Will You Please List the Kinds of Tissue Found in the SMAS Layer?

What are all the different types of tissue found in the SMAS layer?

Doctor Answers 8

The SMAS Layer and why it's important

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The SMAS is a layer of strong connective tissue that envelops the face and connects to the platysma muscle in the neck. As we age the SMAS and other facial tissues loosen and descend. When the SMAS is elevated during a facelift, the tissues are placed in a more youthful position. The tension of the lift is placed onto the robust SMAS. This allows the excess skin to be removed without tension. This avoids a pulled appearance and leads to improved appearance of the scars.

SMAS layer in a facelift.

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There are many ways to get good results in plastic surgery. The "correct" plane during a facelift is one of those controversial subjects we argue about at plastic surgery meetings. The Sub-Muscular Aponeurotic System, (SMAS) facelift has really become the "gold standard." It uses a strong facial layer that is congruent with facial tissue.  While there is always risk to any surgery, the construct of a SMAS facelift is quite safe and effective. It is often a good idea to discuss the operation in detail with a few experienced surgeons. Ask questions, and tell him your concerns. Together you will come up with an appropriate plan that is right for you.

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

SMAS Definition

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SMAS is actually an abbreviation for a tissue layer called the Sub-Muscular Aponeurotic System. As this is a mouthful, most patients and surgeons use the acronym “SMAS”. The SMAS is a relatively thin layer of strong fascial supporting tissue that covers and surrounds the deeper tissues and structures of the face and neck including fat pads and muscles of facial expression, including the entire cheek area. It also attaches to the superficial muscle covering the lower face near the jaw line and neck called the platysma. As the SMAS attaches to all of these areas of the face, a SMAS lift surgically elevates this layer which in turn repositions the soft tissues and structures of the face to an elevated more youthful position

Layers of the SMAS

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The SMAS is a single layer of fascia which is directionally organized collagen and ground substance, it is quite thin but invests or wraps around the tissues of the face and neck. It can be lifted in order to suspend the tissue of the cheek and neck into a better position.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Kinds of tissue in the SMAS layer

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The SMAS (superficial musculo-aponeurotic system) is a dense layer of fascia that envelops the muscles of facial expression and is contiguous with the platysma muscle in the neck.  It is this layer that is utilized during a facelift procedure to allow for a more natural-appearing result.  In my practice, to achieve a natural, more youthful look, I perform an extended sub-SMAS elevation that continues low into the neck in the subplatysmal plane in conjunction with neck liposuction.  The result is a smooth, rejuvinated face and neck with excellent contour of the neck and jawline.

Corey S. Maas, MD
San Francisco Facial Plastic Surgeon
4.3 out of 5 stars 14 reviews


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SMAS stands for "superficial musculo-aponeurotic system" and is shorthand for the connective tissue layer in the face that is generally considered an extension of the platysma muscle in the neck and connects to other structures in the face. It is fascia and not fat but it can move attached fat. Aging faces lose tone in the skin and connective tissue such as the SMAS layer so it is adjusted during facelifting procedures to provide a "tighter" base on which the skin is lifted above it. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Face lift

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SMAS in the face is fat and fascia............................................................................

Samir Shureih, MD
Baltimore Plastic Surgeon

SMAS layer during Face Lift

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This is a point of some debate but after 20 years of performing Face Lifts and manipulating the SMAS, IMHO this consist of the vestigual muscle that's continuous with the Platysma muscle, in the neck and the Parotid Fascia.

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