Of all the various
techniques of lifting (which seem to provoke unsolvable tensions among
surgeons worldwide: compare the latest article by Doctor Goldwyn on plastic
and reconstructive surgery), I have kept faithful to BI-plan lifting since
1975.
The first reason:
The architectural order. It
is in fact possible to dissect the double-layered skin and build up the one
beneath by using scissors instead of a scalpel. The plunged dissection of
skin allows for an easier draping back with harmonic laying-back. This
dissection according to the subcutaneous muscleaponeurotic system (SMAS),
especially in the region beneath the cheekbone, allows for the region to
immediately re-fixate itself, especially in the lower jaw bone region.
Following the idea of
reconstruction, it seems reasonable to build up the SMAS by rotating from
above to the inside, which, I believe, corresponds to the natural direction
of the gravity-related ptosis: The SMAS is in fact fixated in the central
region of the face and moves rotatingly around the mouth opening (lips).
The second reason:
Technique. As a matter of
fact it is much easier to stitch up the SMAS well positioned beneath a free
part of the skin - instead of beneath monobloc skin.
On the other hand this
repositioning of the SMAS in the lower jaw bone region has the same pure
effect which draws the cheek's tissue backwards rather than upwards.
This vertical however is
set in parallel to the big jaw bone muscles. The lifting procedure is aimed
towards the middle of the face instead of towards the cheek which has more
homogeneous and natural effects.
After calculating the
surplus of skin excisates in various vector directions, which are selected
by the surgeon, a cutaneous suture is made with moderate tension.
The third reason:
A natural result. It is
possible to activate the vectors, which vary between the two different
structures, by the effect of SMAS to the parotis region and to the skin.
This procedure is not
obligatory in every lifting operation. In many surgery cases it does however
provide a useful way of forming different vector directions which can be
applied to any patient after studying the development of their faces on
photographs from their youth to older age.
The fourth reason:
Smoothing out the throat.
As a matter of fact, we prefer the backwards retention of skin muscles as
opposed to conducting liposuction on the throat in a separate operation and
pulling the throat skin forward.
The dissection beneath skin
tissue in the throat and neck region makes a frontal approach to the Vena
jugularis externa easier than those which expose the fat and the skin
complex with the platysma.
If the skin is already
lifted, the dissection of the skin muscle in the front face region makes the
exposition of the skin possible. It also enables the surgeon to check the
retractability towards the mastoid and the m. sternocleidomastoideus.
If the expansion exceeds 2
cm, it is necessary to build a retention vector backwards, that is towards
the mastoid.
The cut beneath the skin
muscle is not obligatory. Yet in cases of greater expansion it seems
reasonable to us because that way the surgeon can pull back the entire part
of the side jaw. Almost as if suddenly pulling back a hammock towards
oneself by its natural fixation and backwards to the mastoid region.
This backward-pulling by
the surgeon seems to be sufficient, an additional cut below the jaw bone and
a suture along the platysma is in general not necessary.
An indication for
lipolifting is generally considered to be of the same quality as for the
(lower) throat region or for the cheek. Liposuction can be conducted by
using any of the available cutting methods for lifting in order to perform
the prefered BIplan subcutaneous décollement.
The ultimate reason:
A very natural-like lifting
qualitiy. By conducting separate lifting procedures of the skin and the
underlying structures, especially if applying SMAS, the naturally achieved
permanent retention will take effect after two months.
This quality of smoothing
out wrinkles in skin tissue is accompanied by a re-lifting of much deeper
layers. That is also our key argument for continuing to use this technique
as often as possible.
We have a healthy
apprehension with regard to the currently fashionable mini-liftings, short
cuts, reduced gestures; even more so with regard to cervical lifting because
it produces a certain aging phenomenon.
If traces of the aging
process are identified, it is usually the entire face that is affected. A
focal gesture in a single direction does not result in rejuvenating effects
on the entire face by one favourite gesture.
In summary it may be said
that we prefer bi-plan lifting and the SMAS by separate dissection because
it has produced permanent results and has provided our patients with a
natural appearance for 25 years.
Vladimir Mitz, MD,
12 Rue du Renard
F-75004 Paris
France
Tel: ++33 1 4278 2700
e-mail:
docmitz@club-internet.fr
SMAS-Revolution:
BI-Plan-Lifting
