SMAS Tox FMF ===

[00:00:00] Oh, yeah.

Well, hello, hello guys. You're listening to Beauty Bytes with Dr. K, Secrets of a Plastic Surgeon, and it's time for a 5 Minute Friday! Yay! Today, let's talk about some craziness that we've been seeing on social media. I've been getting so many messages and patients walking in the office asking for SMAS

lifting Botox, a SMAS facelift with Botox. Have you heard of this? Well, let's talk about it. The SMAS is the superficial muscular aponeurotic system. Almost everyone's heard of a deep plane lift where they lift the SMAS and pexy and tighten things. This SMAS, or submuscular aponeurotic system, is a really complex, fibrous network.

It's connected to the muscles of facial expression and it does play [00:01:00] an important role in supporting the midface and the lower face. It's really tightly integrated with your facial muscles, especially around the hairline and ears. And it does help to kind of stabilize muscles and their attachments to bony architecture.

And so I've seen this trend where injectors are injecting the forehead down the temple and front of the ear and then swinging up behind the ear, into the back of the neck and hairline back there. And they're drawing really carefully precise injection points. It's always on a very in. Instagrammy beautiful face.

These videos are done very aesthetically, and these practitioners are alleging and exploring the idea that Botox placed here all around the face circumferentially can lift the face. First of all, let's just say nothing's been published about this technique. And second of all, it does not make a lot of logical sense because that is not what the SMAS does.

And third of all, [00:02:00] Botox relaxes muscle tone. And therefore, when we place it in areas where depressing muscles are pulling down, We can get some lift, but all of these zones are not necessarily designed to depress the face and therefore placing Botox there will not elevate the face at all, whatsoever. It will elevate your bill, your Botox bill.

I think some patients definitely have, um, downward traction and pull of their frontalis muscle. When, that's the forehead muscle. When you raise your brows up, you can watch your forehead line. Just look at that junction of where hair meets skin on the very high forehead. And see if your scalp pulls downwards.

when you raise your brows up. Sometimes the frontalis and the scalp musculature actually contracts downwards a lot. So placing Botox in this high, high forehead area can help with brow elevation. But not everybody has this. Only certain people have [00:03:00] downward pull of that muscle. And definitely in the temples.

Not a lot of movement occurs in the temples. In the preauricular or front of the ear area, there's the masseter muscle. The SMAS is interdigitated here with some of the facial musculature, which I certainly would never want any of the facial muscles that are out there laterally, like the zygomatic muscles or the muscles that help suspend the lower face.

We would not really want them to relax their muscle tone, because that's the opposite of lifting, right? And the markings I see on these ladies videos, They're placing tox in the skin level. I don't think that injecting the masseter here in front of the ear is going to give you any kind of lift effect.

Maybe a little facial slimming, maybe if you're deep enough to be in the muscle, that would work. But not in this mass, which is a fibrous layer. And then behind the ear, And there were some interdigitations of the sternocleidomastoid muscle there behind the ear. That's not going to really [00:04:00] do anything for you.

It's going to make things a little worse on your lower, on your upper neck area. The Nefertiti Lift, where we inject Botox along the jawline, above and below the mandible, to stop the downward pull of the platysma. That is something I can sign up for. Definitely can recommend that. That will give a little sharpening effect.

It reduces the downward traction of the neck on the face, and that does give a little bit of a lifting effect. So lots of us experts doubt the efficacy of using Botox to achieve a SMAS lift. Honestly, it's false advertising, and patients need to just go ahead and get a mini lift or a facelift when they're wanting to get that degree of natural tightening.

This really just is disrupts the natural muscle tensions that support the face. The SMAS also provides a lot of structural support. And when you do inadvertently get some branches of muscles that are woven into the SMAS, muscle weakness and sagging occurs, not lifting. [00:05:00] I think this is so important to go over with patience because we are all so suggestible and we all want to be so beautiful.

We want to do the little things that we're coming in here and getting some talks and why not tweak it and get a SMAS lift. But let's not forget that incorrect Botox placement from one of these so called experts who's touting SMAS lifting can give you facial drooping. asymmetry, difficulty with your expressions, and poor patient satisfaction.

There's literally nothing published about this technique, and generally that means there's literally nothing to it. Um, instead of targeting this mass with Botox, effective alternatives include temple filler, Using a vertical vectoring technique, which we're writing up and publishing, is a technique to bolster and lift support of the lower face by vectoring upwards towards the temple.

Energy based treatments will give lots of these tightening effects. For example, [00:06:00] microneedling with RAD radio frequency, Thermage doing treatments like ulthera, Thermi smooth, which we do in our office, which is radio frequency. These things can give some underground skin tightening, and then you can do Botox in precise areas like we talked about.

Very, very high on the scalp and frontalis. Also in the masseter for facial slimming, which gives a sort of an effect of tightening and lifting, but definitely the Nefertiti Lift is one that I recommend as well. Platysmal bands, I think those are easy to treat and more. effective use of your Botox units than placing it in this random pattern at the periphery of the face to pretend that you're getting a SMAS lift.

So there you have it. That's my two cents. Brutally honest, always anchored in reality, anatomy, and science. I don't think we need to spend money on SMAS lifting techniques. And definitely educate your patients about that. Send me a comment if you have some [00:07:00] points to make or you have a technique that's absolutely fabulous and I just haven't learned about it.

I'm always open to learning. Love to get your info. If you have an amazing Botox technique, we should someday do, um, Five Minute Friday all about really off label amazing things that we're doing with toxins. I think that would be so fun. And we should definitely talk about toxin below the waist. That's a fun area we can talk about for guys and gals too.

I'll save that for a Valentine's podcast, more romantic. That's it for now, guys. Don't forget to find me on podcasts that are longer every Tuesday and a five minute Friday, you can find us everywhere. Podcasts are heard. You can find me on my Instagram. It's Beauty by Dr. K-D-R-K-A-Y, and our TikTok is the same.

Our website is Beauty by dr k.com, where you can find our amazing skincare. And that's it for now guys. Stay beautiful. [00:08:00]