SMAS Facelift

Last updated date: 13-May-2023

Originally Written in English

SMAS Facelift


As we get older, our skin and tissues lose their elasticity. Then we start noticing wrinkles and skin sagging as we age. 

The cosmetic industry is working on these points, all the products we see in the market lately are anti-aging with vitamin C, hyaluronic acid, and many other components that help people keep their skin integrity. However, some people don’t prefer long-term solutions, rather they prefer instant solutions with quick results. The medical field, especially plastic surgery, has accomplished what they wished for.

One of the most significant face support structures is the superficial muscular aponeurotic system (SMAS). It is made up of a tissue layer that exists in the deep inner layers of the skin.

The SMAS lift is a more advanced facelift technique that focuses on the lower two-thirds of the face. The SMAS facelift can deliver excellent, long-lasting cosmetic rejuvenation outcomes by addressing the support layers of facial tissue.

SMAS facelift surgery is a complicated treatment that involves a significant understanding of face anatomy, a very specialized set of surgical methods, and a highly developed aesthetic eye. Because not all cosmetic surgeons obtain facelift surgery training during their residency, it's critical to complete your research before selecting a facelift surgeon.


What is a SMAS Facelift?

SMAS Facelift Definition

As your facial skin ages, it loses elasticity in both the epidermis and the SMAS membrane. This loss causes sagging cheeks around the jaw bone, fleshy jowls, and, in some cases, a double chin. The cheek fat will then fall forward, showing the nasolabial folds.

With age, the SMAS descends on the bottom two-thirds of the face and neck. The "turkey neck" appearance is formed by the front edge of the platysma muscles of the neck.

By tightening the muscle, removing fat, and reducing extra skin, a SMAS facelift can reduce some obvious symptoms of aging.

The SMAS facelift can correct the following:

  • Sagging in the midface.
  • Hollow cheeks.
  • Nasolabial folds.
  • Jowls.
  • Sagging fat.
  • Loose skin and fat under the chin and jawline.
  • Sagging of the neck.


Superficial Muscular Aponeurotic System (SMAS) Anatomy

Superficial Muscular Aponeurotic System

The superficial musculoaponeurotic system (SMAS) is a layer of fibrous tissues and muscles that begins slightly in front of and below the ear and extends down to the neck.

As a continuous fibromuscular tissue, this thin yet strong layer covers and unites the muscles and tissues of the face, midface, and neck. It includes muscular regions, fat pads, and the whole cheek area, as well as adhering to the platysma, a superficial muscle that covers the lower face, jawline, and neck muscles.

As we age, the platysma muscle in the neck produces vertical muscular bands and "turkey neck." This fibrous layer is subsequently hidden behind a fat (adipose tissue) and skin layer. The SMAS's function is to keep the mimic muscles, which are vital for facial expressions, in a normal position.


Benefits of SMAS Facelift

Benefits of SMAS Facelift

Some characteristics of a SMAS Facelift include:

  • Surgery time lasts 1½ to 2 hours long.
  • Repositioning the SMAS results in vertical elevation of the face and neck.
  • Drooping/Turkey Neck and Jowl Removal.
  • the appearance of youth and naturalness.
  • Deep wrinkle removal with long-term results.
  • A simple treatment with few problems.


Who is a Good Candidate?

significant wrinkles

In general, if you have significant wrinkles and skin laxity, you may be an excellent candidate for this operation. Candidates must have a consultation visit to establish whether their skin condition is suitable for this operation or whether alternative treatments are more appropriate for their cosmetic objectives. Patients considering this surgery frequently express concerns such as:

  • Sagging or loose skin.
  • Moderate to severe wrinkles.
  • Sagging jowls.
  • Sunken cheeks.
  • Double chin.
  • Poor jawline.

Because this is a surgical procedure that will require the use of invasive techniques and general anesthesia, you must be completely qualified as a candidate before your treatment is planned. For others, this may imply that specific labs and blood tests must be completed before your treatment may be scheduled. Some of the qualifications we look at to see whether you are a good candidate for this operation include:

1. Good Health:

Patients must be in generally excellent health. This means you don't have any medical conditions, such as high blood pressure, diabetes, asthma or cardiovascular problems. If you are in good health, you will face less hazards if general anesthesia is required for your procedure. Your overall health will also influence how well you recover from the treatment, since people in excellent condition recover more swiftly and easily.

2. Elastic Skin Condition:

Your skin's condition is also important. Your skin condition should be such that some natural elasticity and flexibility remain in the structure of your skin. Essentially, your skin must still have some "bounce" for this technique to be as successful as possible. Your skin should be free of any suspected pathologies such face moles. The suppleness of your skin may be checked by pinching it and seeing how long it takes for it to smooth out. If your skin still feels squeezed, you may not be a good candidate for this operation.

3. Balanced Bone Structure:

It's easy to ignore, but the ideal candidates for this operation are individuals with naturally balanced bone structure. To get the optimum benefits from your therapy, your bone structure should be symmetrical. Of course, if your underlying bone structure isn't suitable for this therapy, other plastic surgery techniques can correct asymmetries, or you can use fillers to sculpt your face to achieve the best results.

4. Realistic Expectations:

You should also set reasonable goals for yourself. On average, this surgery may remove 10 years from your face, but factors like as your skin condition, genetics, and skin type may influence how much younger you seem following this operation. This technique just lifts and tightens the skin; it does not address other concerns, such as those relating to your bone structure. Please with your provider about the outcomes you may fairly expect from this operation.

5. Commitment To Maintain Results:

Patients who want this surgery should ideally be committed to keeping the outcomes of the treatment. Your procedure's benefits will persist for several years, but you will get the most out of them if you are proactive about your skin health. 

When you utilize active skincare products like retinol and protect your skin from UV exposure by wearing SPF during the day, you may be able to keep your results longer.


SMAS Facelift Contraindications

SMAS Facelift Contraindications

Poor medical health, people who take blood-thinning drugs on a regular basis, patients with unrealistic expectations, and heavy smokers are all relative contraindications. Fine wrinkles that may be effectively treated nonsurgically or conservatively are contraindications to facelift surgery. Secondary facelifts should be performed with prudence as well, because the scar from the previous treatment may alter the original tissue planes, increasing the risk of facial nerve injury.


How do You Know If You Need a Face Lift?

face lift procedure

For most people, cosmetic surgery is a "want" rather than a "need." However, there may be certain warning signals to look for to assess whether you may benefit from a face lift procedure. For example, you may do a simple at-home "pull" test to see whether or not this technique will help you reach your aesthetic goals. Simply stand in front of a mirror at home and use your fingertips to gently pull the skin around your ears forward; if this movement also raises the skin on your cheeks, you may find this process beneficial.

Naturally, because everyone's skin needs and goals differ, the signals that this procedure may be suited for you will differ. However, several examples indicate that now is the optimal time for this treatment, such as:

  • Deep wrinkles on the lower face.
  • Prominent cheekbones.
  • Sagging jowls.
  • Double chin or sagging neck.


Types of SMAS Facelift

Types of SMAS Facelift

SMAS facelifts are classified into five types: plication, imbrication, extended, high, and deep plane. Each of them refers to a somewhat different method of lifting and anchoring the SMAS layer. Surgeons have performed many of these types of facelifts throughout the years. Our current belief is that the deep plane facelift type of SMAS lift provides the most natural and long-term outcomes with the quickest recovery, however alternative forms of facelift have provided good results in some individuals. The two most prevalent SMAS facelift kinds are described below: 


SMAS Plication Facelift

SMAS Plication Facelift

  • Procedure:

Mitz's introduction and description of SMAS altered the idea of facelift. This approach was proposed as a new means of manipulating subcutaneous tissues to address senile changes in the face such as surface wrinkles and deep soft tissue sagging at the same time. 

The fibrofatty nature of the SMAS layer offers it higher resilience against gravity than skin. The idea of the SMAS plication method was to manipulate a stronger layer that can withstand higher stresses than skin.

In this approach, the dissection plane is supraSMAS. The SMAS layer is visible after dissecting in the subcutaneous plane. The mobile section of the SMAS layer is connected to the posterior relatively immobile layer (i.e., the parotidomasseteric fascia) by three vertical sutures. To prevent bulging, the excess SMAS layer might be cut after suturing. This method is recommended for people in their forties and fifties who have thin skin and moderate to severe laxity. This approach is not appropriate for obese persons with thick skin.

  • Advantages:

SMAS plication appears to be a simple treatment with minimal risk of facial nerve injury. Despite the manipulation of the SMAS layer, the dissection plane lies above this layer and the facial nerve plane, making this approach generally safe. In this procedure, the operation time is minimal, and the recovery times is favourable. 

This approach may produce a more visually beautiful midface outcome than DPFL. SMAS plication, on the other hand, may allow the surgeon to manage skin motions more effectively than MACS lift and is less invasive than subSMAS treatments.

  • Disadvantages:

This treatment is more challenging than DPFL for resolving neck aging. This problem is caused by an insufficient release of platysma facial attachments. SMAS plication is more invasive than other types of lifting, such as MACS lift. The surgeon is unable to manipulate deeply positioned soft tissues under the SMAS layer, resulting in very short-term effects as compared to DPFLs.


Extended SMAS Facelift

Extended SMAS Facelift

  • Procedure:

Lemmon's description of subSMAS dissection was quickly adopted by aesthetic surgeons. The main principle of subSMAS modifications is to support the overlaying skin by modifying deeper soft tissues (i.e., the SMAS layer). Although SMAS plication appears to produce better results when the SMAS layer is thin, dissection of thick SMAS layers produces better results.

The fundamental approach for this method is to dissect and draw skin and SMAS flaps individually. The skin flap is initially dissected in the subcutaneous plane. After incising the SMAS layer, dissection is proceeded in the subSMAS plane.

There are five critical landmarks during performing extended SMAS facelifting:

  1. The first point is 1 cm inferior to the zygomatic arch, which is the origin of the frontal branch of the facial nerve. The incision to start subSMAS dissection is from this point.
  2. The second important landmark is the beginning point of releasing and dissecting the platysmal auricular ligament. This second landmark is 3 cm below the earlobe.
  3. The third point is 5 cm below the mandibular angle, which is the inferior extent of subplatysmal dissection.
  4. Fourth landmark is the anterior border of the subplatysmal dissection, which is identified by the facial vein where it crosses the inferior border of the mandible.
  5. The last landmark is the zygomaticus major muscle, which is the anterior limit of subSMAS dissection in the cheek.


The SMAS layer's stretching vector differs from that of the skin. The SMAS layer's retracting vector is more vertical than the skin flap's. To enhance the jowl and cervical shape, the SMAS and platysma flaps might be adjusted in the postauricular region. The SMAS flap is advanced superolaterally in the malar fat pad region, perpendicular to the nasolabial fold.

  • Advantages:

By adjusting the skin and SMAS flaps independently, the surgeon is better able to reverse the symptoms of aging. Because the facial ligaments are released and the malar fat pad is repositioned, the results of this method are long lasting. As previously stated, we are capable of replacing the malar fat pad with this approach. A continuous SMASplatysmal flap can be used to provide the best results on the lower face and neck. By separating the skin and SMAS flaps, the strain of the skin flap is reduced, preventing the artificial look of skin found in other facelift procedures.

  • Disadvantages:

This approach requires more time to perform than other modifications. To split the soft tissue of the face into two different sections, this surgery is technically sensitive and requires a great deal of experience. This approach carries a substantial risk of facial nerve injury. Extensive dissection of skin areas increases the risk of necrosis. In this procedure, the impaired viability of the skin flap is a key problem. In younger individuals with minimal age signs and a youthful lower face and neck, this surgery is not recommended. In these cases, less invasive procedures such as short scar facelift methods are used.


SMAS Facelift Cost

SMAS Facelift Cost

The cost of SMAS layer facial plastic surgery varies based on the individual, their specific needs for their facelift, and the surgeon's skill. A SMAS facelift might cost anywhere from $10,000 to $15,000 or more on average.

Of course, keep in mind that the money you spend on the facelift is a direct investment in yourself and your self-esteem.


What Happens After SMAS Facelift?

After SMAS Facelift

A healthcare practitioner will transport you to a room for observation while you recover from your facelift surgery. Once you're stable, you'll be able to leave the hospital. This normally takes a few hours.

A bandage may be wrapped over your face to assist reduce swelling and bruising. Small drainage tubes may also be present.

Your surgeon will give you precise instructions for your facelift surgery recovery, including how to care for your incision site(s) and drains, and will arrange a follow-up visit before you leave. If pain medication is required, your surgeon will write you a prescription.


SMAS Facelift Recovery Time

SMAS Facelift Recovery Time

The amount of time it takes to recover from a facelift depends on the type of surgery and your overall health. You may get bruising and swelling for a few weeks. However, it may take two to three months for your face to feel "normal."


Complications/Risks Associated with SMAS Facelifts

SMAS Facelifts Risks

Facelift-related problems may include, but are not limited to, the following:

  1. Nerve damage. Along with numbness or alterations in skin feeling, facial nerve damage or weakening may develop. This might be either temporary or permanent.
  2. Infection and anesthetic response. As with any sort of surgery, there is a danger of infection and anesthetic response.
  3. Hematoma. A hematoma, or blood collection under the skin, might form. The doctor will usually remove them.
  4. Slower healing rate. Smokers, in particular, may experience a delayed recovery phase after a facelift. Smoking during the months preceding or following surgery might contribute to skin damage and permanent scarring. If you are actively smoking, your surgeon may refuse to conduct your procedure.
  5. Scarring. Scars that do not heal correctly may become more prominent or thicker than expected. This may need additional therapy or correction.



SMAS Facelift

The SMAS (superficial muscular aponeurotic system) is the layer of the muscles of facial expression in their own connective tissue envelope. It lies beneath the skin and subcutaneous tissue. It is one of the most important support structures for the face and neck. The manipulation of this anatomic structure changes the appearance of the face and neck.

The SMAS rhytidectomy, also known as SMAS facelift, is a surgical procedure that corrects the sagging appearance of the neck and the lower two-thirds of the face. It is performed to change the appearance of sagging skin, excess fat, jowls, and loss of volume in the cheeks. It is less invasive than a regular facelift, which targets the superficial skin of the face, and recuperation is faster. ​