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Serdev Clinic - MC "Aesthetic Surgery, Aesthetic Medicine". Rejuvenation and Beautification Without Scars.

Mid-face SMAS Lift via Serdev Suture. No Visible Scars

Transcutaneous SMAS Mid-face lift via Serdev Sutures

The SMAS mid-face lift elevates and stretches the middle and lower parts of the face, as well as the neck. Also, it stretches the cheeks, nasolabial and marionette folds, highlights the so called “hungry cheeks” and restores the youthful jawline. We lift and stably fixate the SMAS only through skin puncture points, using the Serdev Sutures Lifting method.

The SMAS mid-face suture lift is one of the internationally most successful and popular methods of Prof. Dr. Nikolay Serdev. It is most popular among middle aged and elderly patients. However, due to the lack of scars, we also often perform this procedure in younger patients, mostly models, for tightening the initial sagging and asymmetry of SMAS and skin in middle and lower face and neck.

Ultrasound assisted liposculpture may be necessary in cases of fat deposits in the face. The goal is to suck out and remove the fatty deposits on the cheeks, causing the so called “bulldog” appearance. The procedure also tightens the skin on the lower jawline.

Serdev Suture Lifts are the most modern cosmetic surgery SMAS facelifts. Dr. Serdev needs only a few skin puncture points to lift any area of the face. Even the more central zones, unreachable for classic open approach lifting methods, are successfully treated. We achieve this without skin incisions or excisions and therefore there are no scars. In addition, the skin is not separated from its underlying support. Hospitalization and nursing are not necessary. The postoperative recovery is short and does not affect patient’s ability to return to their daily duties.

Read more – Scarless Upper SMAS facelift; Overall face beautification; Lower Face and Neck Lift; Cheekbone lift


What is SMAS?

Back in 1972, surgeons demonstrated that after classic open approach face liftings, the skin is not stable and elongates in minutes. Since then, lifting of the Superficial Muscle-Aponeurotic System of the face (SMAS) became the obligatory method for surgical face lift (including mid-face lift), in order to maintain a long lasting result.

The skin and soft tissue do not drop easily, thanks to their strong fixation to the SMAS. Therefore, if we separate the skin from the SMAS, it will lose its stable support. As a result, a subsequent SMAS lift will not be able to pull and lift the skin. The consequences of separating the skin from the SMAS are a mask-like stretched appearance, changed hairline position behind the ears etc. Naturally, we strongly oppose such approach.


Temporal SMAS Lift Without Scars

What is Temporal Lift / Upper Face Lift?

With age, the cranium shrinks and facial fat volume changes (it increases in most cases). Ptosis occurs (including the SMAS), along with skin laxity and non-elasticity. These factors change the facial expression into a sad and tired looking face. Fortunately, we can reposition the soft tissue facial structures and skin, which are fixed to the SMAS, by lifting the latter and attaching it at a higher position. We achieve this with a temporal lift without scars (also called upper face lift).

Aesthetically incorrect face angles make young people look sad. Therefore, the objective of the temporal SMAS lift in this young population is simply beautification, based on facial aesthetics. Our goal is the restoration of correct proportions and angles of the eyes, eyebrows and lips.

Read more: Brow lift; Lip augmentation; Cheekbone lift; Overall face beautification


What is SMAS and why do we use it?

Back in 1972, surgeons demonstrated that after classic face lifting, the skin is not stable and elongates in minutes. Since then, lifting of the Superficial Muscle-Aponeurotic System of the face (SMAS, described by Mitz and Peyronie) became the obligatory method for surgical face lift (including mid-face lift), in order to maintain a long lasting result.

The skin and soft tissue are strongly fixed to the SMAS in the temporal area. Therefore, if we separate them from the SMAS, the skin will elongate, because it has lost its stable support. As a result, in a subsequent temporal SMAS lifting, we will not be able to lift the skin. The consequences of separating the skin from the SMAS are a mask-like stretched appearance, changed hairline position behind the ears, etc. Naturally, we strongly oppose this approach.


Procedure and Results

In our clinic, we use the Serdev Sutures” lifting method for temporal SMAS lift without scars. It is a less traumatic experience for the patient, and is carried out under local anaesthetic, without incisions or excisions of skin. We perform the upper face lift only through skin puncture points to suture (sew) the SMAS to the skull periosteum. The pinpricks are not visible and disappear within 1-3 days.

Pain is subjective and of variable intensity, depending on the person concerned. Patients usually sleep tranquilly after the operation. Pain can be present mostly by pressure, for which we  prescribe analgesics as necessary. Recovery is rapid. There is less swelling than associated with other methods. It is not visible to others and the patient can quickly resume normal activities.

The results are immediate. The main outcomes of the temporal SMAS lift are: total face lift, change of angles of the eyes and lips, fresh look, younger and more beautiful appearance, cheekbone recovering, as well as skin texture improvement.

After surgery, the patients must take medications exactly as prescribed and must not expose their face to direct sunlight. They can go to the beach, as long as they cover the face with sun screen.


Supra-Temporal SMAS Lift

After a temporal SMAS lifting, there is a further opportunity of lifting the SMAS in the supratemporal area. We recommend the scarless Serdev Sutures Lifting method.


Patient Testimonial

Dr. Serdev’s Author Techniques in Rhinoplasty

Many of the rhinoplasty procedures used in our clinic are done using the so called “Serdev Rhinoplasty Techniques“. These techniques help us achieve the correct proportions of the nose using a closed approach, without trauma. Thanks to the developments made by Dr. Nikolay Serdev in the field of nose correction, our patients leave the clinic with their new desired look, without plasters, casts or intranasal packing.

Read more – journal review of the book “Serdev Techniques in Rhinoplasty”


Serdev Rhinoplasty Techniques

The methodology is based on the achievements of the first president of the American Academy of Cosmetic Surgery – Dr. Julius Newman, surgeon in Hollywood, called “Dr. Nose” and improved by Dr. Serdev.

The internationally recognised scarless Serdev techniques in rhinoplasty are:

– T-zone Excision – for shortening the length of the nose. Protects cartilages from separation/cutting/shortening during surgery, which in older methods often resulted in necrosis (after their separation, processing and returning back to place, cartilages do not always get well vascularised);

– Nasal Tip Rotation by suture – shortens the length of the nose (alternative of the T-zone Excision);

– Columella Sliding by suture – used to correct the tip projection (decreases or increases the height of the tip). The aim is to obtain the aesthetic 30 degree angle of dorsum to profile line;

– Nasal Tip Refinement (narrowing) by suture – narrows and makes a finer tip;

– Alar Base Narrowing by suture – narrows the width of the nostrils;

– Digital fracture instead of lateral osteotomy – closes the open dorsum roof after medial osteotomy (humpectomy) without visible step deformity;

– Medial and/or lower dorsum narrowing by suture.


Patient Testimonial

“I am coming out of surgery just now. For me, the anxiety before the operation was very big, I had fear. But actually it was not an intervention, according to me – as if I was going to the dentist. There was no pain, it was very quick. The difference before and after is so huge… exactly what I wanted! Most importantly, I am not dizzy, there is no pain,  I feel very good. Such a painless surgery, after all others that I’ve had… [3 days after surgery] I don’t have any problems. In short, I can say that the feeling cannot be better. As if there hasn’t been a surgical intervention.”



Dr. Serdev’s rhinoplasty techniques reduce operation time to 15-40 minutes, depending on the difficulty and number of procedures. Due to the minimal trauma in our operations, small linear bruises under the eyes appear in only about 30% of hump removal cases. The lack of trauma and blood loss make intranasal packing unnecessary. Packings are placed in the inner nose, while cosmetic corrections deal with the external nose. Full return to social life is possible from the first to the 5th postoperative day, depending on the presence or absence of minor bruises.

When we only correct the tip, there is no necessity of plaster or cast. No bruising can appear and swelling is not visible to the uninitiated observers, there are no scars. Therefore, patients return to social life almost immediately, without signs of surgery. No one will know that the nose has been operated. Most of our TV presenter patients work on the next day – the team and TV viewers do not even realise that there has been an intervention. The presenter only looks refreshed, rejuvenated and more beautiful.

Of course, the patient has the obligation to appear at the designated check-ups after surgery.

In combination with Serdev Suture Lifts for face and body, we can achieve an overall aesthetic beautification and rejuvenation, without trauma and without scars.


Narrowing of the nose

When narrowing the nose, besides working on the tip and the nostrils, we often have to narrow the dorsum (back of the nose) – the upper half (after removing the hump), as well as its lower or middle part. We perform these procedures using Dr. Serdev’s bloodless and atraumatic techniques.


Narrowing of the nasal dorsum (back of the nose)

This procedure requires closing the open roof of the nasal bones after humpectomy. Removing the “roof” of the nose leaves it open. The standard approach for narrowing the nose requires additional lateral osteotomies of the nasal bones on the side of the base and moving the bones inwards. This leads to bleeding and bruising around the eyes (“black eyes”). This method often forms visible “steps” (known as “crow feet”) of the nasal bones in the middle and on both sides.

To avoid this malformation, as well as trauma and bruising, Dr. Serdev introduced the technique of digital fracture (breaking) of these bones. This technique leads to their tilting towards each other to close the open “roof” (the back of the nose) and its narrowing without bleeding and trauma. This technique is atraumaticdoes not cause soreness and bruising after surgery. In addition, it does not require casts or intranasal packing. The postoperative period is minimal. Minimal bruising can appear in about a third of all cases, in the form of lines on both sides of the nose. Patients tolerate this technique very easily, due to lack of pain. Swelling is minimal. Return to social life is immediate or, in the case of minimal bruises, within a few days.


Narrowing of the lower and middle part of the nose

This technique is done by passing the nose either through the mucous membrane (leaving no scars) or through needle punctures of the skin to collect the tissues on the back of the nose. The latter applies also when narrowing the middle part of the nose. The goal is to suture the cartilages on the back of the nose and narrow it.

As with every injection, the signs of punctures disappear within 1-2 daysThe procedure is bloodless and atraumatic.  Patients can resume their daily activities on the day after surgery or rest for a few days if they wish.

Narrowing the back of the nose can be done as a standalone procedure, in combination with other Serdev Techniques for Atraumatic Nose Correction or with complete rhinoplasty. Thanks to the atraumatic nature of the methodology, rhinoplasty may, if necessary, also be combined with different scarless Serdev Sutures lifts or ultrasonic liposculpture of the face.


Raising concavities to straighten the line on the back of the nose

By using Dr. Serdev’s suture techniques, we can also raise the back of the nose or get rid of irregularities. Sutures are performed through skin punctures. The technique is atraumatic and mini-invasive. No patches, casts or intranasal packings are necessary. The skin punctures disappear within two days.

See more: Humpectomy (hump removal)Narrowing of the nostrilsNose tip correction (narrowing, shortening)


Nasal Tip Correction (Shortening and Narrowing)

The nose is positioned in the middle of the face and the aesthetics of proportions essentially depend on it. In at least half of all cases there is no hump and only have to correct the tip of the nose. The correction consists of narrowing the tip, shortening (reducing the length of the nose), and projecting it.


Shortening the Nose (reducing the length of the nose)

One of the procedures for aesthetic correction of the tip of the nose is its shortening. There are two variations of this procedure, both of them created, described and published by Dr. Serdev. They are mini-invasive, atraumatic, without blood loss, without casts and intranasal packings. Due to the lack of scars from surgery, patients can return to work and social life on the day after surgery. Alternatively, they can rest for 1-2 days.

  1. T-Excision at the tip: this is an ambulatory, bloodless procedure. Skin-color tape (as the one used when we remove the hump) and intranasal packings are not necessary. There is no bruising. Since we do the procedure using a closed approach and do not open the nose, the postoperative recovery is fast and the swelling is not noticeable. There is no post-op pain except by touch. During the first hours after surgery, there is a slight dripping from the nose, which patients only  need to clean gently. We remove the formed crust during the follow-up session on the day after surgery. Breathing is undisturbed, there is no visible scarring and bruising. Patients are free to return to their daily lives without an “operated on” appearance.
  2. Suturing the cartilages to the nasal bones, which shortens the nose. It is done using Serdev Sutures method. This method has received worldwide recognition and is being applied worldwide as a mini-invasive and atraumatic technique, without cuts and bleeding. Patients’ return to their daily routines is almost immediate. To our patients, this is better alternative to classical methods. Classic rhinoplasty, especially when opening the nose, reversing the skin with invasive corrections leads to a long postoperative period and long lasting swellings. Results come late and complications are common.


Projecting the Tip of the Nose (Columella Sliding)

Nasal tip projection, according to aesthetics, should be approximately 30o to the facial profile line. In some cases, this angle is larger and the tip protrudes, while in others it is smaller and the nose is low. Both cases present a small deviation from aesthetics. To correct the projections, we apply the columella sliding technique.

This is a nasal tip correction method, created by Dr. Serdev. It is a simplified technique for fixation of the skin-cartilaginous part of the columella to the septum (the stable cartilage, which divides the two halves of the nose and provides stability to the tip). We can slide the columella up or down to adjust the projection of the tip. In this way, we achieve the aesthetic angle of the nose to the profile line, described above. We do not use implants or transplants. During the follow-up session on the day after surgery, we clean the nose to remove crusts. Patients can immediately resume their social activities.

The intervention is mini-invasive, atraumatic and bloodless. There are no visible signs of surgery and no hospitalisation.


Narrowing the Tip of the Nose

This is a suturing (sewing) procedure, which tightens and narrows the cartilage on the tip of the nose. For this purpose we either pass through the mucosa or through needle punctures of the skin (no scars remain in either approach). Like with every injection, puncture traces disappear within 1-2 days. Because we do not open the nose, the procedure for narrowing the nose tip is bloodless and traumatic. There are no plasters or intranasal tamponade. As with all other Serdev techniques, patients can be socially active immediately after their rhinoplasty.


All nasal tip correction procedures – shortening, projection, or narrowing can be performed independently (in the absence of a hump) or in combination with other Serdev rhinoplasty techniques or as parts of complete rhinoplasty. Thanks to the atraumatic nature  of  these methods, they may be combined with different scarless Serdev Suture lifts or ultrasonic liposculpture of the face.


Read more: Humpectomy (nasal hump removal); Narrowing of the nostrils; Narrowing the back of the nose


Nostrils Narrowing

Thanks to Dr Serdev’s author’s techniques in rhinoplasty, we can do non-invasive and atraumatic nostrils narrowing without scars. The nose sits in the middle of the face and aesthetics proportions largely depend on it. Therefore, when narrowing the nostrils we have to take into account the aesthetic 30 degrees deviation of each nostril from the center line. It is important that the correction des not interfere with breathing, because the function of the nose is more important than its shape.

There is also a method for narrowing the nostrils, where the surgeon has to cut off a part of the nostrils. This is an invasive approach and more or less visible scars may remain. This is why we do not recommend this approach and practice it only in select special cases. In addition, cutting the nostrils requires more healing time.

When using Dr. Serdev’s suturing technique, there is no downtime and no visible scars remain. Patients canimmediately resume their daily routines.

The procedure for narrowing the nostrils can be done as a standalone procedure, in combination with other Serdev Techniques for Atraumatic Nose Correction or with complete rhinoplasty. For the purpose of beautification and thanks to the atraumatic nature of the methodology, rhinoplasty can also (if necessary) be combined with different liftings using scarless Serdev Sutures methods  or VASER ultrasonic liposculpture on face and body.


See more: Hump Removal; Narrowing of the nose; Nasal tip correction (narrowing, shortening)


Scarless Lower Face and Neck SMAS Lift

When is Lower Face and Neck Lift necessary?

Ptosis and laxity of the “subdermal facial mask” (the SMAS) in lower face and neck reflect the signs of overall ageing, including ageing of the lower face. The primary goal of the lower face and neck lift is straightening and repositioning of the subdermal mask (the SMAS/platysma), to which the skin is attached. We thus achieve refreshing the facial appearance, as well as rejuvenation and beautification. The effect of the procedure should correspond to the aesthetic angles, proportions and anatomic position typical for youth.

We use the lower face lift to sculpt the jaw line, define the cervico-mandibular angle and soften the nasolabial and marionette folds. The procedure is necessary mostly in cases of minor and medium jowling, submental laxity and neck wrinkling. It is ideal in cases of beautification, associated with early or medium facial ptosis.

The result is visible immediately after surgery and is durable. Of course, we cannot stop the ageing process, but it will continue from the new, lifted and rejuvenated position.

Read more: Overall face beautification


What is SMAS?

Back in 1972, surgeons demonstrated that after classic open approach face lifting the skin is not stable and elongates in minutesSince then, lifting of the Superficial Muscle-Aponeurotic System of the face (SMAS) became the obligatory method for surgical face lift, in order to maintain a long lasting result.

The skin and soft tissue do not drop easily, thanks to their strong fixation to the SMAS. Therefore, if we separate the skinfrom the SMAS, it will age and drop faster, because it will have lost its stable support. As a result, a subsequent SMAS lift will not be able to pull and lift the skinThe consequences of separating the skinfrom the SMAS are a mask-like stretched appearance, changed hairline position behind the ears etc.Naturally, we strongly oppose such this approach.

"What if I have subdermal fat?"

Subdermal and submental fat in the lower face and neck causes square, "bulldog" appearance. Since it is superficial to SMAS and hangs from the skin, we cannot lift it with the SMAS lift. In such cases, a VASER ultrasonic liposculpture may be necessary to achieve the best possible lifting results. We will thus remove the fat depots, prior to or during the lower face and neck lift procedure. In addition, this procedure tightens the skin gradually.

Serdev Suture Method for Lower Face Lift

Thanks to the concept of transcutaneous Serdev Suture lifts, we tighten and elevate the lower face and neck without unnecessary incisions, thus leaving no scars. As explained above, the SMAS holds the skin and soft tissue. Therefore, lifting and fixating it to a higher position enables repositioning of soft tissue structures as well. We carry out the procedure only through skin puncture points, which heal and disappear in 2-3 days. Patients can immediately resume their sоcial life. There might be a tight, "pulling" sensation in the first week after surgery. Every surgical intervention leads to a reactive swelling. However, swelling after Serdev Sutures liftings is minimal and can be covereed by the hair.

We can apply the procedure to patients of almost any age, if there is sagging of the skin and wrinkling of the neck. This lower face lifting method is suible for men as well, because there is no excision of skin and scarring in front or behind the ears.

Cases when Lower Face and Neck lift might not be sufficient

In cases of more pronounced ptosis, the lower face and neck lift might be insufficient to achieve a satisfactory aesthetic result. In these instances, we have to combine it with temporal and mid-face lifts via Serdev Sutures method, in order to pull the skin from these higher levels as well. We will thus reduce sagging in the lower face and diminish the need to lift it. In this way we rejuvenate the entire face.

When we communicate, we look each other in the eyes. Their beautification is not less important than that of the lower face and neck. The correct approach with suture lifts is to start with upper lifting at a younger, as well as at an older age. In this way we open and rejuvenate the eyeslift the edges of the eyes and lips, restore the cheekbones etc. When we do simultaneously upper, mid-face and lower face and neck lift, we always start with the temporal upper lift.

Other areas which must not be overlooked when ageing are brows and cheekones. A cheekbone lift has a greater effect on the nasolabial and marionette folds.

When we begin the beautification process with some necessary lifts at a younger age (35-45 years), the skin and tissues are more elastic. The effect is more stable, with a more youthful appearance. Ageing is slower, with less sagging. Then, after the age of 55, we can add only a few smaller procedures. We will thus maitain the aesthetic result and will not need skin excision lifts. This is why patients must not wait for an overall facial ptosis after the age of 60 and undergo a classic excision lift. 

Thanks to Serdev Suture Lifts, patients maintain natural look, without the "operated on" appearance. This is a major difference in relation to the classic lifting methods. The latter are characterized with separation and excision of the skin from the SMAS. They are performed at an older age and leave scars, unsuitable for young and middle-aged patients.

Patient Testimonial

Lateral Canthus Lifting via Serdev Suture

Lifting the corner of the eye

We perform the lateral canthus lifting without leaving scars, using the Serdev Sutures Lifting method. This specific procedure is useful in cases of low lateral position of the eye or large round eyes, “scleral show” in thyrotoxicosis. These problems could be congenital or acquired with age. They can also be due to surgeries, such as excessive skin excision during blepharoplasty, incorrect facelift or after removal of tumors.

In the case of the first picture below, the patient had an eye tumor removed. This is why the tissues around the eye hang without support. We therefore lifted the lateral canthus (lateral corner) of the eye to a normal position by suture. The eye line is equalised. This allows the surgeon to place an artificial eye bulb, helping the patient to achieve a normal look.

Read also – Brow LiftLiftings of the face


Atraumatic Procedure

The suture lifting method of Prof. Dr. Serdev allows for lifting and stable attachment of the lateral canthus (corner) of the eye to the orbit periosteum. There is no cutting and separation of skin. Surgeon and patient plan the angle together. The procedure is performed through skin punctures, under local anesthesia. Thus, we cause no trauma. The result is durable and postoperative recovery is fast. Patients can resume their daily activities within 1-2 days.


Cheek Dimples Formation (Smiling Points)

Cheek dimples formation via Serdev Suture method is an easy and simple procedure. It consists of engaging the dermis at the point where the dimple should be located. We do this with the help of a skin puncture point at both ends of the dimple.

We do not cut skin and therefore, we leave no scars. The punctures visibly disappear within 1-2 days. Patients can immediately return to their social life.

The formation of smiling points can be performed as a standalone procedure or as part of cheekbone lift and volumizing and in simultaneous combination with other Serdev techniques.


Read more – Creation of chin dimpleOverall Face Beautification Without ScarsCheeks Liposculpturing

Chin Dimple Creation

Chin dimple creation is a scaless procesure, made possible by Dr. Serdev’s Suture method. It consists of attaching dermis to the periosteum (the firm membrane that covers the outer surface of the bones). We do not use implants, only skin puncture points. They are placed on both ends of the dimple, in order to capture the dermis between them. Additional punctures may be needed in case of additional chin enhancement (lifting, volume creation or position correction).

Read more – Cheek dimples creationOverall Face Beautification Without ScarsVASER Liposculpture of Double Chin

The chin dimple creation is an ambulatory procedure, done under local anesthesia. Puncture points heal and disappear in 1-3 days. Return to social life is immediate and the results are durable.


chin dimple creation

Chin Dimple Creation – Serdev Sutures method

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