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With facelift surgery, it is important for the facelift surgeon to appreciate differences in facial shapes, as surgically repositioning the vector of SMAS movement can help to create balance in the facial shape. At the consultation, patients generally fall into one of 2 categories: wide versus narrow and short versus long. The most commonly encountered facial combinations are the short and wide face and the long and narrow face.
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The direction of the SMAS pull is decided by properly determining the long side of the face. Short faces have an oblique or diagonal direction of pull. Long faces have a more horizontal vector. The decision between SMAS plication or SMASectomy is made by assessing the facial shape. In fuller or rounder faces, the optimum technique is an SMASectomy to remove the excess volume and reduce the width of the face. With SMASectomy, only the superficial part of the SMAS is removed, which preserves the important facial nerve branches beneath the SMAS. With long and thin faces, it is better to perform a SMAS plication to create more volume in the cheek or malar region.
Therefore, for the surgical management of a long and narrow face, SMAS plication with a horizontal vector of pull allows for enhanced cheek fullness while correcting for excess facial length. Similarly, a short and wide face is best treated with SMASectomy and plication in a more oblique vector to maintain facial length while correcting for excess cheek fullness, creating a more youthful look.
The ‘lift and fill’ facelift
Volume loss is a common accompaniment of facial ageing. As an essential part of a facelift, surgeons now use lipofilling or facial fat grafting to address deflated superficial and deep facial fat compartments of the face using the patient’s own fat, also known as autologous fat. The “lift-and-fill” facelift is now the most commonly performed type of facelift at Centre for Surgery. This dual or hybrid facelift is another powerful tool in facial rejuvenation, with precise volume augmentation as a compulsory component of a full or mini facelift. Our surgeons are able to accurately and precisely fill deflated facial fat compartments micro-fat while the SMAS and its involved structures are selectively repositioned according to the facial shape. The lift-and-fill facelift has excellent long-term results and is the gold-standard surgical method of facial rejuvenation.
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