Before reading this article, "What is SMAS?" as an introduction to the subject. I recommend you to take a look at my article.
The story begins like this; In the early stages of facial rejuvenation surgery, we thought that aging originated and occurred in the skin. This was because the signs of aging appear on the “surface” of the skin. The simplest solution that came to mind was to tighten the loose skin and seek a solution to these problems we see on the surface. That's exactly what we did, we lifted the loose skin of the old face, stretched it, removed the excess and stitched it nicely, leaving a delicate scar around the ear. It was beautiful, wrinkles decreased, the shape of the face improved.
These first face lift surgeries were miraculous for that period. Believe it or not, just 100 years ago, it was not possible for you to intervene in the aging process even if you were the richest and most powerful woman in the world. Those "classic" face lift surgeries that we do not like today were a great privilege that only the jet set could have in the early 1900s.
Every son strives to be better than his father, and if he succeeds, he can surpass him. But it is impossible not to give fathers their due. If classical face lift surgery is performed well, very successful results can be achieved in the appropriate patient group. We can think of deep plan face lift surgeries as a businessman who takes over his father's inheritance and turns the family company into a holding company.
“Plan” is used in surgical terminology to mean “plane”. The anatomical planes where we separate the tissues from each other during surgery…
The surgical plane called “deep plane” in facial rejuvenation surgeries refers to the bottom of the SMAS layer. When we move under the SMAS layer and lift the face along the deep plane under this layer, we can mobilize not only the patient's skin, but also the entire soft tissue mass that has loosened and sagged due to aging and gravity.
Working in this layer requires detailed anatomy knowledge and technical competence. He does not accept mistakes. It extends the processing time slightly. But it has important advantages.
Deep plane face lift is performed by Tord Skoog, a Swedish plastic surgeon. It was popularized by U.S. plastic surgeon Sam Hamra and reached its most refined form. On the other hand, many surgeons adopted simpler alternatives than this technique due to the technical difficulties of the application, and deep plane face lift could not reach the wide audience it deserved. During Skoog's period, all hospitals in Sweden were public and anesthesia in public hospitals There are legal obstacles to performing plastic surgery. At that time, classical facelift surgery was typically known as a bleeding surgery, and stopping bleeding was one of the phases of the surgery that took time and required anesthesia. Skoog discovers that bleeding is much less when he works in the deep plane below the SMAS layer. He overcomes the legal obstacles and begins to perform the surgery under local anesthesia.
Since the deep plane is a natural separation zone between the tissues and is relatively vascular, deep plane face lift surgeries typically involve less bleeding and less risk of postoperative blood collection. These are surgeries where postoperative edema is less. Since thicker tissue is removed in deep plane facelift surgery compared to classical facelift surgery, disruptions in tissue circulation and tissue losses seen in classical facelift surgery are less common. It is more advantageous to use this technique in patients at risk of circulatory disorders, such as smokers and diabetics.
Unlike classical surgery, deep plane face lift surgery does not create excessive tension on the skin, the SMAS layer carries the load. Since the skin is not stretched as much, surgical signs that occur due to skin tension in classical face lift surgery (earlobe shifting, hairline shifting, overly tense and flattened face contour, enlarged scars, etc.) are much less common in this technique.
Another advantage is that the surgical results are more permanent compared to the classical technique. The skin is elastic, and when exposed to tension for a certain period of time, it stretches, expands and becomes abundant, just like during pregnancy. Therefore, the effect of facial rejuvenation surgeries due to skin tension ends when the skin becomes loose and abundant again. The SMAS layer in deep plane surgeries is not as flexible as the skin and cannot adapt to the new position given in the surgery. It can provide protection for nearly 0 years.
The best candidates for deep plane facelift surgery are patients who are young and whose face is full in terms of soft tissue, superficial fine wrinkles are few, but sagging due to gravity is severe.
Deep plane face lift surgery also has some disadvantages and limitations. Its effect is limited on thin faces where aging is more "superficial", where fine wrinkles on the skin are high and soft tissue sagging is low. Another issue is that in some patients, deep tissue movements and superficial tissue movements need to be in different directions.
Some of the limitations of deep plane face lift surgery mentioned above are that the skin and SMAS layer are lifted in separate layers and moved in different directionsmultilayer (lamellar) techniques. In the coming days, I will also talk about multi-layered (lamellar) techniques, which is the option I prefer most in my practice.
Until then, stay with love,
Stay Beautiful.
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