Which technique, high SMAS or lateral SMASectomy, provides the most improvement or lift of the cheeks?

When choosing between two different surgeons, each with a different preferred surgical technique, which will provide the best lift of the cheeks: high SMAS or lateral SMASectomy? I am NOT interested in fillers or fat transfer to augment the cheek area but would rather have a lift that will address the cheeks. Thank you!

Doctor Answers 7


In my opinion, a facelift has its power in improving the "jowl" and neck area.  The cheek may receive some minimal improvement. A direct cheek lift or an implant will give you the most improvement in that area.

Which SMAS is best in Facelift Surgery?

Dear Winky52:

I LOVE facelifts because of the uniqueness of every patient and the variation of the anatomy! 

If fillers and fat grafting is left out of the equation, a Midface Lift is your best option to lift and fill the cheeks. As I perform them, a lower eyelid incision is made and depending on the tissues to be lifted, the cheek will be suspended straight up to the inferior orbital rim.

As you have found out there are different proponents for many SMAS lift variations. Some say imbricate at a medium or high cheek plane; some say lift and suspend in front and behind the ear; some say pull tight, cut off the excess and sew to the opposing edge. 

For maximum advancement of the jowl to the cheek deficit, I find a high SMAS imbrication is very straight forward and best option to achieve a youthful appearance. It also lifts the jowl, the platysma and the attached neck soft tissues.

For maximum jowl and neck elevation from the facelift incision, a SMAS elevation and advancement in front of and behind the ear works well.

Lateral SMASectomy similarly lifts the jowl and tightens the soft tissue upward and outward but excises the redundant tissue which can be used to augment the cheek. 

I find that SMAS lifting will not fully address the youthful medial upper cheek; ie., the nasal half of the cheek "apple" just below the eyes. I therefore perform fat grafting from any liposuctioned fat I have contoured from the jowls, jawline and neck. You may also consider fillers such as Voluma. 

This of course only addresses one of many decisions made for customizing a facelift to the individual patients face and neck.

This was a great question. I hope I was helpful. 

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 81 reviews


This is an excellent forum and each of the participants heretofore have explained the issue perfectly.  THE SMAS is for the lower face, neck and jaw line.  If you lift the corners of your face and neck, not touching the mid cheeks, while looking in the mirror, you will see  a nice oval shape to the face appear.  If, however, you see the chin of the high cheeks look wind swepted, then a SMAS alone will not treat the mid face and upper cheeks. Your surgeons I am sure have assessed the brow, midface, and neck, so that the way they handle the SMAS is not as critical as whether they will move some skin near the nose and mouth as well, if you need it.  If you have a wind swept crease when pulling up on the neck skin toward the ear, then perhaps some midface work,  cheek implants, fat grafts, or suture suspension of the fat pads will be in order.  Also more  cheek lift lifting and direct suspension in front of the ear may be applied. These are the questions you can now ask.

Sometimes the recovery from a straight forward lower facial SMAS or SMASectomy may be shorter, so you can recovery faster.  A full comprehensive face lift will address the lateral corners of the brow, midface, cheeks, neck, jaw line, lips and smile but can require more a la carte elements to be added to the operation.  So, the manner by which the SMAS is handled is not the key concern, it is the company the SMAS keeps with regard to other elements of your facial aging.

Donn Hickman, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 1 review

Facelift, smas

This a great question and you seem to be very well educated as to differing types of facelift procedures!  

When choosing between surgeons, board certification is key along with their experience and judgement.   The surgeon you feel most comfortable with is another key factor.

As far as technique goes, there are a number of differing facelift techniques all with great results.  What the surgeon feels most comfortable with also enters into the equation.  Looking at your photographs  and consultation are important too before rendering an opinion.  Honestly, you can have wonderful results with differing techniques.

Other questions to ask would be what type of surgery for the neck, etc.  Also fat grafting appropriately and skillfully  done can be very helpful in the cheek areas.

Good luck!

Paul Watterson, MD
Charlotte Plastic Surgeon
5.0 out of 5 stars 41 reviews

SMAS facelift type to lift the cheek

The technical differences between the SMAS type facelifts generally vary among plastic surgeons, but may not have much real difference on the final appearance on outcome. A patient's individual anatomy likely plays a more important role on final outcome. All facelifts primarily improve the neck and jawline, but the cheeks may be lifted at the same time without fillers, again through a variety of techniques.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Facelift comparison candidate

 Both a high SMAS and a lateral SMASectomy are a  type of facelift that  addresses lifting the jowls, not lifting the cheeks.  If the goal is to lift the cheeks, then cheek implants should be considered. It is better to choose your surgeon, not the specific technique.  In our practice, we utilize a high SMAS technique that lifts the jowls, tightens loose facial and neck skin, tightens the neck muscles in 3 locations , and removes fatty deposits in the neck. For many examples of a high SMAS face lift, please see the link and the video below to our facelift  photo Gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Which technique, high SMAS or lateral SMASectomy, provides the most improvement or lift of the cheeks?

Good results can be achieved with either result in the appropriate patient. What is more important than the specific technique is the experience and artistry of the plastic surgeon.

I would suggest your a plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with who has all of the modalities of treatment available. You should discuss your concerns with that surgeon in person.

Facial rejuvenation needs to be individualized. What would be an ideal approach for one patient is not necessarily the same for someone else. Based on the examination and discussion at the consultation, you should have a better understanding of the various options that can achieve the best cosmetic result for you.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 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.