Mini facelift or SMAS facelift?

Question

I have sagging jowls caused by jaw reduction. I've seen 2 doctors, 1 doctor recommended mini facelift, cutting excess skin without tightening muscles underneath, the other one recommended SMAS which will tighten muscles. May I know which one is recommended for my case. I'm 36 years old, given my sagging is due to the jaw reduction.

Alan B. Brackup, MD, FACS · Answer

Thank you for your question. I do think a photo would help in giving a better opinion on this since your age is the only thing that is making me unsure. Typically I always recommend addressing both the skin and the underlying structures (muscles, etc). I would suggest you meet with a provider who can assess you in person for a more accurate suggestion.

Jason Emer, MD · Answer

FaceTite can internally tighten the skin in the lower face and neck. After all the skin has been heated and contracted, we shape the neck with liposuction to give definition and remove stubborn pockets of fat. In one quick treatment, we can tighten skin, remove fat, and contour the lower face, jawline, and jowls with only a weekend of downtime.​  Keep in mind that combination approaches will give you a more significant improvement as opposed to a single procedure. I recommend getting a consultation with a board-certified cosmetic dermatologist and facial sculpting expert. Best, Dr. Emer

Larry S. Nichter, MD, MS, FACS · Answer

The existing terminology for surgical facial rejuvenation is certainly confusing. In reality a mini-facelift may involve tightening of the SMAS which is the supporting structure for the overlying skin and underlying muscles that sag with the aging process. See the below link for further details for example, the LiteLift# which is a combination of both procedures.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question.  Just with skin tightening, because skin is so elastic the longevity will only be a few months.  The SMAS muscle needs to the tightened to ensure the longevity of a 5-10 years.  As you are young and possibility do not have a lot of lose skin, a mini lift maybe ok for you now, as long as you have the expectation that it may only last a few months - year.  However, this may see you through until you need a SMAS facelift.  I think you have to examine what your expectations are so you are not disappointed.  All The Best

Konstantin Vasyukevich, MD · Answer

Dear Isabelle,Thank you for your question.  I would strongly recommend choosing a facelift with muscle (SMAS) tightening as oppose to skin only facelift.  In my opinion, a facelift with muscle tightening will produce a far better result.  It will also look more natural and the result will last much longer.  Skin only facelifts are rarely performed today even as a part of a mini facelift.Best wishes!Dr. Konstantin

Robert M. Tornambe, MD · Answer

Isabelle.   Since you are so young, It sounds like you are a candidate for a Mini-Facelift. My favorite technique is the MACS short scar Mini-Facelift. Developed in Europe, it is the ideal approach for the younger patient, not ready for a full facelift, or patients who desire a less invasive procedure with a shorter recovery time. You might also consider fat grafting to your face to re-define your jaw line and fill out those areas that have lost volume after your jaw surgery. Be certain to consult with a board-certified plastic surgeon. Good luck!

Paul S. Howard, MD · Answer

We are all subject to language confusion in plastic surgery especially in facelift surgery. In my lexicon a mini-facelift refers to the smallest incision possible facelift which generally depends on the amount of skin to be removed and the skin's elasticity. I do a SMAS plication with every facelift regardless of the incision length so the SMAS work is not an either/or with a mini-lift. At 36 you can have the best of both worlds and probably have a mini-facelift with a SMAS correction also. Don't vote on the either/or scenario.

Leon Goldstein, MD · Answer

Photos would be helpful, but an in-person consultation even more. I usually perform a SMAS procedure with any facial procedure as this adds so much to the final result and a more lasting effect.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Non smiling photos of your face from the front and side would help in the evaluation.  I recognize the difficulty in differentiating between different opinions and even the types of facelifts themselves so let me say a few things in that regard.  
1. The primary indication for any form of facelift is the presence of "jowls" in the lower face.  
2. The reality is that there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  So it's paramount for you to understand exactly "what" any proposed facelift is designed to accomplish.
3. It's helpful to think of the facial tissues in layers from the inside out:  The bone, the muscles that move the face/nerves that operate those muscles, the SMAS muscle layer, the subcutaneous fat layer and finally the skin.  Facelifts are by nature designed to reduce the appearance of "jowls", tighten and remove excess skin.  In the 1980's it became standard that the SMAS muscle layer was also lifted as it was shown to not only improve the aesthetic appearance, following a facelift, but add longevity to the results.  Over the years there have been numerous methods of addressing the SMAS, with "imbrication" being the "gold standard" and most effective.  Imbrication means the SMAS layer is dissected, lifted, trimmed and re-sutured back together in the elevated position.  Plication means the SMAS is not dissected, lifted or trimmed but is "folded" upon itself. While this method is faster and easier for the facelift surgeon it's not accepted as effective as SMAS imbrication.  Finally, even less effective are suspension SMAS techniques using sutures or threads.
 Modification and shaping the face then should address the fat layer and the skeletal structure to create either a soft, feminine heart shaped face in women or a chiseled, angular handsome face in men.  Liposuction is a tried and true method of reducing subcutaneous fat in the face which I have used for over 30 years.  Dissecting the fat, by itself, would just split the fat layer into an upper and lower layer and would not remove or shape the fat and face.
4. In my experience when evaluating the face, it's key to determine the following:  Are the cheeks, chin and lips the ideal aesthetic shape?  Are "jowls" present and is there excess fat and skin in the face and neck.  Once these factors are determined, the proper aesthetic plan can be determined to make the face balanced, (for women) feminine and more naturally youthful and beautiful (while for men creating a more chiseled, angular and handsome face).
5. In my humble opinion, no facelift technique alone can properly shape all of the "key" aesthetic facial features.  For this reason, I always aesthetically shape the face when performing facelifts in order to make the face more naturally attractive.  
 Following my beauty principles, 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.  Conversely, men look chiseled and handsome when they have angularity in the cheeks, chin and mandibular angles.  The facelift is designed to lift the sagging SMAS muscle layer (and jowls) as well as remove excess skin from the face and neck.  Other procedures must be applied to properly shape the cheeks, chin, lips, chin and jaw line as needed.  
And finally. 
6. Aesthetically improving the face so that it is soft, feminine and youthful (for women) or chiseled, angular and handsome (in men) requires the proper aesthetic judgement to accomplish that goal.  All "Facelift Surgeons" are not the same, nor do they all share the same aesthetic judgement.  So don't be surprised if you get different opinions on suggested procedures and treatments.
 From the photos your cheeks have a slight amount of excess fat (more so on one side), the cheek on one side is a bit flat in the front, jowls are present and there is some excess skin under the chin with overall skin aging present in the face and neck.  These factors combine to create a rectangular shaped face. 
 Following my beauty principles, 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.  Liposuction to reduce the slight amount of excess fat can be done to further shape the cheeks and face.
 "Jowls” are sagging facial tissues and the main 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 SMAS facelift is the minimally invasive, short incision SMAS 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 anesthesiano incisions within the hair = no hair lossexcess fat can be removed from the face and neckexcess skin removed from the face and neckcheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implantsmost 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.
 Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more. Skin only facelifts (do not properly address the underlying SMAS layer) were found to be far less effective than SMAS facelifts and were pretty much abandoned in the mid 1980's.Hope this helps.

Mini facelift or SMAS facelift?

Answers (9)

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