SPA Face Lift: SMAS Plication-Anchoring

Abstract

A variation of the superficial musculoaponeurotic system (SMAS) plication called SPA face lift is here described. An axial line and then two medial and lateral parallel lines are penciled on the skin from the lateral canthus to the earlobe to show the future plication area. The undermining zone is delimited 1 cm beyond the medial line. In face- and neck-lifting, such marks extend vertically to the neck. Once the skin is undermined up to the delimiting marks, the three lines are penciled again on the fat layer, and a running lock suture is used for plication, with big superficial bites between the two distal lines. In fatty faces, a strip of fat is removed along the axial line to avoid bulging that can be seen through the skin. Because the undermining is limited, minor swelling occurs, and the postoperative recovery is shorter and faster. The same three lines can be marked in the contralateral side or can differ in cases of asymmetry. This report describes 244 face-lifts without any facial nerve problems. The author managed five hematoma cases in which surgery to the neck was performed. Three patients had to be touched up for insufficient skin tension. The SPA technique is consistent and easy to learn.

Evaluating Pull-Out Strength of Barbed Suture In Vitro by Using Porcine Tissue and Polydimethylsiloxane (PDMS)

“…In thread lifting surgery, surgeons pass barbed sutures into deeper layers of the face, and the barbs along the sutures act as hooks to anchor and elevate SMAS [ 29 , 32 , 33 , 34 ]. To imitate the procedure, we inserted the suture sample into the fascia in fresh porcine tissue to simulate the facelift in SMAS tissue.…”

The Difficult Neck in Facelifting

“…22 In 2006, submandibular gland suspension to improve the appearance of the neck was described by Sullivan et al 23 This variety of methods for managing the anterior platysma bands, as well as the SMAS, have also been reported and are widely adopted. 20,[24][25][26][27][28][29][30][31][32][33][34][35] The deep plane technique has been advocated to address the heavy neck. 36 As these techniques to address neck contouring and lifting evolved, several systems emerged for assessment and classification of neck appearance in the 1980s.…”

Anatomical Evaluation of Facial Nerve Pathways and Dissection of “Premasseter Space” for Rhytidectomy in Asians

“…Superficial musculoaponeurotic system (SMAS) [12,18]based tightening procedures have recently become the standard for elderly and middle-aged Caucasian patients undergoing rhytidectomy [3,8,9,19,22,28]. Some surgeons harbor concerns, however, over the inadequacy of simple SMAS-based face-lifts, especially for some patients with rigid subcutaneous structures.…”