Facial Rejuvenation Today is More Than a Lift

NEW YORK, NY (April 29, 2002) — "At first, facial aging was approached as a problem isolated to loose skin," says Dallas plastic surgeon Fritz Barton, Jr., MD. "But today, plastic surgeons know that effective facial rejuvenation involves reshaping the face as well." The journey from simple "skin tightening" to more advanced techniques forms the basis of a Special Presentation by Dr. Barton at the Annual Meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), April 27-May 3, 2002, in Las Vegas.

As early as 1960, says Dr. Barton, plastic surgeons noticed the shortcomings of the traditional facelift designed to tighten skin and smooth facial wrinkling, but the concept of facial shaping by repositioning fat that has descended as a result of aging was not yet recognized. Over the next 15 years, attempts were made to develop rejuvenating procedures to elevate and secure descended cheek fat using sutures; however, none of these techniques involved under-mining, or separating, the deeper tissues and all relied upon the skin to hold suspension sutures in place. The "high SMAS" (superficial musculo-aponeurotic system) technique, presented for the first time at the 1989 Annual Meeting of the American Society for Aesthetic Plastic Surgery, was part of a new generation of facelift techniques that involved undermining and suspension of the cheek using the deeper tissues, rather than the skin, as a "handle."

Whether the SMAS layer should be left attached to the skin, separated from the skin and manipulated independently, or whether undermining should be carried out on even deeper tissue planes remains controversial. Clinical studies have not been able to scientifically determine which technique produces the best and most long-lasting results.In fact, some surgeons claim that, for properly selected patients, the traditional "skin lift" produces comparable results to the deeper tissue techniques with reduced risks.

Dr. Barton, who is an ASAPS past president, believes that the "high SMAS" technique, which he helped to pioneer and has used for more than 18 years, produces predictable and consistently excellent results. "While there are certainly other effective facial rejuvenation techniques available, the 'high SMAS' technique powerfully repositions facial fat in such a way as to return the square, jowled face to its more youthful trapezoidal form," says Dr. Barton.

As the art of facial rejuvenation continues to evolve, more recent developments include minimally invasive endoscopic procedures, used most frequently for lifting and smoothing the upper third of the face. Cheeklift techniques have allowed plastic surgeons to better address problems of the midface, improve the nasolabial folds and create a smoother interface of the lower eyelid and cheek areas. The use of tissue glue, also called fibrin sealant, is growing in popularity; proponents claim improved healing and recovery time may result from its use in facelifts and other cosmetic surgeries.

"What matters most in facial rejuvenation surgery is an individualized approach to each patient and the skill of the operating surgeon," says ASAPS President Malcolm Paul, MD. "All of the current techniques, including traditional methods, can produce excellent results in the hands of an experienced, board-certified plastic surgeon."

Dr. Barton's presentation is scheduled for Tuesday, April 30, 8:00 am PDT.

FRITZ BARTON, JR., MD, and MALCOLM PAUL, MD, are available for interviews.


The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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