Does Lifting and Tightening the SMAS Cause Cheeks to Flatten?

A doctor told me that tightening the SMAS causes the cheek to flatten. Is this true and if so how do you avoid that? Also, if you just do a composite necklift which address the lower third of the face is the SMAS involved?

Doctor Answers (17)

Lifting the SMAS will add volume to your cheeks. Injecting fat can help too.

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It’s an excellent question. The SMAS is a layer of connective tissue that envelops the face and connects to the platysma muscle in the neck. As we age the SMAS and other facial tissues loosen and descend. When you re-elevate the SMAS you actually return these tissues to their original location. A SMAS facelift will restore volume to your cheeks, elevate your jowls, and improve the appearance of your neck.

As we age, we lose volume in our face. This volume can be improved by lifting the SMAS, but it’s often beneficial to add more volume with fat. Fat can be harvested using liposuction and transferred to the face with a small injection cannula. The volume restoration can be dramatic and adds a youthful appearance that goes beyond what a facelift can do alone. Fat can be injected into many areas within the face including the cheek area (malar area), the nasolabial fold, the junction between the lower eyelid and the cheek, along the superior orbital rim, as well as the temporal area.

Your surgeon will help you determine which treatments will work best for you.


Portland Plastic Surgeon

SMAS Facelifts Augments Cheeks

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Just the opposite of what you were told. The SMAS lift re-positions your cheek fat over your cheek bones to augment, not flatten it. A composite lift is losing favor among many plastic surgeons due to the very long recovery time. It moves tissues at a deep plane level close to the bone in many areas lifting all tissues more superficial including the SMAS. As this is not the location for tissue aging it makes less sense than turning back anatomically the aging process

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 51 reviews

SMAS Facelift and Cheek Flattening

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The use of the SMAS does not cause the cheek to flatten.  The use of the high SMAS procedure will actually increase the fullness over the cheekbones and help to restore the heart-shaped face of youth.  The use of the SMAS will also allow for for improvement of the lower face and neck.   

Michael Sundine, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 15 reviews

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SMAS plus adding volume to the cheeks

+1

No, SMAS should not cause the cheeks to flatten. But keep in mind that the cheeks are not addressed with lifting during SMAS. If your cheeks need to be rejuvenated, that will require add volume to them with fat, Sculptra or fillers.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

SMAS and cheek flattening

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It depends upon where the muscle is sutured. The important thing, if a patient has any qualms about which area of the cheek would be tightened and flattened, is to discuss them with her plastic surgeon.

Robert L. Kraft, MD
New York Plastic Surgeon
5.0 out of 5 stars 13 reviews

Smas facelift

+1

Liftint he soft tissue of the face by suing the SMAS doesn't flatten the cheeks but often autoaugments them.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

SMAS Elevation Creates Voluptuous NOT Flat Faces.

+1
It is skin tightening across cheeks that causes flat faces.  A advanced technique SMAS Facelift should uses the SMAS layer as a vector to carry the facial fat to more superior positions, enhancing cheeks, periorbital, and cheekbone regions.  This result actually looks more full and voluptuous, with little tension applied to the skin for the actual lift.  Facelifts that rely upon tension on the skin move little of the facial fat, and when pulled over structures such as the cheekbones, actually make structures appear flatter, due to the taught skin draped over them.  While these types commonly performed skin facelifts, results are disappointing after 3-6 months when swelling subsides, and little change is seen.  Due to the skin tension applied to perform such facelifts, incisions and resulting scars are usually obvious and such patients generally look "pulled".

Daniel Shapiro, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 100 reviews

SMAS cause cheeks to flatten

+1

As the majority of the expert posters have stated NO! The SMAS if done correctly can not flatten the cheek, just the opposite happens. Please re think the question.

From MIAMI DR. B

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 64 reviews

SMAS facelift do not cause cheeks to flatten

+1

The cheeks themselves are not flattened with SMAS tightening. However, there can be a slight flattening effect in the area in front of the ear due to tightening of the SMAS itself. This is not over the cheek area; it is just in front of the ear. The SMAS is involved with a comprehensive face/neck lift. The SMAS is not involved with a neck lift only procedure.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

SMAS Facelift do NOT flatten cheeks

+1

The cheek or the malar eminence is a bony structure which short of being hit well with a powerful blunt object cannot be flattened. There is no way in which pulling on the SMAS will lead to cheek flattening and I must only conclude that either your surgeon was inarticulate or you may have misunderstood him.

There is a large number of SMAS manipulation based Facelift procedures all of which lift the neck and sagging face structures and put them back in their attractive youthful positions. It is THE most effective and popular Facelift in the world. IF such procedures resulted in facial flattening and narrowing, do you think they would be so popular?

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 66 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.