Best face lift/procedure for malar crescents? My surgeon told me a SMAS lift would work. Is he right?

I would agree with your doctor that SMAS facelift can significantly improve the contour of the malar area.  However, if you have significant malar bags you might need additional treatment of this area.Best wishes!Dr. Konstantin

This type of a question is very difficult to answer without pictures.  Most likely you would need more than just a facelift to correct true malar bags

A photo would be very helpful to see the extent of your problem.  True malar bags or festoons are difficult to treat and fully correct.  A SMAS facelift may improve their appearance but additional procedures on the lower eyelid would likely be needed to maximize this improvement.

True malar crescents, or malar bags are difficult to fully eradicate.  However, in my experience, the best strategy for patients with this problem is a SMAS based facelift combined with a lower lid Blepharoplasty/ cheek elevation.  It is important to understand that the majority of Facelifts in this country are performed with manipulation of the SMAS.  The degree of SMAS manipulation and the experience of the Surgeon are the two most important factors in the type and longevity of the result you will receive.  In my opinion, techniques that allow for SMAS imbrication (lifting and resetting of the SMAS) yield superior results to SMAS plications (suture tightening of the undisturbed SMAS layer).

In my opinion a SMAS facelift is excellent for the lower jaw area and neck.  Malar crescents are typically not treated with a SMAS facelift. 

The SMAS facelift is a general term for the lifting of the face with two separate planes of lift. The first plane is the deep tissues of the face which includes fat, muscle and fascia. The second plane is the superficial fat and overlying skin. This is the basic description for the best of all facelift techniques. The first techniques attempted utilized pulling of only the skin. Early on it became apparent that pulling of the skin alone led to early recurrence and excess scarring - not an ideal outcome. Other techniques have been attempted with a modicum of success. The most prominent of these other procedures is the deep plane technique whereby the entire sandwich of tissue (Skin, fat, muscle and fascia) is lifted together. This technique leads to a large amount of swelling but an early recurrence of the signs of aging. But most importantly, this technique does not allow us to lift the tissues vertically.The process of aging is caused by gravity, facial animation, stresses on the skin (weight gain, smoking, drinking, sun damage and age). The combination of gravity and facial animation pulls the tissues of the face in a downward and inward direction. Smiling reverses the sag - so look in the mirror and smile to see where your facial tissues use to be and where you hope that surgery would replace them. It is for this reason that the SMAS lift should move all tissues in a vertical direction - put the tissues back to where they once were.So with that said, what are the risks and benefits of the Vertical SMAS Facelift.More natural lifting of the fascial tissue avoids the windblown or pulled look of many other techniques.Vertical lift adds to the volume of the cheek, removes the jowl and marionette lines to yield a more oval face.Vertical lift often eliminates the malar depression or tear trough.The SMAS facelift has a lower risk of facial nerve injury than the deep plane facelift and recovery from swelling is significantly shorter.Perhaps the only really increased risk relative to other techniques is the risk of bleeding or hematoma. The creation of two flaps of tissue can result in an increase risk of bleeding. But these small blood clots under the skin are still infrequent and ultimately resolve.In the end, the SMAS facelift is an ideal procedure when performed in a vertical fashion. Find a board certified plastic surgeon with experience in performing this technique. If you would like more information on facelifts, please read my book " A More Beautiful You - Reverse Aging Through Skincare, Plastic Surgery and Lifestyle Solutions".

A SMAS facelift is great for the jowls, jawline and cleaning up the neck.  A high SMAS can potentially improve the malar crescents if a lower lid blepharoplasty is done simultaneously and the undermining is to the lateral orbicular is muscle. Typically, it is a combination of operations that make the difference.

Do you mean malar bags?  Malar bags are like swollen legs they do not go away.  They can be a bit camouflaged by the facelift especially with elevation of the cheek.

If by malar crescents you mean malar bags or festoons the standard SMAS facelift is unlikely to improve them.The surgical procedure to improve malar bags or festoons involves an extended lateral lower eyelid incision with cheek elevation directly.  Even this maneuver cannot always correct them.Considering the scarring involved with a direct lateral extended eyelid incision after many years  I have chosen to treat malar bags by using filler injections in the crease below the bag which creates a satisfactory cosmetic result.