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

Does cheek skin fascia get cut and skin detached from muscle in SMAS surgery or in SMAS skin is not getting detached from muscle but moved together with a muscle (and after that muscle cut or tighten)? I want to understand the major difference between facelift where just skin moved and SMAS Thank you!

Doctor Answers 32


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Good question.  Lots of different types of facelifts.  The SMAS is the name given to the layer of the face that has the muscles that are lifted during a facelift.  Think of a slice of meat in a sandwich (Gross-- I know) . The SMAS is a layer located below the skin. Think of the skin as a slice of bread over the meat (once again---I know).  A facelift can be performed where the skin is separated from the SMAS and only the skin is tightened.  The skin and the SMAS can be elevated separately and both can be tightened, separate from  each other.   The skin and the SMAS can be lifted together, i.e. lift the skin and SMAS as a unit. This type of facelift is called a "deep plane".  Everybody needs or benefits from different approaches. I feel strongly that any facelift should involve the SMAS. As you can see, I am working on my analogies.

Burbank Plastic Surgeon

Facelift options

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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 Specialist

Quintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Differences in Technique

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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. 

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

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

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 What is more important than the specific technique is the experience and artistry of the plastic surgeon. In a SMAS procedure, the tissue deep to the skin is either tightened, parially resected, or elevated which generally achieves a longer lasting and better result. Each surgeon has his or her own approach of how they dissect and what they do with the SMAS. Artistic natural results need to be individualized depending on the patient's anatomy.

I would suggest your a plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with who has all of the modalities of treatment available. You should discuss your concerns with that surgeon in person. Facial rejuvenation needs to be individualized. What would be an ideal approach for one patient is not necessarily the same for someone else. Based on the examination and discussion at the consultation, you should have a better understanding of the various options that can achieve the best cosmetic result for you.

Robert Singer, MD FACS

La Jolla, California 

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

SMAS -skin facelift?

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Most surgeons tighten both skin and SMAS with a full facelift. Don't try to figure out the technique but rather look at the surgeons actual results. Over 35 years of Facelifting I have seen so many bad results from patients picking a technique rather than an excellent experienced facelift surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

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

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 Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts.  Non smiling photos of your face from the front and side would help in the evaluation.  The SMAS layer is a thin muscle layer situated below the subcutaneous fat which is below the layers of the skin.  A proper SMAS facelift will do much more than simply remove the fascia (outer tissue layer of a muscle) but rather dissects, lifts, trims and re-sutures the entire SMAS layer into a lifted, elevated position.  This is the "primary" treatment for jowling of the face as described below. 

 Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:

  • very small incisions and no incisions extend or are placed within the hair.
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op

I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

SMAS facelift vs. skin facelift

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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.

Steven H. Wiener, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

SMAS Facelift Technique

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Personally, I use two different techniques for my facelifts both of which address the SMAS (a thin layer of connective tissue or fascia below the skin and above the muscle). Both techniques tighten the underlying muscle layer which is what gives you a lifted, youthful contour and then redrape the skin, trimming any excess. I think that addressing the SMAS delivers a more natural looking, youthful result than facelifts of old. Hope this helps.


Kouros Azar 

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 38 reviews

Facelift options - addressing loose skin and the SMAS layer

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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!


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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,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 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.