Facial Widening with SMAS Facelift

Four months after SMAS facelift my face is still wide where the SMAS was folded for suturing. Is there a reason why a surgeon elects to fold the SMAS rather than trim (SMASectomy)?

Doctor Answers 12

SMAS Techniques

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Hi Oklahoma City2013-

There are many different ways to handle the SMAS during facelift surgery - fold, excise, reposition, purse string, long flap, short flap, deep plane, etc. The choice of which to choose is determined by the patient's physical attributes and the techniques that work best in the hands of the particular surgeon.


Tom Kaniff

Sacramento Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Folding SMAS over the Zygoma

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The SMAS layer is folded under for two reasons.

1. it gives extra strength to the repair where it is sutured to the cheek bone (zygoma)

2. It gives more fullness and definition to the cheek bone area which is frequently lost over time, or not well developed in the first place.

This is a standard practice.  The fullness should resolve over the next year.


Customizing SMAS facelift is key

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I routinely perform SMAS facelifts, but customize the actual lift for each individual's anatomy. Some patients have very thin tissue and folding, or plicating the SMAS can be appropriate. Others have thicker tissue. In these patients I remove a strip of the SMAS and then lift the SMAS and suture it back to itself. This prevents the bunching and unwanted volume in that area. You may still see some thinning of the area, but after 4 months the majority of healing has occurred. I would recommend speaking with your surgeon about your concern.
Andrew C. Campbell, M.D.
Board Certified Facial Plastic Surgeon

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Facial widening after facelift

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The SMAS can be trimmed, cinched or folded depending on the technique and goals for your surgery.  Some upper facial  widening may occur with repositioning the SMAS and soft tissues upward.  This may be desirable and  rejuvenating as it helps to transform the " triangle" of aging marked by descent of tissue resulting in widening at the jowls to the "inverted triangle" of youth with more upper fullness.          



David J. Levens, MD
Coral Springs Plastic Surgeon
5.0 out of 5 stars 79 reviews

Wider face after SMAS lift

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The SMAS procedure you had may have been done to restore facial volume. However, at only 4 months after surgery, swelling is more likely to account for the facial width. You may discuss it with your plastic surgeon but waiting a few more months may help.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Facial widening with SMAS facelift.

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The reason is personal preference of the surgeon and his aesthetic goals. You will have the swelling go down for 1 year and if it is still wide, return to your surgeon or get a second opinion.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Folding the SMAS for volume enhancement

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In patients with slender or medium faces, it is common to fold the SMAS in order to add volume to the cheeks and to give a thicker layer to sew and maybe have it heal better.  In fatter faces, the extra SMAS is trimmed off so as to not make the cheeks look too full. 

Facial Widening after SMAS Facelift

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One of the advantages of the SMAS facelift is the versatility of the lift and the ability to tailor the facelift to the needs of the patient.  Most patients with facial aging need the softness restored over their cheekbones and not the zygomatic arch.  The SMAS will allow for the facial fat to be repositioned over the cheekbones and allow for the softness to be restored.  The top of the SMAS could be folded onto itself to  give volume over the zygomatic arch, but this application should be necessary only in a few cases and will result in the facial widening that you are observing.  The vector of a SMASectomy is actually perpendicular to the direction that the SMAS was folded in your case.

Michael Sundine, MD
Orange County Plastic Surgeon

Techniques for a SMAS facelift may vary

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Performing a SMAS plication versus a SMAS-ectomy depends on the experience of the surgeon.  Many studies have shown no difference in the two techniques and the SMAS-ectomy, so it's really surgeon preference.

SMAS facelift techniques

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Folding of the SMAS is a way to help augment the cheeks while performing the facelift.  The question of when to fold and when to excise is determined on a case by case basis.  No one face is the same as another so it is a judgement call.  I prefer SMAS flap with trimming of the flap.  Some folks just do an excision.  Some plicate.  In the end, it all seems to do about the same if the surgeon is experienced and routinely gets great results.

Jay Calvert, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 52 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.