, taking into account safety precautions):

1st row – from the head of the eyebrow to the “anchor” point; 2nd row – from the middle of the eyebrow to the “anchor” point; 3rd row - from the tail of the eyebrow to the “anchor” point.

Additionally, under the eyebrow, in the area of ​​​​the fixed eyelid, additional lines are drawn on the D7 cartridge - 1.5 mm.

Rice. 11. Result before and after using Doublo HIFU high-intensity focused ultrasound.

Expert conclusion:

After several years of practice, I came to the conclusion that the Doublo HIFU ultrasonic SMAS lifting procedure has virtually no disadvantages. In one procedure, a full-fledged ultrasound diagnosis and elimination of the problem occurs. For me and my patients, Doublo ultrasonic lifting is an indispensable method for rejuvenation and eliminating age-related problems. The ability to choose the depth of impact and provide multi-level lifting. High efficiency, lack of rehabilitation, safety, all-season use, and the ability to combine lifting with other rejuvenation techniques are the undoubted advantages of the procedure. Excellent results and rave reviews from patients strengthen my love for this technique.

Aigul Rishatovna Ibatullina

Candidate of Medical Sciences, dermatovenerologist, cosmetologist.
Clinic for health diagnostics and modern cosmetology Heliocity, Ufa.

Clinical case 6

Patient, 41 years old.

She is somatically healthy, has a stable weight throughout the entire observation period. Complaints about deepening of nasolabial folds, the appearance of “jowls”. Tired aging morphotype with excess fat packets in the mid-cheek area and the jowl area. Until the procedure on the Doublo device, I did nothing except facial treatments (Fig. 12)

.

Thanks to high-resolution ultrasound examination of the skin, the depth of the ligamentous apparatus and fat packets in the middle and lower thirds of the face was determined, and a procedure protocol was drawn up.

Total number of lines: 200.

The procedure was carried out according to the classical scheme of uniform treatment with cartridges D4 - 4.5 mm and M7 - 3 mm, with additional strengthening with reinforcing vectors from problem areas to the retaining ligaments.

Rice. 12. Result before and 8 months after using Doublo HIFU high-intensity focused ultrasound.

Expert conclusion:

Doublo ultrasonic HIFU SMAS lifting is a great way to start any course of treatment for patients. Lifting when working with the ligamentous apparatus manifests itself most quickly; moreover, in patients with severe morphotypes, the procedure can be repeated locally along the ligamentous apparatus after 6 months to enhance the lifting effect. The effect of tissue “shrinkage” can develop up to 6 months after the procedure! All this provides a complex and pronounced effect from the procedure, for which we really appreciate it at the Heliocity clinic.

Suna Ragimovna Kazikhanova

Candidate of Medical Sciences, chief physician of the clinic, dermatovenerologist, cosmetologist.
Clinic of Aesthetic Medicine "Renaissance", St. Petersburg.

Clinical case 7 (integrated approach)

Doublo hardware SMAS lifting, thanks to the variability of the maniples and detailed ultrasound scanning, allows you to create an individual protocol for each patient. I actively use it in complex anti-aging therapy. The course of treatment begins with SMAS lifting of the soft tissues of the face and eyelids. I actively combine it with botulinum therapy, phototherapy and bioreomodulation (Fig. 13)

.

This technique has proven itself well in combined protocols for the face, eyelids, and correction of local problems on the body (including the back and inner thighs).

Rice. 13. Results before and 8 months after using Doublo HIFU high-intensity focused ultrasound.

Advantages of ultrasonic SMAS lifting

Hardware SMAS lifting - what is it and what are its advantages? Among the obvious advantages of using ultrasound technology are the following:

• no pain;
• minimal recovery period;
• low morbidity;
• complete absence of risks associated with infection or damage to nerve tissue;
• clear skin without scars or traces of surgery;
• the possibility of performing the operation at any time of the year;
• minimum restrictions for the rehabilitation period after the procedure.

The only recommended rule after surgery is a two-week abstinence from intense physical activity, visiting baths and saunas, and prolonged exposure to the open sun.

Unlike other methods, ultrasound affects all levels: fatty tissue, SMAS, deep layers of the epidermis.

Suboptimal patient

Of course, there are patients in whom the expected results may be reduced. For such patients, additional methods may be required in the course of treatment to achieve significant results.

Reasons for decreased efficiency:

• Connective tissue dysplasia and its subclinical forms
• Significant reduction in the amount of connective tissue in subcutaneous fat and SMAS
• Excessive development of subcutaneous fat – requires an adipocytolytic protocol and course treatment
• Severe dehydration of the patient’s tissues – a course of biorevitalization is required
• Deficiency of vitamins and microelements in the body of patients
• Excessive tissue ptosis – indications for plastic surgery

Rice.
5. The scanogram shows weakly defined trabeculae and septa of subcutaneous fat - fewer “targets” for HIFU SMAS lifting. In clinical practice, we often encounter patients with subclinical forms of connective tissue dysplasia and a concomitant decrease in the amount of connective tissue in the subcutaneous fat and SMAS.

High-resolution ultrasound diagnostics allows us to identify such patients and approach them with comprehensive treatment to obtain optimal results. You can use a combined protocol - collagen-stimulating procedures followed by Doublo hardware SMAS lifting.

Clinical case 2

Patient, 40 years old.

From the anamnesis: in 2022, a thread lifting procedure was performed. The immediate effect was good, but lasted for a short time - 2 weeks. No contraindications have been identified, she is practically healthy. Tired type of aging, tissue ptosis is minor, but causes great discomfort to the patient. At the stage of ultrasound diagnostics, a sharp decrease in the amount of connective tissue at the level of subcutaneous fat and SMAS was revealed.

It was decided to carry out the course of treatment in two stages. At the first stage, the procedure is collagen stimulation with a polylactic acid preparation, after a period of biodegradation - the SMAS-lifting procedure.

Rice. 6. Scanogram before the collagen stimulation procedure, there is a sharply reduced amount of connective tissue in the subcutaneous fat and SMAS.

Rice. 7. Scanograms 6 months after the collagen stimulation procedure. There is a thickening of the skin and connective tissue in the subcutaneous fat.

At the first stage

During the course of treatment, a collagen-stimulating procedure is carried out: preparations of polylactic acid, hydroxyapatite, reinforcing threads.

At the second stage

– SMAS lifting procedure in the classical protocol using the method of uniform treatment.

Before the second stage, the patient noted a significant improvement in the condition of the skin: increased density, smoother texture, flattened wrinkles, and evened out complexion.

To enhance the lifting effect, the second stage was carried out - Doublo hardware SMAS lifting in the area of ​​the middle and lower third of the face. The classic uniform development protocol was used.

Rice. 8. Results before and 2 months after the hardware SMAS lifting procedure.

“Ultraformer” procedure – what is it?

Today, the use of ultrasound in medical and cosmetic applications is one of the most common and effective solutions. The basis for the methods is serious scientific research. The hardware component is represented by a large selection of accurate and efficient equipment. Perhaps the most functional and practical option is the Ultraformer device.

The HIFU technology implemented in this device allows you to use the energy of ultrasonic vibrations in the range from 2 to 11 MHz, that is, to influence even the deep layers of the epidermis.

The popular technology is based on two main processes that occur in tissues when they are exposed to an ultrasonic wave:

• thermal ablation, or the conversion of mechanical energy into thermal energy;
• acoustic cavitation, complemented by the body's immune response.

What is an "Ulraformer"? This is a device that uses thermal ablation as its main method. The duration of exposure does not exceed 3 seconds, during which time tissues are locally heated and coagulation processes caused by the cytotoxic effect are started.

So what is “Ultraformer” lifting and how safe is it for humans? It is worth noting that ultrasonic facelift is a procedure that has undergone a huge number of clinical trials in leading American scientific centers. Experimentally, scientists were able to establish that the effect of ultrasound on the body is completely harmless. And the effectiveness of the method is at least 89%! Thanks to such high results, the technology was the first to receive registration from the Food and Drug Administration in the USA in the “Lifting” category.

What to expect from SMAS rejuvenation?

So what kind of procedure is this - ultrasonic SMAS lifting and what result should you prepare for when deciding to undergo rejuvenation using ultrasound? First of all, it’s worth saying. That now this is one of the few affordable and worthy alternatives to classical surgical rejuvenation.

Thanks to deep, precise and controlled effects on strictly defined areas of the face, ultrasonic lifting allows not only to visually reduce the number of wrinkles, but also to make facial contours clearer.

The functionality of the Ultraformer device makes it possible to determine the thickness of the fat layer, muscles and epidermis individually for each patient. Depending on the data obtained, the specialist can choose the appropriate depth of exposure and significantly increase the effectiveness and efficiency of the procedure.

Ultrasonic facelift is indicated:

• people of old and mature age, when the use of general anesthesia is undesirable;
• patients who are afraid of facial surgery and any other surgical interventions;
• people who have already undergone classic SMAS lifting and want to prolong the effect of the operation without repeated surgery;
• for those who need the fastest possible effect without a long recovery period.

How is the procedure done?

This is a comfortable and safe procedure. SMAS lifting does not require punctures, incisions, or injections - it is a very soft hardware treatment without anesthesia. All the patient feels is a slight tingling sensation and pleasant warmth.

Before the start of the smas-lifting session, the doctor will assess the condition of the skin, prepare it (cleanse and apply gel), mark it and select the optimal depth of ultrasound penetration. The device displays the structure of the SMAS layer, so the entire procedure takes place under maximum control. A smas-lifting session lasts 30–60 minutes.

The cosmetologist works along the lines - he selects the required number of lines that each patient needs. For reference: on the face the maximum number of lines is 1100.

Is it possible to combine the procedure with other hardware techniques?

What is SMAS face lifting and what is it combined with? Surgical rejuvenation methods practically exclude the possibility of using non-invasive methods to improve the condition of the face. At the same time, SMAS lifting using ultrasound is perfectly combined with other anti-aging techniques.

The complex effect significantly enhances the positive effect of the procedures and helps to significantly prolong the youth of the skin. When performing an ultrasonic facial lift, it is also possible to:

• introduction of fillers for more effective plastic surgery and restoration of facial contour;
• application of biorevitalization and mesotherapy techniques;
• improving the condition of the skin and complexion through microdermabrasion.

The list of contraindications for ultrasonic SMAS lifting includes:

• pregnancy and breastfeeding;
• presence of a pacemaker;
• installation of metal implants in any part of the body;
• hormonal disorders;
• complicated central nervous system diseases;
• multiple foci of inflammation on the skin;
• diseases of the cardiovascular system;
• oncological diseases;
• taking medications that affect blood clotting;
• chronic and acute infectious diseases;
• scleroderma and lupus erythematosus;
• age under 18 years.

Contraindications for ultrasonic lifting

The SMAS lifting technique has gained well-deserved popularity due to its effectiveness and safety, but still it is not suitable for everyone. There are a number of contraindications:

• Pregnancy, as well as breastfeeding;
• Diseases of diabetes mellitus, cardiovascular system;
• Oncology and blood diseases;
• Infectious skin diseases.

Advantages of non-surgical SMAS lifting

An important advantage of ultrasound skin rejuvenation is the absence of the need for plastic surgery. Moreover, the effectiveness of this method is comparable to the result of instrumental intervention.

Among other rejuvenation techniques, SMAS has a number of advantages:

• individual determination of the level that requires restoration;
• the ability to adjust the depth and power of ultrasound exposure;
• suitable for any problem areas;
• the procedure is absolutely painless;
• long-lasting results and increasing effect;
• there are no postoperative scars;
• the recovery period passes quickly;
• can be combined with other types of cosmetic procedures;
• safety.

The SMAS lifting technique allows you to get rid of skin problems in just a few minutes.