The LiteLift™ is a type of modified SMAS facelift technique

Dr. Larry Nichter

A SMAS lift in general refers to any facelift technique that tightens the SMAS layer along with the overlying skin in a more youthful position making you look younger. Specifically, the SMAS face lift does its magic by lifting and tightening the jowls, neck, and cheeks to a more youthful position. These techniques generally produce more natural and long-lasting results than the “skin only” face lifts, and now considered by most board certified plastic surgeons as the most preferred method.

Here are some specifics of how this is performed.

SMAS is an abbreviation for a tissue layer called the Superficial Muscular Aponeurotic System. As this is a mouthful, most patients and surgeons use the acronym SMAS. The SMAS is a relatively thin layer of strong fascial supporting tissue that covers and surrounds the deeper tissues and structures of the face and neck, including fat pads and muscles, and the entire cheek area. It also attaches to the superficial muscle covering the lower face near the jaw line and neck called the platysma. As the SMAS attaches to all of these areas of the face, a SMAS lift surgically elevates this layer which in turn elevates the soft tissues and structures of the face. To do this, the SMAS layer can be folded superiorly and attached to itself, called SMAS plication, or it can be tightened and lifted by removing a redundant portion and then reattaching itself in the uplifted position (SMAS resection, or “SMASectomy”).

Now the confusing part:

The SMAS facelift may be part of the traditional facelift type procedures which have longer scars, more undermining of skin than some of the mini-lift procedures. Unfortunately there are a lot of brand names attached (especially to mini face lifts) and not all include the SMAS lift. The mini-lifts may be tough to choose from because of all the brand names such as LifeStyle Lift, S-Lift, Quick Lift, LiteLift, MACS and others. In many cases there are more similarities than differences between these procedures as they share the use of smaller incisions, quicker recoveries, and are often done under local anesthesia with oral sedation. Differences are often more related to the surgeon’s experience and preference of surgical technique. I understand how confusing this must be to the consumer. For example, in my practice we perform the LiteLift™—see below link for further details.

The skill and experience of the surgeon is far more important than the technique chosen. Factors such as the lift directional vector, how tight to lift it, and the skill to not go too deep where underlying important structures could be harmed is essential to the best outcome and longevity of the procedure. After more than a quarter of a century performing face lifts and seeing the results of other less-trained surgeons, my advice is: Always go with the best when it comes to facial rejuvenation.

Remember it is the skill and experience of the surgeon that counts—not the name! Great surgeons get great results, period. The best way to find one is to start with a Board Certified Plastic Surgeon or Board Certified Facial Plastic Surgeon with extensive experience over many years. Ask to see “before and after” photos, especially long term ones. Ask the number of times you will be seen afterwards by the surgeon rather than a medical assistant. A good place to start is “Find a Doctor” on the American Society of Plastic Surgeons or American Society of Aesthetic Plastic Surgeons web sites.

—Dr. Larry Nichter, MD FACS

The Facelift History and Evolution of the Lite Lift™

Dr. Larry Nichter

The history of the facelift can be viewed as possibly the epicenter and roots of cosmetic surgery. This article is my understanding of the history of popular face lifting methods. It is not meant to be completely inclusive; it reflects what I feel are some of the most important historical developments.

Early Twentieth Century

The facelift surgical history began by removing a strip of skin in front of the ear, then stitching the skin together with minimal undermining if needed for closure. The skin strip excision method is probably the precursor to “mini facelift.” Here are some of the important first recorded events regarding face lifts and skin strip excision.

  • Hollander (Germany, 1901) published a short article about skin strip excision in front of ear.
  • Miller (Chicago, 1906) wrote a book on Surgical Treatment of facial imperfections.
  • Lexer (Germany, 1910) “natural evolution” of surgery to include maintenance of beauty also stressed cosmetic surgery — unique and complicated, requiring specialty training (no specialty boards then) — he added suturing of subcutaneous tissue. This put him ahead of his time. He also wrote about weakening muscles to reduce frown lines (the reason that Botox was later developed). Surgeons were highly secretive about the procedures they developed at this time; they did not want other surgeons to be able to offer the same techniques. Many surgeons did not even tell their colleagues that they were involved in plastic/cosmetic surgery.

As you can imagine, many surgical “misadventures” at the hands of untrained surgeons led to the formation of both the American Society of Plastic and Reconstructive Surgeons in 1931 and the American Board of Plastic Surgery in 1937. Despite the establishment of these institutions more than 75  years ago, there are still increasing numbers of rogue practitioners extolling expertise and unrealistic promises without training. Incredibly, some of these charlatans still use century-old techniques.

Mid Twentieth Century

  • Skoog (Sweden, 1973), Tessier (France), others in USA—developing the use of SMAS technique
  • Millard (USA) directly removed fat from neck to improve neck line.

The next major advances in facial plastic surgery gained popularity more than a half century later in the 1970s. To a large extent this was because of advances achieved in general anesthesia and the development of craniofacial surgical techniques, many of which were developed out of the need to reconstruct the casualties from World War II, the Korean War, and the Vietnam War.

Plastic surgeons began to do more extensive undermining and looked at the importance of deeper structures. This included the confluent thin layer of fascia, also called by the acronym, SMAS, covering the underlying muscles and soft tissue that also sags with the aging process. Many surgeons found that lifting this structure with sutures further improved results and longevity. However, it was also found that pulling in an oblique manner often resulted in a swept-away appearance.

Late Twentieth Century

The 1980s – 1990s were the next period of major evolution in face lifting techniques. This period was marked by even more aggressive and invasive approaches to face lifts. For example:

  • Hamra (1903) develops deep plane technique, composite facelift and others

These more invasive surgeries often took several hours under general anesthesia, involved longer scars, extensive bruising and swelling, long recoveries often lasting 1–2 months or more. Although results in expert hands were improved the downside of the long recovery, extended scars, and general anesthesia were/are of significant concern to patients and plastic surgeons alike.

Twenty-first Century: Better Results through Less Surgery

  • 2000–Present: Modified Facelifts such as the Lite Lift™, MACS, Short Scar facelifts, etc.

The last decade has seen a general movement in all surgical fields to less invasive yet more effective surgery. Dr. Nichter’s and Dr. Horowitz’s main focus during this period, like many other plastic surgeons around the world, was in distilling the essential elements of earlier facelifts while minimizing side effects.

Over and over again our patients have told us what they want during the past 15 years:

  • Easier, minimally invasive, and less radical surgery
  • Maintenance of youth rather than dramatic changes
  • Appearance of natural beauty so that others would not guess surgery was performed
  • A natural look without a swept-away appearance
  • Shorter scars that are hidden
  • Short recovery times
  • Option of in-office procedure with local anesthesia and oral sedation without IVs or general anesthesia
  • Affordability

The Lite Lift™ meets all of these 21st Century patient desires. The Lite Lift™ is a modified face lift with approximately 40% less scarring than a traditional facelift, with about half the recovery time. It is performed in an office setting with local anesthesia and oral sedation. This is what most patients prefer, but IV sedation or even general anesthesia options are available. The whole procedure takes about two hours. Each surgery is customized to our patients’ needs and desires. Frequently, as needed, other procedures can be performed at the same time such as Eyelid Lifts (blepharoplasty), Neck Tightening (platysmaplasty), Brow/Temple Lift, Fat Transfer, filler injections and/or skin resurfacing (e.g. Obagi Blue Peel). As healing for each of these procedures is simultaneous and not sequential there is still a short recovery time.

—Larry Nichter, MD FACS