Before reading this article, “What is SMAS?” I suggest you take a look at my article.

The story begins like this; In the early stages of facial rejuvenation surgery, we thought that aging was caused by the skin and occurred in the skin. This was because the signs of aging appeared on the “surface” of the skin. The simplest solution that came to mind was to stretch the loose skin and seek a solution to these problems that we see on the surface. That’s exactly how we did it, lifting and stretching the loose skin of the old face, removing the excess and stitching it up nicely to leave a gentle mark around the ear. It turned out well, the wrinkles decreased, the form of the face improved.

These first facelift surgeries were miraculous for that period. Believe it or not, even if you were the richest and most powerful woman in the world 100 years ago, it was not possible for you to interfere with the aging process. Those “classic” facelift surgeries that we don’t 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, if he succeeds, he will surpass him. But it is impossible not to give the fathers their due. If classical facelift surgery is performed well, very successful results can be obtained in the appropriate patient group. We can think of deep-plan facelift surgeries as a businessman who takes over his father’s legacy and turns his family business into a holding.
“Plan” is used to mean “plane” in surgical terminology. The anatomical planes that 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 below this layer, We can activate not only the skin of the patient, but also the entire soft tissue mass that loosens and hangs due to aging and gravity as a whole.

Working in this layer requires detailed anatomy knowledge and technical competence. It does not admit error. It slightly extends the processing time. But there are important advantages that come with it.

The deep plan facelift was popularized by Tord Skoog, a Swedish plastic surgeon, and was most refined in the hands of US plastic surgeon Sam Hamra. On the other hand, many surgeons have adopted simpler alternatives than this technique due to the technical difficulties of the application and the deep plan facelift has not reached the wide masses it deserves.

In Skoog’s time, all hospitals in Sweden were publicly owned and there were legal barriers to plastic surgery with anesthesia in public hospitals. At that time, classical facelift surgery was typically known as a hemorrhagic surgery, and stopping the bleeding is one of the stages of the surgery that takes time and requires anesthesia. Skoog discovers that when he works in the deep plane below the SMAS layer, the bleeding is much less. He overcomes legal obstacles and begins to perform the surgery under local anesthesia.

Because the deep plane is a natural zone of separation between tissues and is relatively avascular, deep plane facelift surgeries are typically less bleeding, less risk of postoperative blood collection, and less postoperative edema. Since a thicker tissue is removed in deep plane facelift surgery compared to classical facelift surgery, disruptions in tissue circulation and tissue loss seen in classical facelift surgery are less common. It is more advantageous to use this technique in patients at risk for circulatory disorders, such as smokers and diabetics.

Contrary to classical surgery, deep plane facelift surgery does not create excessive tension on the skin, and the SMAS layer carries the load. Since the skin is not very stretched, surgical signs (earlobe slippage, hairline slippage, excessively tense and flattened facial contour, enlarged scars, etc.) due to skin tension in classical facelift surgery are much rarer in this technique.

Another advantage is that the results of the surgery are more permanent compared to the classical technique. The skin is elastic, when exposed to tension for a certain period of time, it stretches and becomes looser, just like in pregnancy. Therefore, the effect of facial rejuvenation surgeries due to skin tension ends when the skin loosens again and becomes abundant. The SMAS layer in deep plane surgeries is not as flexible as the skin and can maintain the new position given in the surgery for about 10 years.

The best candidates for deep plane facelift surgery are the patients whose face is full in terms of soft tissue, with few superficial fine wrinkles, but with advanced sagging due to gravity.

Deep plane facelift surgery also has some disadvantages and limitations. Its effect is limited on thin faces, where aging is more “superficial”, fine wrinkles on the skin are more and soft tissue sagging is less. Another issue is that deep tissue movements and superficial tissue movements need to be in different directions in some patients.

Some of the limitations of deep plane facelift surgery mentioned above are that the skin and SMAS layer are lifted in separate layers and moved in different directions. multilayer (lamellar) techniques exceeded with In the following days, I will also talk about multi-layered (lamellar) techniques, which is the most preferred option in my own practice.

Until then, stay with love,
Stay Beautiful.

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