SMAS and skin fascia, what are the major differences between a Facelift where the skin is moved and SMAS?

There are a variety of facelift techniques, but all should be focused on lifting the deep layer (SMAS) of the face. Lifting on skin alone will not create a good result or a lasting result. I personally recommend a customized approach to facelifting. Many of my patients can get a fantastic result with a technique that I perform in the office setting (a minilift), while others have anatomy that needs a more sophisticated approach that I perform in an operating room (high SMAS deep plane facelift). Some need additional surgery under the muscle under the chin. I would highly recommend you see someone that specializes in facial rejuvenation.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

There are several different types of face-lift techniques available today.  The SMAS layer is the fascia and skin below your facial and neck skin.  By mobilizing this tissue, and tightening this layer, you will have a more natural and longer lasting result.  This is the layer of tissue that sags with aging.  A skin only face-lift, will not be long lasting, and is a much simpler procedure.

Hi there. It is can be quite confusing with so many different terms and variations in technique so you are not alone in struggling to decipher the differences. Basically, a skin only facelift is a historical procedure except in very rare circumstances. Manipulating the deeper tissue of the face (SMAS layer) is the key to getting a natural look and long-term results. This can be done in a variety of ways - removal of a section of SMAS, suspending the SMAS (pulling it higher up on the cheeks), or just tightening it (plication or imbrication techniques). All SMAS techniques work to some extent and the key is probably your surgeon's experience or expertise with a particular technique. Good luck!

Thank you for your question. For a facelift to be successful, the anatomical changes of aging must be reversed. A modern facelift does not just tighten the skin. This gives a windblown and unnatural appearance. Instead, the most advanced techniques refinish the skin, reposition and contour unfavorable fat deposits and tighten the muscles creating a natural appearing and long lasting, youthful facelift. I suggest that you discuss with your surgeon. Your surgeon should be more than willing to disclose with you all of your surgical information. That transparency is part of the patient-surgeon relationship. Always consult with a board certified facial plastic surgeon.Best wishes,

Skin placed under tension will stretch. For this reason I feel strongly that every facelift should have the tension placed in the SMAS and or muscle layers before advancing and removing skin excess. Additionally, like making a bed, the underlying layers should be firmed  before removing the slack from the top layer (skin) for a smooth toned appearance.  The direction of lifting should that which naturally removes the slack. This may be somewhat different for each layer and even vary for each person

SMAS is a layer of tissue under the skin and subcutaneous fat that when manipulated in a facelift either by imbricating it or raising it as a flap and suturing it under tension, helps give facelifts results longevity.  Skin only lifts tend not to last as long. 

SMAS (superficial musculo aponeurotic system) is a layer of connective tissue that connects the skin to the underlying muscles. It is a thin layer that has strength. The layer may be tightened by raising it and attaching to itself in a higher position. It may also be partially removed and the edges tightened as well as imbricated ( meaning it is folded on itself and held there with sutures). 
The difference between a skin procedure and a SMAS procedure is that in the latter you tighten both the skin and SMAS. Both require skin removal as well.
I personally always do SMAS manipulation in my lifts. There is little risk and the benefits are worth it.
Hope this helps
Dr. J
A. Dean Jabs, MD, PhD, FACS

Excellent question, thank you Zeyah.The SMAS is made of all muscles of facial animation, which are linked together by collagen fibers called fascia.  They form one layer.  The SMAS also has small attachment to the skin.A 2 layer facelift will normally lift both the skin and the SMAS independently for some distance after which point they may be raised "en bloc" i.e. as one unit.I like to use part of the SMAS to create flaps so I can lift and secure my tissues with 2 or 3 different vectors (high SMAS facelift), so I often cut the SMAS closer to the ears and away from the facial nerve branches.  I like to use a few permanent sutures.It is also important to release the retaining ligaments.Hope this helps!Kind regards,Dr. Marc DuPere, Aesthetic Plastic Surgeon

Today, modern facelift surgery addresses both the skin and deep tissue layers, which encompasses the SMAS and Platysma muscle.  "Skin Only" facelifts only remove and tighten excess sagging facial skin.  The skin is a very elastic tissue.  Surgeries which rely on the skin as the only layer of "facial tightening", typically do not provide lasting results.  Today's facelift surgery first addresses tightening the SMAS and platysma, allowing these deeper structures to provide the foundation for a lasting facelift.  Excess skin is then removed and the skin can be tightened without excessive tension, allowing for a more natural appearing result.  Good Luck!

The difference between a "skin only" facelift and a SMAS based facelift is huge.  The former is performed far less commonly because skin is an elastic, stretchable material that is not reliable for durable results.  Most experienced facelift Surgeons will utilize the SMAS in some capacity as the strength bearing layer for their facelift technique.  The way I describe it to my patients is that it is like pulling on the carpet liner (SMAS) so that you can remove redundant carpet (skin).  There are many ways that the SMAS can be handled successfully and no two Surgeons will perform a facelift the exact same way.