Printed by Dr. R. Brannon Claytor
If you wish to restore a youthful look within the face, a Philadelphia facelift generates a surprising enchancment. The “after” pictures reveal sweeping jawlines, youthfully excessive cheekbones—all utterly natural-looking. However the first query that each Philadelphia affected person asks is that this: what’s the distinction between a deep aircraft facelift and a SMAS (conventional) facelift?
Maintain studying to study what units the deep aircraft method aside, and watch the video beneath for Dr. Claytor’s demonstration with visuals!
Philadelphia plastic surgeon Dr. Brannon Claytor explains how the deep aircraft facelift method differs from the extra frequent SMAS plication facelift.
Present transcript »
Dr. Claytor right here, sharing with you what a deep aircraft facelift is and the way it generates that sort of enchancment.
So right here we now have our pretty affected person—her earlier than and her after. Her greatest frustration is her neck and her jowls which have come down. What she’s in search of is a younger return to her earlier self, and that’s actually what we’re after. We’re not about altering folks and making them look completely different. We would like them to be the perfect model of themselves.
What occurs after we age is we get facial descent. Our malar eminence—our bone right here—it involutes and all the pieces drops down. So what we begin to see is downward descent of our face, and that’s exhibited not solely in jowling down right here, but in addition in extra neck fats and pores and skin down right here. It’s very, very irritating, and sufferers are available in often saying, “Pay attention, this isn’t who I’m. I look within the mirror and I don’t see myself.” And truly, within the profile view, it’s even worse.
So the objective of this operation is to rejuvenate the affected person’s growing old parts—to enter the face and carry again vertically what had been falling down inferiorly. The way in which we do that is with very small incisions which are hidden alongside the ear, what we name the hairline and the sideburn area. Then these come again they usually’re hidden behind the ear, after which they arrive down alongside the hairline there in order that they’re very effectively disguised. Not occasionally, I may even go up into right here, which supplies me entry to be lifting in that orientation.
That takes us to: what’s the distinction between a SMAS plication and a deep aircraft facelift? That query comes up each single time a affected person is available in for a session, and so it’s an amazing query. We’re going to reply it right here.
Right here we now have our platysma muscle in our neck. It actually has no perform aside from being a muscle of animation—you progress it round and you’ll see your neck muscle tissues transfer. It has nothing to do with truly shifting your head. Proper alongside right here is our mandible, and the mandible comes down alongside right here. Under the mandible is the place you may have your platysma muscle. Above the mandible is the place you may have your SMAS muscle, which stands for Superficial Musculo-Aponeurotic System.
So that you go from pores and skin to SMAS, right down to the muscle, and then you definately go down deeper to the bone.
When folks have a SMAS plication, what’s taking place is the SMAS facet of it’s lifted and plicated up right here, and it’s for a really superficial carry. You’re actually solely getting about that a lot carry. Some folks will go down right here with it and permit the entire space to carry up, however that’s what a SMAS plication is.
Within the deep aircraft carry, what we’re doing is we’re going beneath that SMAS. This SMAS is constant up right here, and so that you’re making the incisions that we’ve marked right here. We’re lifting up that tissue, we’re shifting in beneath the pores and skin layer, after which we’re coming as much as this SMAS. What we do within the deep aircraft carry—so that is the deep aircraft—is that we make the incision just about from the lateral facet of the attention right down to the nook of the jaw, kind of on this orientation. That’s the place we make the incision down into this SMAS to go up beneath it. In order that’s the deep aircraft facet of it.
Whereas we’re there, we come throughout these retaining ligaments. These are very, very stout ligaments that sit right here and right here and right here, they usually’re what maintain the face’s tender tissue from being superior superiorly. They’re kind of, if you’ll, big stakes within the floor which are stopping something from shifting round.
So we have to go in first within the deep aircraft dissection and dissect into the areas in between these retaining ligaments. We dissect down into right here, we dissect down into right here, and we dissect down into right here, so these tongues, if you’ll, are opened up. Then we are able to very clearly see what’s happening, and we come throughout the retaining ligaments as we attempt to join these two.
What makes this operation so difficult are the facial nerves which are touring on this space. They’re very delicate, they’re very small, they usually should be handled with large warning. Apparently, the nerves run very near the retaining ligaments, in order you’re releasing the retaining ligaments, it’s good to be in search of the very delicate facial nerves. The facial nerves come out from beneath the ear right into a sample that’s considerably like this.
So you possibly can see that the deep aircraft facelift principally goes proper alongside the place the facial nerves are shifting from behind the ear out into innervating the facial musculature. And once more, that is what makes this operation so extremely technically difficult.
However in the event you can perceive these completely different tongues which are superior in between the retaining ligaments after which, due to this fact, permit connection between these two to additional launch and determine and take away these retaining ligaments—as soon as these retaining ligaments are launched, now this whole space could be very cell and might be repositioned.
In the event you have a look at folks on a three-quarter view, sufferers who’ve a really excessive cheek space have a really youthful and aesthetic look. Once we age, that cheek space drops down. In that three-quarter view, you see that space drop down after which it bunches up down right here within the jowls, which is admittedly what offers you that aged look.
So by mobilizing this SMAS after you’ve launched the retaining ligaments—keep in mind I stated that this space will get lifted—think about that this whole space is now lifted up this manner. Now sutures might be hooked up as soon as these areas are related and the retaining ligaments have been launched and also you’ve very delicately labored across the facial nerves and left them intact. Now the sutures might be secured right here and up right here, and that’s what takes this tissue and elevates it superiorly. That’s what creates the large energy and impact of the deep aircraft facelift.
If we transfer over to our after affected person, why does she look completely different? She appears to be like completely different as a result of all of those tissues have been moved up and we’ve been in a position to reposition her malar eminence again in a younger place. That’s a part of it.
The opposite a part of it’s down within the neck. How can we create this lovely jawline? Nicely, the way in which you do that’s by coming down alongside the mandible right here and releasing that platysma muscle—once more, needing to be very cautious of the facial nerves. However these are equally, similar to these tongues into and beneath this SMAS, that is launched alongside right here, typically nearly to concerning the nook of the mouth or what we name the marionette line. So the discharge of the platysma is all the way in which alongside to there. By releasing that, now you’re in a position to take this platysma muscle, which is a part of the hanging, sagging pores and skin of the neck, and carry it and reorient it. As well as, all of the fats that’s in right here is eliminated—so all that extra fats we take out.
Now as soon as that’s launched, the muscle is then elevated and secured again right here, again into the mastoid fascia, and that’s what creates that extremely highly effective, robust neckline. The jawline—there’s the mandible. Now that muscle which used to go this manner, now the muscle comes up right here and it’s very properly secured again to the mastoid fascia right here.
So with the platysma muscle part beneath the jawline, that creates this beautiful, sharp neckline and extremely well-defined jawline. Together with this SMAS now being elevated superiorly and secured on this orientation, it offers you a 5-10 12 months lifting results of rejuvenating and refreshing and supplying you with that youthful look.
So the massive distinction once more between SMAS plication and the deep aircraft facelift is: in SMAS plication, you’re actually simply reefing up a small portion and also you’re not releasing the retaining ligaments. Versus the deep aircraft facelift, you’re getting into beneath this SMAS, you’re figuring out the facial nerves, you’re figuring out the retaining ligaments, and also you’re releasing the retaining ligaments.
I can’t stress sufficient—actually, the largest distinction between SMAS plication and the deep aircraft facelift is the power to launch these deep retaining ligaments. And that’s what offers you that very sustainable and dramatic carry and addresses the jowl and addresses the cheek area and offers you that youthful form again to your face.
I hope you discovered this useful. Trying ahead to creating extra of those movies to assist clarify a few of these complicated points which are turning into extra commonplace when sufferers are available in they usually’re citing subjects. Sufferers are coming in right now way more educated, and it’s so enjoyable to have the ability to share this info in a digestible kind in order that whenever you are available in, you’ve bought a framework to ask the questions as you’re in search of your rejuvenation journey.
Thanks a lot.
SMAS plication facelift
The commonest sort of surgical facelift, an SMAS plication facelift works on a shallower layer of tissues than the deep aircraft facelift. The SMAS is the superficial musculoaponeurotic system beneath the pores and skin in your mid-to-lower face. “Plication” is the time period for a surgical tightening of tissues, which often includes lifting, eradicating extra, and rejoining remaining tissues. In a SMAS plication facelift, the SMAS layer is lifted vertically and re-anchored in entrance of the ears to create a carry of about 1 cm. Some surgeons may additionally carry from additional down into the cheek, on the entrance of the earlobe, for expanded results. Nonetheless, even an expanded SMAS facelift process can’t examine with the extra complete enhancements provided by a deep aircraft facelift.
Deep aircraft facelift, step-by-step
A deep aircraft facelift leaves the SMAS intact, as a substitute requiring your surgeon to entry deeper attachments within the cheeks and decrease face to boost and tighten tissues. Listed below are three main steps within the surgical procedure:
1. Incisions are made inside the hairline and within the pure folds of the ear.
A deep aircraft facelift is carried out by means of discreet incisions positioned within the sideburn space, inside the folds of the ear, and alongside the hairline behind the ear behind the neck.
Not occasionally, Dr. Claytor may even create an incision inside the hairline above the ears (simply behind the temple); this permits him to carry the SMAS of the face at one other necessary vertical axis, which can be extra helpful for sure sufferers.
2. The SMAS is separated, retaining ligaments are launched, and the tissue is anchored greater for an outlined cheek and firmer jowl space
SMAS is surgically separated from underlying tissues to permit Dr. Claytor to succeed in the retaining ligaments. These ligaments have a powerful maintain on the tissues of the cheek and decrease face, conserving tissues in place. Thus, Dr. Claytor releases them so as to have the ability to carry the pores and skin, fats, and SMAS greater on the facial bone construction. The pores and skin is sutured steadily within the newly raised place, and anchored above the ear.
Ligament launch is the first step that makes the deep aircraft facelift so completely different from the SMAS method: it permits for extra impactful, dramatic outcomes as a result of the cheek’s youthful, excessive form—a.ok.a. the malar eminence—might be extra absolutely restored, leading to a surprising, youthful sweep within the mid-face.
3. Neck bands are launched and anchored greater for a chiseled jawline.
Within the neck, somewhat than SMAS, you may have the platysmal muscle tissues positioned beneath the ear, beneath the mandible, and towards the entrance of the neck. These muscle tissues kind the tight, vertical traces you see on the entrance of your neck whenever you clench your jaw (they don’t have an effect on how you progress your head).
To create a sweeping, younger jawline look, the platysma is launched alongside the jawline, permitting Dr. Claytor to anchor these muscle tissues behind the ear. This could create a chiseled mandible or jawline, as you possibly can see on this earlier than and after photograph:
The significance of an skilled, skilled deep aircraft facelift surgeon
A deep aircraft facelift works on the identical layer of tissues the place your facial nerves lie. Nerves unfold from beneath and behind the ear, out into the cheeks, jawline, and beneath the attention space. The nerves that thread all through the facial ligaments are launched in a deep aircraft facelift, so it’s critically necessary that your surgeon is well-versed on this anatomy and in methods for sustaining the integrity of facial nerves. As soon as a surgeon dissects beneath the SMAS layer of the face, they have to determine and really delicately function across the nerves.
Don’t settle relating to selecting a board-certified plastic surgeon: keep away from surgeons who supply below-average pricing, or who don’t have the earlier than and afters, critiques, cosmetic surgery credentials, and repute that show they’ll safely obtain glorious facelift outcomes. Dr. R. Brannon Claytor teaches his deep aircraft facelift method at nationwide conferences of plastic surgeons, and is extensively thought of to be a deep aircraft skilled.
“The entire expertise was unbelievable! The outcomes exceeded my expectations! I appear and feel 10 years youthful. Dr. Claytor and his workers made me really feel so comfortable and comforting. He is a wonderful surgeon with a beautiful bedside method and persona. It is among the greatest selections I ever made. I’d extremely advocate Dr. Claytor; actually my neighbor has an appointment with him subsequent month.”
Ought to I think about a deep aircraft facelift?
Sufferers who’re good candidates for deep aircraft facelifts usually come to us with unfastened pores and skin that has succumbed to gravity, together with forming jowls (unfastened pores and skin across the jawline and chin) and sagging within the neck. As we age, we expertise facial descent: our cheek construction (malar eminence is the technical time period) involutes, and what we begin to see is downward descent of our face—creating jowling, and extra neck pores and skin and fats.
candidate for this process is trying to return to a extra sculpted jawline and lowered wrinkles. Dr. Claytor’s objective is that can assist you appear like the perfect model of your self: We’re not right here to make you appear like another person!
In the event you’re able to expertise these rejuvenating outcomes your self, we’d love to satisfy with you to debate choices! Dr. Claytor serves sufferers from everywhere in the Bryn Mawr, Primary Line, & Philadelphia areas. Name 610.527.4833 or contact our Philadelphia cosmetic surgery apply on-line to schedule your private session with Dr. Claytor right now.
