SMAS techniques

This results in:

• sunken cheeks
• Loss of jawline definition
• smoother neck contours
• chubby cheeks
• deeper wrinkles
• and more pronounced facial features.

Modern facelift surgery therefore does not focus solely on the skin, but primarily on this underlying layer.

Why tried-and-tested SMAS techniques remain highly relevant

On social media today, one often gets the impression that deeper deep-plane or sub-SMAS techniques are fundamentally superior.
Dr Richter’s experience is considerably more nuanced.
A well-planned and precisely performed SMAS procedure can, in suitable anatomical cases, achieve results that are every bit as good as modern deep-plane techniques in terms of both function and aesthetics.
Currently at:

• mild tissue laxity
• in a favourable ligamentous situation
• good skin quality
• less prominence of the midface
• and harmonious tissue elasticity

Traditional SMAS techniques often yield very natural, stable and long-lasting results.
For Dr Richter, the true quality of modern facial surgery therefore lies not in the most aggressive dissection, but in choosing the right plane.

Why not every face requires deep preparation

Not every patient automatically benefits from maximum ligamentous release or particularly deep dissections.
Older people, in particular, often already have significantly weakened supporting structures.
In such situations, more aggressive preparation may:

• cause unnecessary distress
• Increase swelling
• Prolong the healing process
• and potentially increase risks without necessarily leading to better results.

This is where, in Dr Richter’s view, tried-and-tested SMAS techniques often demonstrate their particular strengths.
They can be gentler on the tissue whilst delivering very harmonious and natural results.
For him, experience therefore also means knowing:
When less dissection is the better choice.

Different SMAS techniques

Over the past few decades, numerous SMAS techniques have been developed.
These include, amongst others:

• SMAS-Plication
• SMAS resection
• SMAS flap techniques
• High-SMAS
• as well as various hybrid methods.

These methods differ:

• in the depth of field
• in the mobilisation of the tissue
• in the treatment of ligamentous structures
• and the inclusion of the midface.

None of these techniques is inherently ‘the best’.
The key factor is always:
What is the patient’s anatomy, and which form of ageing is predominant?

SMAS-Plication

In SMAS plication, the SMAS is folded and stabilised without the need for extensive deep dissection.
This procedure can produce very elegant and natural results, particularly in younger patients or in cases of moderate tissue laxity.
Dr Richter particularly values the technique for its controlled and tissue-sparing properties.
Used correctly, it can:

• Distribute the load evenly
• relieve the skin
• Reduce swelling
• and at the same time create very natural contours.

SMAS resection

In SMAS excision, a specific portion of the SMAS is removed and the remaining structure is repositioned.
This makes it possible to:

• Define contours more precisely
• Distribute the voltage more evenly
• and stabilise the lower face and jawline.

Here too, Dr Richter’s view is that:
It is not maximum resection that produces the best results, but the right balance between tightening, volume and natural tissue distribution.

SMAS flap techniques

In the SMAS flap procedure, the SMAS is mobilised and repositioned as a separate layer.
This allows:

• the skin is significantly relieved
• The load is distributed more evenly
• and the lower face can be repositioned more harmoniously.

Many modern deep-plane and high-SMAS techniques are ultimately based on further developments of precisely these classic principles.
This is precisely why Dr Richter does not view classic SMAS techniques as being at odds with modern procedures, but rather as their anatomical foundation.

The role of ligaments

A key component of modern facial surgery is what are known as the retaining ligaments – the ligaments that support the face.
You play a key role in:

• the position of the cheek
• the stability of the midface
• the jawline
• and the transitions between the different areas of the face.

As we age, these structures lose their elasticity.
At the same time, however, it is important to note that:
Not every patient requires the same aggressive ligamentous treatment.
It is precisely here that Dr Richter sees the importance of experience.
To recognise:

• when deeper preparation is advisable
• when a standard SMAS procedure is entirely sufficient
• and when additional mobilisation tends to cause unnecessary trauma.

The face as a functional and aesthetic unit

In Dr Richter’s view, a good facelift never targets just one specific area.
That is why he always analyses:

• Forehead and eyebrows
• eyelids
• Midface
• Neckline
• Lips and mouth area
• Skin quality
• Volume loss
• 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
• Neck treatments
• Midface stabilisation
• or eyelid and eyebrow surgery.

It is not extreme change that creates harmony, but the right balance between structure, volume and expression.

Skin quality and regeneration

A facelift alone cannot replace good skin quality.
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 skin texture
• Promote regeneration
• Improve tissue quality
• and make the results look more natural in the long term.

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

• pre-operative skin preparation
• renewable energy concepts
• post-operative aftercare
• and long-term tissue stability.

Why experience is more important than trends

Dr Richter does not believe in one-size-fits-all facelift solutions.
For him, experience does not mean using the most aggressive techniques possible or following the latest trends.
Experience means:

• to have a firm grasp of all aspects of facial surgery
• to be able to apply classical and modern techniques in a nuanced way
• Assessing risks realistically
• and to find the right solution for every face.

For him, the most demanding aspect of modern facial surgery is not the most spectacular technique, but the ability to use the right technique to achieve a natural, harmonious and long-lasting result.

His personal approach

Dr Richter does not view modern facelift surgery as a competition between individual surgical techniques.
His aim is never to bring about the greatest possible change.
His aim is:

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

A successful result should not look artificial.
It should look as though the face has regained its serenity, clarity and natural firmness.
It is precisely in this that Dr Richter sees the true art of modern facial surgery.