SERDEV SUTURE TECHNIQUES
Lower SMAS Face LIFT
PROF. NIKOLAY P. SERDEV, M.D., PH.D.
Head of Medical Center “Aesthetic Surgery and Aesthetic Medicine”, 11 “20th April”
St., 1606 Sofia, BULGARIA
President of the Bulgarian Society of Aesthetic Surgery and Aesthetic Medicine
ANATOMY
Point A – fixation at mastoid periosteum
Point B – fixation of lateral border of platysma (lower SMAS) to be lifted to A. A-B direction to cervicomandibular angle.
Point C – fixation of check SMAS and lateral border of platysma (lower SMAS) ) to be lifted to A. A-C
direction to mandibular angle.
Fig. 1. LOWER SMAS FACE LIFT BY SERDEV SUTURE:
1. Buccal SMAS lift
2. Plastysma lift
DIRECTIONS:
1.) A-C Buccal SMAS lift
1a.) Local anesthesia in points A, B, and C and on the way of the needle passes.
1b.) Perforate only skin deep points A, B, and C with scalpel blade 11. Position blade in Langer lines
direction
Warning: Deep perforation with the blade can hurt following underlying anatomical structures:
only skin, stay away from mastoid (point A), paritid gland (located deeper at point C), and
submandibular gland (could be near point B).
1c.) Through point A, enter needle perpendicular through the skin perforation (without to fix any dermal
tissue), than tangential through mastoid periosteum of anterior mastoid border.
Warning: 1. do not push needle into mastoid - it is very soft and can be easily perforated, 2 do not
push or pull the needle - twist it forward or backwards,
1d.) Proceed in a zig-zag fashion, through fascia colli and superficial subcutaneous tissue
to point C. Proceed paralel to skin below it = place needle tip
(handpiece concavity) lateral. Handpiece concavity shows position of needle tip.
Warning: Do not introduce needle below sternocleidomastoid muscle (danger: vascular nerve
bundle, a. and v. jugularis interna). Stay away from external jugular vein.
1e.) Just before exit at point B & C, SMAS (cheek SMAS, platysma) is grabed. To grab SMAS, turn
needle tip down, progress a bit and twist needle tip up.
Warning: Stay away from parotid gland (just below cheeck SMAS)
1h.) Pass through perforation point C.
Warning: Do not push through skin perforation point C. Place skin perpendicular to needle tip,
twist needle softly and progress softly and easily . Needle tip should apeear in to perforation C without
resistance in front. Perforation resistance means engagement of dermis and hardly removable
dimple after suture is tight.
2.) A-B Plastysma lift
repeat similar pass from point A to point B.
Address for correspondence:
Prof. Nikolay Serdev, MD, PhD
National Consultant of the Ministry of Health in the Specialty of "Cosmetic (Aesthetic)
Surgery" 2006-2008
Medical Center "Aesthetic Surgery, Aesthetic Medicine"
11, "20th April" Str., 1606 Sofia, Bulgaria
Phone: +359 2 952 4652
Mobile: +359 88 571 9696, +359 8888 0 2004
Fax:
+359 2 951 5668
e-mail: serdev@gmail.com
URL:
www.cosmeticsurgery.bg/en
www.drserdev.com
President
The Bulgarian Society of Aesthetic Surgery and Aesthetic Medicine