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

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

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!

In a composite facelift The skin remains attached to the SMAS and is carried with it as the SMAS is repositioned and secured. This improves blood supply to the skin and allows for a tension free closure of the skin. The more conventional facelift separates the skin from the SMAS where they are dealt with independently.

Your question is a great one and you will certainly find lots of different opinions but the true difference between a SMAS facelift and a composite facelift is actually the number of planes of dissection.  Simply put in any "SMAS" approach the skin flap is undermined as a separate entity from the superficial surface of the SMAS.  A true SMAS flap facelift then completes a full dissection underneath the SMAS to mobilize and support it.  Thus a SMAS facelift has two separate flaps and two complete plains of dissection.  There are of course variations of this such as "SMASectomy" and SMAS plication.  In my opinion of the SMAS techniques the extended full SMAS flap is superior as it affords excellent control of vectors and natural redraping.  Early in my career I trained with James Stuzin who is an advocate of extended SMAS facelifts and had wonderful results with this technique.  My technique evolved however to selected dissection and towards more of  a composite technique for several important reasons and I believe my results and recovery period is vastly superior to my previous results.  A composite facelift means that for the most part the SMAS and skin are a composite unit transposed together.  This makes  a lot of sense- instead of devascularizing both the skin and SMAS weakening them and relying on scar planes to hold them together, a composite facelift harnesses the power of ligamentous zones of adhesion to support the lift.  In the composite lift that I employ, subcutaneous dissection is very limited and the SMAS is opened in the mobile space over the masseter muscle.  at this point a potential space called the premasseteric space is entered and developed.  The roof of this space is freed and the branches of the facial nerve are left on the floor.  Some surgeons are not comfortable with this proximity but personally I feel it is the safest as the anatomy is clearly visible in general.  Once the space is developed the composite unit of healthy well vascularized skin and SMAS is elevated and repositioned and secured to the fixed SMAS closer to the ear creating a new ligament between sturdy tissues with excellent blood supply.  Because the complosite unit is moved back together, there is almost zero dead space and very low risk of hematoma.  I have found that I can get a more dramatic natural appearing rejuvenation with less swelling and recovery doing things this way.  Another advantage is that unlike the full SMAS technique where there is always some degree of tension on the skin flaps(although most is supported by SMAS) the composite flap is secured so close to the suture line that skin closure can be truly zero tension and the scars are almost imperceptible in days.  Keep in mind that every surgeon has different variations in the way they address these issues and may use the words composite to describe something different.  Although I am now a huge proponent of the composite technique with my personal modifications, there are good and bad results with all techniques and the most important aspect of your decision is the surgeon that you choose.  There's more than one way to skin a cat!  I hope this helps!all the best,Rian A. Maercks M.D.

Your question is a good one.It demonstrates that you have been doing some homework to better understand the variety of surgical techniques being used in Aesthetic Surgery, and it reflects your difficulty realizing a clear definition of these different approaches.This difficulty is understandable given that these are the same issues being discussed at national plastic surgery society meetings. It is hard to find consensus on these matters among surgeons as well. This is due to the fact that many different maneuvers have developed for use during a face and neck lift, each of which manipulate small areas within the structure of the face, in turn producing subtle differences in the results obtainable.However I would argue that the question is not a good one if you are looking for a good surgeon to give you a good and safe aesthetic surgery result.Whether he uses a SMAS or Composite technique, or one or multiple of
many other options which exist, should not be your concern.I recommend you concentrate on finding a surgeon who is well educated, board-certified, works in a safe environment, is recommended by local hospital staff, who can communicate well, who listens to you, who has patients you can speak with, and offers a solution for your goals which makes sense. Be well.-drB

It is very difficult for the lay person to understand the nuances and differences between these 2 types of face lifting techniques. Even with 10 facial surgeons in the room,  each surgeon would have different opinions on what is the right procedure to do.  Both of these procedures  involve lifting the facial muscles/ fascia and deep structures. More importantly, is to perform the facelift procedure so that  you end up with  natural appearing results. Each surgeon may have a small different twist on each one of these procedures so it can get rather confusing. Look for a facelift surgeon with lots of before and after photographs that you like, has excellent ratings, reviews, testimonials, and is board certified. For many examples of facelifts, please see the link and the video below

Thank you for the question. SMAS- describes a layer of support tissue which sits below the skin and subcutaneous tissue of the face continuous with the platysma muscle in the neck. SMAS facelift procedures involve elevating or tightening and suturing this layer to recreate a youthful look. A composite facelift involves elevating and repositioning the SMAS, platysma, cheek fat and orbicular muscle  of the eye through a more extensive incision extending into the hairline. In the correct patient, either procedure can produce a great result.

There are many variations of facelifts. A composite facelift is a SMAS facelift that includes a mid-facelift. When done properly, it has excellent results. However, a modified MACS Lift and mid facelift or an "Extended MACS Lift" with modifications can do the same thing with faster recovery and more natural results in my opinion.