What is a composite facelift and how does it differ from a SMAS?

Thank you for your question. In a composite facelift the flap is elevated under the SMAS with the skin remaining attached to it. In a SMAS facelift the skin is elevated from the SMAS; the SMAS is then either plicated (folded on itself with sutures) or imbricated (partially excised and then closed with sutures). I hope this helps!

To begin, there are many types of facelift procedures. In general, there are three main issues that modern facelift surgery must address - the loose skin, the underlying support, and the loss of volume in the face. While there are general themes of change as we age, patients can present with different degrees of problems related to the above issues. That's why treatment should be individualized for the specific needs of the patient. I do not believe that one technique fits all.After learning the Composite first hand from it's "inventor" Dr. Sam Hamra, I have learned which patients benefit most from this more technically demanding technique. The Composite lift uses a deeper level of dissection in order to create a thicker "flap" of tissue. This thicker flap of tissue, which included the skine and SMAS together, can better withstand a tighter movement. Also it tends to restore volume in a very natural way. I generally perform a midface lift with the Composite lift. This combination gives the smoothest transition from the cheek up into the the lower eyelid. The Composite lift gives great support to the midface lift - so they complement each other very well. The down side is that there is usually more swelling and takes a few more weeks to recover from. i think it is worth it in the right patient.The SMAS technique is the workhorse of most experienced Plastic surgeons. Once the skin is lifted the the SMAS, which is the support layer of the face, is manipulated in a number of different ways. It can be lifted, reduced, moved, and folded on itself to create more volume. Some SMAS procedures are superficial while others are very comprehensive. Again, depending on what problems the patients have will depend upon what choices the surgeon will make on how to deal with the SMAS. As you can see there is not a one-size-fits-all procedure. let your surgeon help you to understand what your issues are and what technique might work best. good luck.

Composite facelifts are not routinely done anymore and have some long term sequelae which may not give you the natural look that you desire.  SMAS facelift incorporates lifting the deep layers laterally and filling centrally therefore a lift and fill facelift gives you a natural, long term look.  Please seek out a board certified plastic surgeon for an in-depth consultation