What Are the Facial Muscles, Ligaments, SMAS Attached to During a Facelift? Bone, Other Muscles. I Can't Quite Picture It.

Doctor Answers 12

Where the SMAS is attached during a facelfit

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The SMAS layer is thick and relatively inelastic (at least compared to the skin) and therefore tolerates a lot of tension and pull. It can only be tightened however if it is attached to something equally sturdy. The SMAS layer in the upper neck is attached firmly to periosteum over the mastoid bone. (That's the firm bone you feel just behind your earlobe). Periosteum is a thick inelastic layer that covers all bone. The SMAS layer along the jawline and lower face is attached to the fascia ( thick fibrous layer) over the parotid gland. Because these two structures are secure and wont stretch they make an ideal attachment point for a high tension suspension of the SMAS. Attached here is a video which will aid you to better understand the lower face. 

Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 113 reviews


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This is a complicated but good question you ask.   The various attachments and exact dynamics of facial muscles is complex, but is well demonstrated on the internet.  Go to facial anatomy on Google.   In general here is how to get a grasp on this.  The SMAS which means Superficial Muscular Aponeurotic System is the tough fibrous cover OVER the facial muscles.  The system spans the cheek and neck.   It is this SMAS that can be lifted and used to enhance the suspension of a sagging face.  The SMAS lift adds durability and excellence to the face lift.  No facelift should be done without it.   The underlying facial muscle must never be moved or touched directly.  To do so may cause paralysis.  Fortunately the innervation to these muscles comes from the underside and thus affords considerable protection.  Facial nerve injury and weakness during a facelift usually comes from stretching a nerve AND THESE WEAKNESS PROBLEMS SELF CORRECT 99% OF THE TIME.  The actual origins and endpoints of the many facial muscles are very complex, and again I refer you to an anatomy textbook where chapters are devoted to this very issue.  The old skin lift alone did quite a bit, but when the SMAS lift and fat reduction in some areas, and fat grafts in others are added the results are spectacular.   I know this is a brief answer to your question but hope it helps.  My Best,  Dr C

What Are the Facial Muscles, Ligaments, SMAS Attached to During a Facelift?

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 During a Facelift, the skin is elevated and the underlying muscle layer, called the SMAS, is dissected, lifted, trimmed and re-sutured to itself.  The ligaments and facial muscles for animation remain untouched.  The SMAS muscle layer is a thin layer of Parotid fascia combined with remnants of a thin vestigial muscle that's continuous with the Platysmal muscle in the neck.

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

Anchor Points in a Face and Neck Lift

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Thanks for the great question! In most facelift techniques, the SMAS and platysma muscle (which are in continuity as you go from the jawline into the face) are released from the deeper fascial and muscle layers and reattached to the deeper tissues at a higher point. There is some variation depending on the specific approach, but the general idea is that the tissues are released, some laxity and excess are removed, and then the tissues are resuspended.


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There is a layer of tissue under your skin called the SMAS, the subcutaneous muscular aponeurotic system.  This is the extension of the platysma muscle, the broad muscle just under the skin of your neck that blankets the neck.  In most facelifts this is lifted, often cut and lifted, and sutured to the deeper tissue just above the front of the ear, directly in front of the ear and behind the hear. This lifts the skin with it.  The excess skin is trimmed.  Under the chin the platysma muscle is often also tightened.  I have attached a link to a page that explains the basic principles. 

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
4.5 out of 5 stars 26 reviews

Facial Muscles

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Facial muscles are unique in that they attatch to the skin to animate your face. The deep lining around the muscles, the SMA, is tightened during the procedure. This tightens the deeper structures so your facelift lasts longer and you have a better sculpted look. Consult a board certified plastic surgeon in your area for advice and a consultation. We do not operate on the bone at the time of a facelift. The soft tissue reconstruction will enhance your existing bone structure. All the best.

What Are the Facial Muscles, Ligaments, SMAS Attached to During a Facelift?

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Thank you for your question. An anatomy book will show the different facial muscles present in the lower face area and mid cheek area.  These areas are the main section of the face where muscle tightening is done.  This is called the SMAS or Superior Muscle Aponeurotic Muscle System. I hope this helps.

Vivek Bansal, MD
Danville Plastic Surgeon
4.9 out of 5 stars 26 reviews

What is the SMAS attached to ?

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thank you for your question.  The SMAS muscle is attached to either periosteum, or fascia, or itself.  It depends on the technique that is used.

Best Wishes,

Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
4.9 out of 5 stars 41 reviews

Attachments to the facial muscles

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 The platysma muscle in the neck is the only muscle in the entire body that has 2 insertions Into the skin and no origin onto bone.  The muscle is tightened in the front portion of the neck in the submental area,  and in the posterior jawline area without detaching it from the underlying structure. The  SMAS in the face is more of a fascia layer that is tightened upon itself without detaching it from the underlying structures. The skin is simply lifted  above the SMAS so that the fascial layers could be tightened.  A facelift also involves  conservatively tightening skin in addition to the muscles and fat removal in the neck above and below the platysma muscle. Please see the link below for examples to our facelift  photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

SMAS facelift pros and cons.

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SMAS stands for "Sub Muscular Aponeruosis System" describing the depth level at which the operation is performed. The key words are "sub muscular" which means that the disection is below the facial muscles. This is a very dangerous level to operate in as all  facial muscles are innervated by the branches of the 7th Cranial nerve entering these muscles from the underside. Small palsies or malfuntions of these muscles can occur after surgery. Facial surgery which includes the SMAS layer or is totally above this layer can produce an excellent result. Statistically, long term follow up on above or below SMAS patients show no discernable difference.   

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 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.