High-SMAS Facelift

The importance of the midface

The midface plays a key role in how youthfulness is perceived.

As we get older, the following changes occur:

• Volume shares
• ligament tension
• Fat compartments
• as well as the junction between the lower eyelid and the cheek.

This results in:

• sunken cheeks
• Loss of the zygomatic projection
• more pronounced mid-face contours
• tear ducts
• Malar Bags
• and softer transitions between the eyelid and cheek.

Whilst many traditional facelifts improve the appearance of the neck and jawline, they have only a limited effect on the midface.

It is precisely in this respect that Dr Richter sees a particular strength of the High-SMAS approach.

This is because the midface is not treated in isolation, but is understood to be a natural part of the overall facelift approach.

The principle behind the High-SMAS facelift

In a high-SMAS facelift, the SMAS dissection is extended significantly further upwards.
This often results in:

• a more pronounced lift of the cheek
• a smoother transition between the eyelid and cheek
• softer mid-face contours
• and a more natural vertical repositioning.

It is the vertical component in particular that plays a decisive role here.
Whilst many older techniques tended to create horizontal tension, the High-SMAS approach is more closely aligned with the natural anatomical vectors of the midface.
As a result, the results often appear more natural, softer and less taut.
For Dr Richter, the true quality of the procedure lies in the fact that the lower and mid-face can be harmonised simultaneously – without these regions appearing artificially separated from one another.

“To bring the midface along, so to speak”

Dr Richter makes particular use of the High-SMAS technique when:

• a facelift is needed
• and there is also significant sagging of the midface.

It is precisely in these situations that the midface can, so to speak, be ‘affected’.
This means:
The midface lift is harmoniously integrated into the facelift, without necessarily requiring a separate, isolated midface lift.
This often results in:

• more natural overall vectors
• smoother transitions
• smoother facial contours
• and a much more harmonious transition between the lower eyelid and the cheek.

It is precisely this integration that Dr Richter regards as one of the most elegant aspects of modern High-SMAS techniques.

Particularly suitable applications

In Dr Richter’s view, the High-SMAS facelift offers particular advantages in the following areas:

• sunken cheeks
• more pronounced sagging of the midface
• Malar Bags
• heavy midface
• softened cheek contours
• and pronounced transitions between the lower eyelid and the cheek.

It is precisely the more pronounced vertical repositioning of the midface that can produce very natural and harmonious results in this context.
However, the aim is never simply to lift as much tissue as possible.
The key factor is always:
Which form of ageing is actually predominant.

Difference from the deep plane facelift

On social media, ‘High SMAS’ and ‘Deep Plane’ are often used almost interchangeably.

However, in Dr Richter’s view, the two concepts have different focuses – even though they are closely related anatomically.

He considers the Deep Plane facelift to be particularly effective:

• for moderate nasolabial folds
• marionette lines
• corner of the mouth
• Kinnlinie
• and the natural repositioning of the lower third of the face.

The High-SMAS approach, on the other hand, often offers particular advantages:

• in cases of more pronounced sagging of the midface
• sunken cheeks
• Malar Bags
• and the transitions between the lower eyelid and the cheek.

The midface in particular is often affected more significantly with the High-SMAS technique than with many traditional deep-plane techniques.

For Dr Richter, therefore, it is not important which term is used.

The key factor is the specific anatomical situation and which procedure offers the most harmonious solution.

Ligaments and midface

Ligamentous support structures play a key role, particularly in the midface.
You play a key role in:

• the position of the cheek
• the stability of the midface
• the junction between the eyelid and the cheek
• and the formation of certain wrinkles or bags.

However, as with deep-plane techniques, the following also applies here:
Not every patient requires the same degree of aggressive ligamentous release.
Older people, in particular, often already have significantly loosened tissues.
Experience is therefore crucial in order to:

• to avoid unnecessary trauma
• to maintain natural stability
• and finding the right balance between exercise and rest.

For Dr Richter, this is one of the key differences between standardised surgical techniques and truly personalised facial surgery.

The face as an aesthetic whole

In Dr Richter’s view, a good high-SMAS facelift never focuses solely on the cheeks.
That is why he always analyses:

• eyelids
• Midface
• Brewing position
• Neckline
• lip area
• Skin quality
• Loss of volume
• as well as the jawline and chin.

It is often the combination of small, complementary measures that creates a natural look:

• Lipofilling
• renewable processes
• Skin improvement
• Midface stabilisation
• Eyelid surgery
• or neck treatments.

It is not maximum change that creates harmony.
Harmony arises from the right interplay of all structures.

Skin quality and regeneration

A lifted face does not automatically look young.
Skin quality remains crucial.
That is why Dr Richter is increasingly combining modern facial surgery with regenerative approaches such as:

• Microfat
• Nanofat
• autologous fat transfer procedure
• and natural skin improvement.

These procedures can:

• improve the quality of the fabric
• Promote regeneration
• create smoother transitions
• and make the results look more natural.

It is precisely in this area that Dr Wiedner complements the joint approach by placing particular emphasis on:

• regenerative preparation
• pre-operative skin preparation
• post-operative aftercare
• and long-term tissue stabilisation.

Why experience is more important than trends

Modern facial surgery is often defined today in terms of specific surgical procedures.
Dr Richter takes a deliberately nuanced view of this.
It is not necessarily the case that the most modern or aggressive technology automatically produces the best results.
The following remain crucial:

• Anatomy
• Fabric quality
• ageing process
• natural vectors
• and bespoke planning.

For him, experience also means knowing:

• when a more extensive midface repositioning is advisable
• when less preparation looks more natural
• and when complementary regenerative or volume-restoring approaches are more important than additional mobilisation.

His personal approach

Dr Richter does not view modern facial surgery as a race to achieve the most dramatic transformation.
His aim is:

• natural harmony
• Restoring balance
• smoother transitions
• smooth facial contours
• and consistently strong results over the long term.

He particularly values the High-SMAS approach for its ability to treat the midface and lower face as a single, cohesive unit.
A successful result should not look as though it has been surgically altered.
It should appear as though the face has regained its serenity, its structure and its natural balance.
It is precisely in this that Dr Richter sees the true art of modern facial surgery.