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 (16)

SMAS Facelifts Augments Cheeks


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

Orange County Plastic Surgeon
5.0 out of 5 stars 45 reviews

SMAS Facelift and Cheek Flattening


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

SMAS plus adding volume to the cheeks


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 3 reviews

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SMAS and cheek flattening

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
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Smas facelift


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 17 reviews

SMAS Elevation Creates Voluptuous NOT Flat Faces.

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 95 reviews

SMAS cause cheeks to flatten


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.


Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

SMAS facelift do not cause cheeks to flatten


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 58 reviews

SMAS Facelift do NOT flatten cheeks


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 61 reviews

SMAS face lift


The SMAS in a face lift is the vital structure that allows the tightening of the facial structures. There are many ways to deal with the SMAS depending on the experience and knowledge of the surgeon.

When contemplating and planning for a face lift, the amount of subcutaneous tissue is taken in consideration as well.

The SMAS can be used to give bulk to the cheek and infact there are techniques that  the SMAS can lift the cheeck.

If there is not enough subcutaneous tissue then add fat grafting during the face lift.

See a BOARD CERTIFIED PLATIC SURGEON to discuss your needs

Samir Shureih, MD
Baltimore Plastic Surgeon

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.