What is SMAS lifting: indications, contraindications, description of the device

Introduction

Many were able to appreciate all the advantages of the modern SMAS lifting procedure: it allows you to perform a facelift without resorting to the services of a surgeon.
One procedure is enough for age-related changes in the form of wrinkles and sagging skin to disappear. For those who have not yet encountered this procedure, below we will analyze how safe and effective the procedure is? Is it worth paying attention to it and adding it to the list of services provided? What does the expression SMAS lifting mean?

What does SMAS lifting mean?

SMAS is one of the newest methods developed by a group of scientists from the USA. The abbreviation “SMAS” stands for Superficial Muscle Aponeurotic System, translated as the lower muscular aponeurotic layer. We are talking about the muscles that form the frame and shape the oval of the face.

Age and constant gravitational influence affect the muscular aponeurotic layer, and it gradually weakens, the muscles cease to fully perform their functions, and as a result the skin sagging. In addition, the following appears on the face:

• Expression wrinkles;
• Bags under the eyes or crow's feet
• Pigmentation;
• Nasolabial folds;
• Changing the contour of the lips;

Surgical facelift
When the surgeon gets to work and does a facelift, which gives the effect of rejuvenation, he performs all manipulations only with the muscles that make up the frame.

Hardware SMAS lifting

The principle of operation of a cosmetology SMAS device is the same; it affects the muscles that make up the frame of the face.

Traditional devices for carrying out procedures affect only the upper layers of the skin, while the deeper layers of the skin remain completely at rest. They lose sight of the fact that it is the muscles that form the frame that are responsible for the formation of a clear contour and the absence of:

• Double chin;
• Deep nasolabial;
• Wrinkles;
• Lumps "bush"

Carrying out the SMAS procedure

The cosmetic device for SMAS lifting is able to penetrate into the deep layers of the skin, thus affecting the muscles, due to this it is possible to achieve the much desired effect of tightening and rejuvenating the face without surgical intervention.

Externally, the SMAS lifting device resembles ultrasound equipment and consists of:

• Racks (not all devices are included);
• Handles or several handpieces depending on the configuration;
• Control display;
• Stands for manipulas

Microprocessors are connected directly to the handpiece itself, which transmit ultrasonic pulses passing through the upper layer of the skin and reaching deeper layers.

• SALE

What is SMAS lifting (facelift)?

SMAS lifting is a facelift procedure without surgery using an ultrasound machine.
The process uses ultrasonic waves, because they can penetrate deep into the skin. The impact on the deeper layers of the skin provides a better and more lasting effect.

Let's figure out exactly how the procedure goes. Ultrasound penetrates the skin to a depth of approximately 3.5 mm in the facial area and up to 13 mm on the body, reaching the SMAS layer. It consists of muscle, collagen and elastin fibers. Deterioration of the condition of this layer leads to loss of skin tone, the appearance of wrinkles, changes in the structure of the corners of the mouth and eyelids, and sagging skin on the thighs.

Ultrasound stimulates the synthesis of collagen and elastin fibers, as a result the skin begins to regenerate, that is, the oval of the face is restored, wrinkles and sagging areas disappear, and overall skin health returns.

“Ultraformer” procedure – what is it?

Today, the use of ultrasound in medical and cosmetic applications is one of the most common and effective solutions. The basis for the methods is serious scientific research. The hardware component is represented by a large selection of accurate and efficient equipment. Perhaps the most functional and practical option is the Ultraformer device.

The HIFU technology implemented in this device allows you to use the energy of ultrasonic vibrations in the range from 2 to 11 MHz, that is, to influence even the deep layers of the epidermis.

The popular technology is based on two main processes that occur in tissues when they are exposed to an ultrasonic wave:

• thermal ablation, or the conversion of mechanical energy into thermal energy;
• acoustic cavitation, complemented by the body's immune response.

What is an "Ulraformer"? This is a device that uses thermal ablation as its main method. The duration of exposure does not exceed 3 seconds, during which time tissues are locally heated and coagulation processes caused by the cytotoxic effect are started.

So what is “Ultraformer” lifting and how safe is it for humans? It is worth noting that ultrasonic facelift is a procedure that has undergone a huge number of clinical trials in leading American scientific centers. Experimentally, scientists were able to establish that the effect of ultrasound on the body is completely harmless. And the effectiveness of the method is at least 89%! Thanks to such high results, the technology was the first to receive registration from the Food and Drug Administration in the USA in the “Lifting” category.

How to prepare for SMAS lifting?

No preparation is required for the procedure. If the cosmetologist has free time, lifting can be carried out immediately at the first appointment.

Men are recommended to remove hair in the area where lifting is planned.

In some cases, your doctor may prescribe medications or adjust or stop medications you are already taking. Tests or a medical examination may also be required.

If there are skin defects, mesotherapy may be prescribed.

It is not recommended to smoke or drink alcohol before the procedure.

Most often, nothing special needs to be done before the procedure; the listed appointments are individual and discussed with the doctor before the session.

Before lifting, the cosmetologist will cleanse the skin himself.

Indications for SMAS lifting

The main indications for SMAS lifting are:

• swelling;
• painting bags;
• decreased skin tone;
• large fat pad in the cheek area;
• fat deposits in the chin and abdomen combined with weak skin in these areas;
• fuzzy oval face.

Ultrasound helps get rid of fat deposits that are located between the dermis and the SMAS layer. On the cheeks this is most of the fat, on the chin and around the eyes there is less of it, but the procedure will still be effective.

Suboptimal patient

Of course, there are patients in whom the expected results may be reduced. For such patients, additional methods may be required in the course of treatment to achieve significant results.

Reasons for decreased efficiency:

• Connective tissue dysplasia and its subclinical forms
• Significant reduction in the amount of connective tissue in subcutaneous fat and SMAS
• Excessive development of subcutaneous fat – requires an adipocytolytic protocol and course treatment
• Severe dehydration of the patient’s tissues – a course of biorevitalization is required
• Deficiency of vitamins and microelements in the body of patients
• Excessive tissue ptosis – indications for plastic surgery

Rice.
5. The scanogram shows weakly defined trabeculae and septa of subcutaneous fat - fewer “targets” for HIFU SMAS lifting. In clinical practice, we often encounter patients with subclinical forms of connective tissue dysplasia and a concomitant decrease in the amount of connective tissue in the subcutaneous fat and SMAS.

High-resolution ultrasound diagnostics allows us to identify such patients and approach them with comprehensive treatment to obtain optimal results. You can use a combined protocol - collagen-stimulating procedures followed by Doublo hardware SMAS lifting.

Clinical case 2

Patient, 40 years old.

From the anamnesis: in 2022, a thread lifting procedure was performed. The immediate effect was good, but lasted for a short time - 2 weeks. No contraindications have been identified, she is practically healthy. Tired type of aging, tissue ptosis is minor, but causes great discomfort to the patient. At the stage of ultrasound diagnostics, a sharp decrease in the amount of connective tissue at the level of subcutaneous fat and SMAS was revealed.

It was decided to carry out the course of treatment in two stages. At the first stage, the procedure is collagen stimulation with a polylactic acid preparation, after a period of biodegradation - the SMAS-lifting procedure.

Rice. 6. Scanogram before the collagen stimulation procedure, there is a sharply reduced amount of connective tissue in the subcutaneous fat and SMAS.

Rice. 7. Scanograms 6 months after the collagen stimulation procedure. There is a thickening of the skin and connective tissue in the subcutaneous fat.

At the first stage

During the course of treatment, a collagen-stimulating procedure is carried out: preparations of polylactic acid, hydroxyapatite, reinforcing threads.

At the second stage

– SMAS lifting procedure in the classical protocol using the method of uniform treatment.

Before the second stage, the patient noted a significant improvement in the condition of the skin: increased density, smoother texture, flattened wrinkles, and evened out complexion.

To enhance the lifting effect, the second stage was carried out - Doublo hardware SMAS lifting in the area of ​​the middle and lower third of the face. The classic uniform development protocol was used.

Rice. 8. Results before and 2 months after the hardware SMAS lifting procedure.

Contraindications for SMAS lifting

Despite the great benefits of smas lifting, there are still contraindications. Facelift cannot be done by people under 18 years of age.

The procedure is also prohibited when:

• pregnancy;
• lactation;
• oncological diseases;
• infectious diseases;
• diseases of the cardiovascular and endocrine systems;
• mental disorders;
• using a pacemaker;
• the presence of metal implants in the area affected by ultrasound, except for dentures;
• purulent inflammation;
• acne and blackheads;
• predisposition to the appearance of keloid scars.

If you have at least one of the points, you should first make an appointment for a consultation. The doctor will decide whether the procedure can be performed and, if necessary, prescribe an additional course of treatment.

conclusions

High-resolution ultrasound diagnostics Doublo (SMAS-lifting Doublo) is the most important tool not only in developing an individual procedure protocol, but also the main assistant in drawing up a course of treatment for complex categories of patients. The high energy level of Doublo HIFU up to 2 J/cm2 ensures lasting, stable and pronounced results.

Thanks to the wide variety of protocols and manipulatives, the Doublo device is suitable for any course of treatment for cosmetic patients, and the possibility of high-quality diagnostics protects the doctor from mistakes and opens up endless opportunities for the growth of professional skills.

SMAS lifting procedure: pros and cons

Any cosmetic procedure, regardless of its nature, has its advantages or disadvantages. The pros and cons of SMAS lifting are determined from the point of view of effectiveness, contraindications, price, result, period of preservation of the result, rehabilitation period and other important criteria. It is very important that each patient is fully informed before the procedure, however, if you have questions, you can always contact our doctors and clarify the details.

Pros of facelift

If we talk first about the positive aspect, we cannot fail to emphasize the biggest plus, namely the absence of the need for surgical intervention and, accordingly, improving the appearance of the face quickly and painlessly.

SMAS lifting is a universal method of combating skin problems in different areas of the face, neck, décolleté and body. For each section, the required length of ultrasonic waves is selected so that they accurately reach the SMAS layer.

The results of the procedure are noticeable after the first session, the skin has a healthier and more elastic appearance, and lasts for a long period of time.

Most often, just one procedure is enough to achieve the desired effect. If necessary, the procedure can be repeated; the doctor will independently select the time interval between sessions. The minimum period is 1.5 years, as the result lasts quite a long time.

The rehabilitation period after SMAS lifting is not very long and does not cause excessive discomfort in patients.

Another feature of this facelift method is that it is painless. There may be discomfort during the lifting, but there will definitely not be pain.

Cons of facelift

We can talk a lot more about the advantages, but it must be emphasized that this procedure also has disadvantages. First of all, SMAS lifting is not performed on patients over 65 years of age due to the fact that it will not bring any effect. For those who have advanced the problem too much and have not taken advantage of the necessary treatment methods from the very beginning, lifting may not be sufficient, then the doctor will prescribe surgery.

For some clients, the price of a facelift may also be a disadvantage, but it is worth mentioning that one session is usually enough, so a one-time investment can significantly improve the situation with problem skin.

Duration of the effect of the SMAS lifting procedure

Lifting technology is a safe and painless alternative to surgery.

SMAS lifting is a non-invasive treatment without side effects. The process uses high-intensity ultrasonic waves that affect the deep layers of the skin. The procedure takes no more than 2 hours, with an additional half hour to apply anesthetic cream.

Pulses generated by the device selectively heat the desired area, causing thermocoagulation at the level of the SMAS layer. There is an immediate contraction of collagen fibers in different layers of the skin, followed by their retraction and stimulation of new collagen synthesis. The process of forming a new collagen matrix usually takes 3-4 months. As a result, a natural lifting effect occurs, which lasts for 1.5-2 years.

Hardware SMAS lifting: getting younger with ultrasound

The most comfortable, safe and painless procedure: facial lifting using ultrasonic waves. The Ultraformer apparatus is widely used for this purpose. The technique does not require the use of general anesthesia - local anesthesia is sufficient, and it is also shorter and takes only about an hour and a half.

How is such an operation performed?

• Before the procedure is scheduled, the patient must undergo a thorough preoperative examination.
• Preparation includes drawing lines on the skin along which the lifting will be carried out.
• A special gel-like texture is applied to the skin in the treatment area.
• The specialist acts on selected areas with a special manipulator of an ultrasonic device. No pain. There may only be a slight tingling sensation

The effectiveness of the method is noticeable much earlier than after classical or endoscopic methods. Within a week, an improvement in facial contours and skin structure becomes noticeable. And the maximum effect will become obvious 3 months after the procedure. The result does not last long - about two years, after which the ultrasound facelift can be repeated. This technique is designed to eliminate age-related changes that appear at the age of 35-45 years.

Rehabilitation after SMAS lifting

The difference between a non-invasive SMAS lift procedure and one that involves surgery is the recovery period. If surgery was unavoidable, the recovery period and complete healing will be longer and more difficult.

During the rehabilitation period after surgery, the patient should spend some time under the supervision of specialists, and should wear a support bandage for several days. Rehabilitation will take about two months. This time is necessary for the restoration of damaged muscles and tissues, as well as the resorption of hematomas. To ensure that the postoperative period passes without complications, it is recommended to use cooling compresses and take antibiotics. The patient is prohibited from drinking alcoholic beverages, smoking and visiting saunas and steam baths.

In the case of SMAS face lifting, the circumstances are completely different. During the session, the skin is not damaged, so there is practically no need for a rehabilitation period, while the obvious results of the procedure are preserved.

Types of SMAS lifting: time-tested classics

Since the scope of application of the technology is quite large, the general concept of SMAS lifting can be defined as a combination of several types of procedures:

• classic lift;
• endoscopic rejuvenation method;
• ultrasonic lifting.

Each type should be described separately. What is SMAS classic face lifting? This is the most traumatic and expensive method. The operation requires careful preparation of the patient, and the time spent on the operating table under general anesthesia can range from 2 to 3 hours. After surgery, enough time is needed for the face to fully recover and acquire the expected attractiveness. But this technique is the most effective, since one procedure is enough to not think about age for another 10-15 years. The classic method is recommended for people over 40 years old, since it is at this age that changes on the face become noticeable to others.

SMAS lifting: what is it and how is the procedure performed?

• After the patient is put under anesthesia, the doctor makes an incision from the area behind one ear in the temple area, around through the anterior facial area to the area behind the second ear. The top layer of skin is peeled off in order to tighten the SMAS system to the desired level.
• Excess (redundant) tissue is excised.
• If necessary, liposuction is performed to reshape the position of the upper layer of skin.
• In the correct position, the skin is carefully fixed until complete healing.
• Cosmetic sutures are placed along the hairline and are removed no earlier than two weeks after the operation.

During the recovery period, the patient should be observed by a doctor to monitor the condition. The bandage can be removed after 3-4 days. In total, rehabilitation takes at least one and a half months. During this time, tissues and muscles have time to recover, postoperative hematomas finally resolve, and swelling subsides.

It is important to follow the doctor’s recommendations: apply cooling compresses in a timely manner, take antibiotics, and do not bend over.

Attention! Even at the stage of preparation for surgery, you should give up cigarettes and alcohol. After the operation, it is strictly forbidden to visit baths and saunas.

What is the harm from the SMAS lifting procedure?

SMAS lifting does not have a negative effect on the skin, does not lead to hematomas or tissue damage, does not require stitches or long periods of rehabilitation, therefore, if all recommendations are followed, the risks and harm from it are minimal.

If there are contraindications, the doctor will refuse to perform the procedure, as this can greatly harm not only the skin, but also the entire body: keloid scars, panic attacks (for mental disorders), seizures (for epilepsy) are possible. That is why, if any contraindications are found, you should pay attention to other rejuvenation methods.

What to expect from SMAS rejuvenation?

So what kind of procedure is this - ultrasonic SMAS lifting and what result should you prepare for when deciding to undergo rejuvenation using ultrasound? First of all, it’s worth saying. That now this is one of the few affordable and worthy alternatives to classical surgical rejuvenation.

Thanks to deep, precise and controlled effects on strictly defined areas of the face, ultrasonic lifting allows not only to visually reduce the number of wrinkles, but also to make facial contours clearer.

The functionality of the Ultraformer device makes it possible to determine the thickness of the fat layer, muscles and epidermis individually for each patient. Depending on the data obtained, the specialist can choose the appropriate depth of exposure and significantly increase the effectiveness and efficiency of the procedure.

Ultrasonic facelift is indicated:

• people of old and mature age, when the use of general anesthesia is undesirable;
• patients who are afraid of facial surgery and any other surgical interventions;
• people who have already undergone classic SMAS lifting and want to prolong the effect of the operation without repeated surgery;
• for those who need the fastest possible effect without a long recovery period.

How often should a facelift procedure be performed?

Of course, one of the advantages of an ultrasound facelift procedure is that there is no need to visit a cosmetologist frequently. Reviews from patients who have already undergone this procedure often mention that the visual effect is observed even after the first session.

The number of sessions required and the period between them are selected in accordance with the general condition of the patient and the problems he has. It is imperative to take into account their severity and the area in which the procedure is performed.

Most often, SMAS lifting procedures are performed once every few years, usually once every 2 years. Thus, another advantage of this method is that the effect lasts for 1.5-2 years, which allows clients to save money as well as time and enjoy the beauty and elasticity of the skin on the face, neck, décolleté or body for long periods of time.

What is endoscopic SMAS lifting?

Another type of lifting is endoscopic. It is much less traumatic, since it does not require incisions, and therefore no stitches. True, this is still an operation and it is performed under general anesthesia. The duration of this procedure is about 3 hours.

The endoscopic method is recommended for people under forty, since its results last only five years. In addition to a more gentle procedure, this method of restoring youth is affordable, especially compared to the classical procedure, the cost of which can reach many hundreds of thousands of rubles.

Despite the absence of incisions, the operation is performed with violation of the integrity of the skin; the endoscope is inserted through pinhole punctures in the temple area on the scalp. Recovery after surgery also requires at least 1.5-2 months, but the likelihood of damage to nerve tissue is minimal. And there will be no significant swelling after the operation.

What skin type is SMAS lifting suitable for?

SMAS lifting has the unique ability to lift, tone, and reshape skin tissue and is suitable for all skin types, but let’s go through each one.

The procedure is ideal for patients with dry and dehydrated skin. It is quite rough, so it may feel like the skin is “squeezing.” Also, this type is most prone to peeling and sensitivity. Signs of premature aging include the appearance of fine or even deep lines and loss of skin tone, firmness and elasticity.

Lifting, which is aimed at collagen synthesis, does an excellent job of removing all these signs.

For obvious reasons, patients with sensitive skin are recommended to replace aesthetic surgeries with SMAS lifting sessions whenever possible. This is due to minimal damage during the procedure and no adverse effects.

The effect of the procedure will be noticeable on any skin, however, before SMAS lifting, you must go to a consultation to exclude the presence of contraindications.

Worthy alternatives to HIFU devices

As you can see, the ultrasound HIFU therapy device can improve the condition of the face and neck, but it is not omnipotent. At the same time, there are worthy alternatives to this technology in the aesthetic market in the form of radio frequency (RF) lifting and dynamic muscle activation (DMA).

Radiofrequency lifting

The principle of radio frequency (RF) lifting is the non-surgical tightening of tissue using local heating. In this case, an effect similar to an ultrasound HIFU therapy device is achieved in a slightly different way.

During the RF lifting procedure, the electromagnetic field causes the movement of charged particles in the tissues, causing their temperature to increase. The degree of heating depends on the tissue resistance to radiofrequency exposure, the power of RF energy and the duration of the session. In fact, collagen molecules “heat”, leading to partial denaturation of the protein. At the same time, collagen fibers can be shortened by up to 30%, creating instant skin tightening and a lifting effect.10

The second and in a certain sense even more important effect of RF on tissue is thermal stimulation of cellular activity. In response to sublethal heating, cells begin to actively divide, and the synthesis of collagen and other components of the extracellular matrix accelerates.

Modern radiofrequency lifting is most often performed using mono- and multipolar devices:

• Monopolar RF lifting – Thermage device.
• Multipolar RF lifting – Legend Pro+ and Divine pro devices (TriPollar RF technology).

Monopolar Thermage has a strong and pronounced effect in just one session, and the multipolar handles of the Legend Pro+ and Divine pro devices, using special TriPollar RF technology, warm up the tissues more gently and in several sessions.

At what age can you do SMAS lifting?

Most often, SMAS lifting is done after 40 years. At this age, processes begin that deteriorate the quality of the skin. The first wrinkles may appear. If there is unwanted fat, the procedure can be performed from the age of 18.

If necessary, it can be done earlier, but it is important to consider that face and body lifting is not a preventive procedure. It is aimed at eliminating existing problems with the skin, ligaments and muscles.

Between the ages of 25 and 35, you will need to consult with a specialist to confirm the need for SMAS lifting. The age limit is 18 years, but the cosmetologist may recommend the use of other technologies if he considers the symptoms insufficient for ultrasound tightening.

After 65, lifting will no longer bring the desired result, since the SMAS layer becomes too thin and collagen is lost.

Is it necessary to consult a cosmetologist before a facelift?

Consultation with a qualified cosmetologist is required before undergoing SMAS lifting. Only a specialist will be able to accurately determine the patients’ problems and their severity. The cosmetologist will also help identify all indications and contraindications.

The doctor will determine your skin type and prescribe treatment that can be used after the procedure to improve the result. The next visit to a cosmetologist for a facelift may not be necessary, and if there is a need, it will only be in a few years. The interval between sessions is also determined by the cosmetologist.

Adverse effects and post-procedure care

After the procedure using the ultrasound HIFU therapy device, no special care is usually prescribed. Patients can immediately return to their normal daily routine. Another thing is that the procedure itself is often very painful for the patient. In this case, local application of anesthetic cream has practically no effect, because tissue damage occurs to a considerable depth.

In the first hours after the session, mild erythema and swelling are expected - in most cases they disappear without a trace, although in 22-100% of patients they can persist for up to 48 hours.6 After SMAS lifting, a small bruise may appear, and if there is insufficient contact of the sensor with the skin, white blisters. In the latter case, topical corticosteroids are indicated.6

Temporary numbness in the treatment area has been reported in up to 18% of patients.7 It does not require treatment and resolves spontaneously within 2-3 weeks.

On a more serious note, the literature describes the occurrence of temporary paresis of the frontal branch of the facial nerve in 1 patient after using a HIFU device on the forehead.9 Eyebrow function was gradually restored within 2 weeks.