SMAS Facelift: What You Need to Know

Pros

• Most plastic surgeons consider the SMAS facelift technique the modern standard of facial rejuvenation. It provides better, more durable results than the skin-only traditional facelift of the past, which often left patients looking overly taut (the dreaded “windblown” result) and had less longevity.
• The SMAS lift typically addresses the neck as well as the soft tissues of the face to correct submental (under chin) fullness, laxity, and banding, for a more youthful appearance.
• In addition to smoothing sagging skin and creating a more defined jawline, the procedure can reduce nasolabial folds, jowls, a double chin, platysma bands, and other signs of aging that can be difficult or impossible to treat with nonsurgical methods.
• Incisions can be hidden in front of and/or behind your ears. Over time, scars that heal well become barely perceptible.
• Results from a SMAS facelift procedure last 10 years or more.
• While facelifts are often performed under general anesthesia, local anesthesia with oral or IV sedation is an option for patients who want to reduce their anesthesia risk and expense.

Cons

• It's a more significant surgical procedure than a skin-only facelift and comes with approximately two weeks of downtime.
• A SMAS facelift won’t address superficial skin concerns (fine lines, age spots, melasma, and so on). Ask your doctor about other skin rejuvenation options, like chemical peels and laser resurfacing, if you’d like to improve the tone and texture of your skin along with your lift.
• This type of facelift addresses the lower two-thirds of the face, from the cheeks to the neck, so if you want to lift your brow or eyelids, or improve the shape of your nose, you’ll need additional facial plastic surgery (a brow lift, blepharoplasty, or rhinoplasty, respectively). These procedures are commonly performed at the same time as a SMAS lift.

• Average Cost:
• $10,950

• Range:
• $9,600 - $24,000

Your SMAS facelift cost will depend on your surgeon’s level of experience, their practice location, and the details of your procedure. 

A facelift is elective cosmetic surgery, so it’s not covered by health insurance.

You can finance your treatment with CareCredit.

The SMAS facelift photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Good candidates for a SMAS facelift are healthy nonsmokers who are bothered by sagging, loose skin, jowls, deep folds, neck bands, and other prominent signs of aging in the lower face and neck. 

Younger patients with less severe skin laxity may benefit from a mini lift or a nonsurgical facelift.

SMAS facelifts are typically performed under general anesthesia, but they can be performed under local anesthesia with oral sedation or under IV sedation, says Dr. Madnani. 

The procedure can take under two hours or up to four, depending on your surgeon's technique and the extent of your procedure. Here’s what happens:

• First, your surgeon will make the incisions. They typically start in the hairline tuft/sideburn area, follow the natural lines around the front of the ear, and then travel down and around the earlobe, behind the ear.
• Then your surgeon will lift the skin and subcutaneous fat off of the SMAS and reposition, tighten, and secure the fibromuscular layer into a lifted position.
• A section of SMAS may be removed or the tissue may be folded over onto itself, to shorten and elevate the structure.
• Your surgeon will redrape your soft tissues and facial skin to complement the new contours of your face, trimming excess tissue before closing the incisions with tiny sutures. 
• In some cases, your surgeon will insert small drain tubes, to remove excess fluid that your body produces naturally during the healing process. 

You’ll leave the surgical facility the same day, with your face wrapped in bandages. Expect to be groggy from the anesthesia and make sure a trusted friend or family member is there, to get you safely home.

Downtime for a SMAS facelift averages 7–14 days. 

Your surgeon will give you detailed post-operative instructions for how to take care of your incisions, what issues to watch for, and when to take any pain medications. They’ll also schedule follow-up appointments to remove your stitches and drains (if you have them).

Your face will be swollen and bruised, especially during the first three days. The swelling will lessen significantly over the first two weeks after surgery. 

During that time, limit your activity, to avoid elevating your heart rate or sending blood to your face—that means no bending over, heavy lifting, or exercise beyond light walking. 

You’ll begin to see the results of your facelift as the swelling and bruising dissipate, but you probably won’t feel ready to go out in public until about two weeks after surgery. 

Your face may also feel tight and numb, both of which are considered normal and will resolve on their own within a few months.

You’ll see a difference in the contours of your face and neck as soon as your bandages come off, but it takes time for tissues to settle and swelling to recede. Normal movement should be restored within two to three months.

“Swelling after a facelift can take many months to resolve completely, but the majority of it is usually gone by about six weeks after surgery,” says Dr. Matthew Richardson, a facial plastic surgeon in Frisco, Texas. “After this point, the changes are more subtle, but swelling does continue to improve slowly over time.”

You’ll see your final results in six months to a year, once all the swelling has resolved.

The effects of a SMAS facelift typically last 10 years or more. It’s considered a permanent procedure, but your face will continue to change naturally as you age. 

“I like to explain to my patients that I cannot stop the aging process, but we were able to reset your face about 10-15 years back, and you will start aging forward again from this point,” says Dr. Madnani.

Risks include bleeding, infection, hematoma, asymmetrical results, distortion, sensory nerve damage, delayed healing, and poor scarring. 

All of these complications are rare, and you can reduce your risk by choosing an experienced, board-certified facial plastic surgeon.

Another risk to consider with any surgery is dissatisfaction with your results. It’s not uncommon for patients to complain of undercorrection—to feel disappointed in their outcomes if they were expecting a greater degree of improvement than they ultimately got. 

Have an honest discussion with your plastic surgeon about your expectations and the limitations of the SMAS facelift before undergoing surgery.