What is the difference between a Facelift combined with a neck lift doing the SMAS technique vs a platysma?

I have been to 2 prominent plastic surgeons in NYC. Both said they would do the facelift, one using the smas technique for the face and neck, the other doing the smash for the face and platysma for the neck. Do both get the same results? and why would they differ?

Doctor Answers 31

Face and neck lift

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Hi Nina,

The SMAS layer refers to the "superficial muscular aponeurotic system", which consists of the superficial muscles of the face and neck.  There are different approaches to the SMAS layer during face lift.  One of the most common techniques is a SMAS plication.  This involves resuspending the facial muscles which have descended over time to restore volume in the midface region.  Stitches are placed in the SMAS layer to resuspend it and no tissue is actually removed.  During a SMASectomy (which is a different technique), a portion of the superficial muscle layer is removed and the edges are stitched together.  I recommend clarifying with your surgeon before proceeding to understand the risks and benefits of these techniques.  There is slightly higher risk of nerve injury when a portion of the SMAS is resected, since the nerves travel deep to this layer.  Although a nerve branch may still be injured with a suture during SMAS plication, there is lower risk of actually dividing the nerve.

The platysma is a superficial muscle in the neck, which is a continuation of the SMAS layer.  It is often resuspended during face and neck lift to increase definition of the submental region and cervicomental angle (where your jaw meets your neck).

It sounds as though the two surgeons are using different terminology to describe similar techniques.  

Stephanie Power MD, MSc, FRCSC

Smas and platysma

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Sounds like they are using slightly different terminology for the same thing.  The SMAS layer in the face is continuous with and the same layer as the platysma muscle in the neck.  However, there are different techniques for dealing with the SMAS in the face as well as the platysma in the neck.  Although both surgeons are talking about the same layers, they may be planning on utilizing different techniques to handle them - the only way to know what their respective plans are is to ask each of them what they are planning to do with both the SMAS and the platysma.  Hope that helps -

J Weinrach MD FACS

What is the difference between and facelift combined.......

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Hi Ninakb

Results from the techniques you mentioned are just as dependent on the skill of the surgeon as they are on the specific technique.  Since you have consulted with the surgeons, you should have been able to see before and after photos of patients who had that surgeons procedure (i have attached my photo's as an example).  In addition, both surgeons should have been able to relate their experience in terms of the number of procedure performed.  Surgeon experience with their particular technique and their ability to tailor the procedure for each patient will lead to lasting and natural results.  Many surgeons are good a doing many things however a few are great a doing one thing.  Find your expert who you feel comfortable with, both a surgeon and a person.  Thanks and good luck with your search. 

Sonny O, MD
Mount Pleasant Plastic Surgeon
4.2 out of 5 stars 13 reviews

SMAS vs. platysma

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Hello Ninakb,

That is a great question and really it is two ways of saying the same thing for the most part.  The SMAS refers to the superficial musculoaponeurotic system.  It is a layer of tissue in the body that is under the skin but above the muscles of the face.  It works great for facelifts because it can hold a lot of strength so when we tighten it the results last.  As you go to the neck the SMAS layer disappears but it is continuous with the platysma muscle.  This is a large muscle that is located on the front of your neck extending down to your collar bone.  This is the muscle that is lifted in continuity with the SMAS above.  

Now a difference can exist when dealing with the mid portion of the neck.  First, the platysma is the muscle responsible for those bands that run from the chin towards the collar bone.  To help address this you can make a small incision just under the chin and then free up the middle edges of the muscle.  You then can either sew these edges together (platysmaplasty) or you can cut them in various ways (platysma myectomy).  This may be what your surgeon was talking about and is a great way to help with those bands.  Simply pulling on the back edge of the platysma (or SMAS) will not improve these bands in the neck.  

I hope this helps to clear things up and good luck.

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Approach to Facelift

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Look at the before and after photos of results of surgery from each surgeon. Do both surgeons share your aesthetic ideal? Consider how well each surgeon listens to you and understands your goals. Check the training of each surgeon. Look into their safety record. Who assists them in the OR? Is their OR credentialed by either the Joint Commission, AAAASF, or both? Is the MD anesthesiologist at your bedside for the duration of surgery?  

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Face and neck lift technique

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The short answer to your question is that the SMAS and platysma are basically the same layer.  Its called the SMAS in the face and platysma in the neck.  There are many good face and neck lift techniques but the one thing they all share in common is not relying on the skin for lifting but on the deeper layer which is the SMAS/Platysma.  It is very likely that the two surgeons were talking about similar things.  The best technique is something highly debated amongst surgeons so I don't think focusing on the exact technique will help you make a good decision.  Instead look at reviews, before and after photos, and make sure the surgeon has all the proper credentials.  Hope this helps.

Dino R. Elyassnia, MD
San Francisco Plastic Surgeon

Facelift techniques

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Plastic surgeons commonly differ in opinions regarding giving patients the best results.  This is due to training an personal preference.  During a consultation, I could give you the reasoning behind each technique based upon your physical exam.

Face and Neck, SMAS and Platysma Lifts

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Dear Ninakb:

Good pick-up on the conversation. About 40 years ago, a second layer of face lifting was introduced which offered many advantages in lifting, suspending and duration of results. This layer is used in various techniques today.

The SMAS or superficial muscular aponeurotic system is a layer of flat muscle and fascia within the face. The platysma muscle of the neck resides in that same layer.  Your 2 prominent NYC plastic surgeons are both correct. 

This layer of tissue is tougher and therefore can be plicated, lifted, elevated and advanced, suspended and different ways to improve the results of the traditional facelift. 

My personal techniques include: 
  1. High plication of the SMAS to lift the jowl, fill the upper cheek lift the corner of the mouth and pull upwardly on the platysma. 
  2. A corset platysmaplasty to join the medial bands of the neck muscle to create a tighter, smoother neck and jawline crease and support the floor of the mouth. 
  3. A neck suspension suture to sling and support the neck creating a more apparent neck crease and outlining the posterior jawline. 
  4. Other options occur depending on the needs of the patient. 
For more specifics on their techniques, please contact the Plastic Surgeon directly.

I hope this helped. All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

Techniques of facelift

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It sounds like both surgeons are recommending the same procedure and maybe just using slightly different terminology.  Since it sounds like they are both well-credentialed, concentrate on their results, their staff and their personal bedside manner.  Your relationship needs to be solid in case there is a complication.  Best wishes. 

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Terminology can be difficult...

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When seeing several surgeons for facelift or searching on the internet, all of the different terms can have different definitions that can be confusing. In reality, the SMAS is the same plane as the platysma in the neck so the two surgeons are describing the same thing. The thing to know is whether they are entering the deep plane in the face which can result in a better and longer lasting result in some patients. 

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 222 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.