Professor Nikolai Serdev shared with estet-portal.com the features of his author's SMAS facelift technique, methods that allow you to avoid scarring after a facelift, and also spoke about rejuvenating rhinoplasty.
The interview was recorded during the ISAPS International Congress held in Kyiv on 19 and 20 May.
Nikolai Serdev (Bulgaria) – President of the National Bulgarian Association of Aesthetic Surgery and Medicine, Director of the Council of the International Academy of Aesthetic Surgery, author of the method of scarless skin tightening (fio elastico), honorary professor and director of aesthetic surgery at New Bulgarian University, certified specialist in aesthetic surgery.
Tell our readers about the features of your author's SMAS facelift technique.
N.S. During these two days, my colleagues perform operations to restore facial volume, achieve a lifting effect, lipofilling, blepharoplasty, eyebrow lifting, etc. The duration of operations is approximately 3-5 hours. Thanks to the atraumatic method of scarless skin tightening developed by me, the effect of rejuvenation can be achieved very quickly.
When we had the opportunity to start a private practice in the late 1990s, we were approached by very young girls and boys (aged 17 and over) who wanted to look beautiful. For young people, unlike adults, the appearance of scars after operations is extremely undesirable, and the low-impact procedures allow young patients to immediately return to their normal lives.
How do you manage to avoid tissue scarring after a lift?
N.S. SMAS-lift – This is a superficial musculoaponeurotic system (SMAS) lift. Previously, to perform a surgical facelift, it was necessary to make incisions in order to completely open the required area and, visually controlling the process, sutured the tissues. Now I know the layered anatomy of all areas of the face, since this was also one of my developments. And each layer has its own characteristics. This allows me to penetrate the skin with a special needle, take the fascia and suture it in advance.
What are the main features of anti-aging rhinoplasty?
N.S. Rhinoplasty – this is a very important procedure since the nose is located in the middle third of the face. Basic aesthetic rules – these are proportions, volumes and angles: angles must be raised, volumes – reestablish. As you know, there is the concept of a triangle of beauty, which provides that the nose should not be below the median line. If it is lower, the proportions of the triangle are violated, negatively affecting the appearance of the patient. Therefore, the nose should be located on one third of the face.
Suturing the nose can be done if the tissues are soft enough, but this procedure is more suitable for Asians or African Americans than Europeans. There are other methods of my own that allow you to carry out the procedure of anti-aging rhinoplasty atraumatically and without bloodshed. In addition, surgical and thread methods can reduce the width of the nose and maintain appropriate angles, which is also extremely important.
At what age do patients turn to a plastic surgeon?
N.S. We can operate on patients who are 18 years old, and America – from 21 years old. However, in the presence of psychological complexes associated with appearance, minors must obtain a signed consent from their parents for the operation. On average, patients turn to a plastic surgeon between the ages of 30 and 55. In Bulgaria, this is the age when a woman still looks good, but minor signs of aging that give away the age of the patient must be eliminated.
At what age is the SMAS facelift procedure most effective?
N.S. This procedure is effective at any age because the SMAS is fixed on the bone, but with age, the volume of the bone tissue decreases, and the SMAS and skin lose their elasticity and sag. Our task – pull up SMAS. When the patient's facial symmetry is broken, it can be restored and all tissues tightened. However, the possibilities of such an SMAS lift are limited, since tissues can only be pulled up to a certain point – no more.
Therefore, thread methods are used to solve the above problem – they improve the appearance of the patient without visible signs of surgery.
What complications can occur after an SMAS facelift?
N.S. If skin excision is necessary or during open lifting, there is a risk of bleeding, nerve dysfunction, inflammation, etc. Such complications make up a certain statistical percentage. As for thread methods, they use a blunt needle that cannot damage either blood vessels or nerves. Therefore, this procedure is atraumatic.
After a thousand procedures, I analyzed the statistics and found that the complication rate was only 0.003%. In this case, complications appear exclusively in the form of minor inflammation on the surface of the skin, but not in the form of a reaction to the threads. There is no nerve dysfunction or bleeding after an atraumatic SMAS lift, so the patient can immediately return to their usual social life. Of course, it is desirable to provide a recovery period of 1-3 days.
Are there any contraindications for SMAS facelift?
N.S. This procedure is contraindicated in dependent and psychologically unstable patients, as well as in the case of chronic diseases that may worsen. Before the operation, it is necessary to normalize the patient's condition, control all diseases. An important point is also a consultation with the patient's doctor, who will give recommendations on preparation for the operation, measures during the operation and care after the operation. After the procedure, the patient must be observed by his attending physician.
How often can an SMAS facelift be done?
N.S. The effect of the threads is maintained for 5, 10, 15 years. In some cases, a second procedure may be needed even after a year – All this is individual and depends on the age of the patient. It is important to understand that there are a lot of areas on the face and, in addition to the SMAS lift, other anti-aging procedures should be carried out, taking into account the anatomy of each area of the face. For example, due to the characteristic features of the jaw area, procedures in this area can be repeated more often, say, after a year. However, in addition to this, it is necessary to pay attention to other problem areas, for example, lift eyebrows, cheekbones, etc.
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