Can a SMAS lift injury any of the underlying sensory nerves?

Thank you for an interesting question.  It is normal to have temporary numbness after a facelift.  Most facelifts performed today involve some form of SMAS modification.  However, the extent and the duration of numbness does not seem to correlate with how the SMAS was lifted, but rather with the extent of the skin flap elevation.  In other words, the primary cause of numbness is cutting the small nerve twigs that go directly to the skin and not the injury to deep sensory nerves.Best of luck!Dr. Konstanitn

Any type of facelift has the potential to injure sensory nerves. In most instances it is short-term but occasionally numbness can last for many months. The greater auricular nerve is quite large and can be avoided by the surgeon. It is not the type of facelift that can cause the problem but usually just elevating the skin flap. I would not shy away from a facelift based on sensory nerve issues if you are otherwise motivated to proceed. Get a few opinions by qualified surgeons.

With a SMAS facelift, the skin in the cheek and neck is dissected from the underlying connective tissue, and the underlying muscle of facial expression, as well as the connective tissue system enveloping them (called the SMAS) are lifted and tightened.  As tiny skin sensory nerves are cut and stretched, numbness is normal an expected in a horseshoe-shaped pattern around the ear and around the chin incision.  Such numbness resolves over weeks-months, as the unnamed sensory nerves grow back together.  Itching and "crawley" sensations typically indicate proper skin nerve healing after facelifting surgery.Injury to the bigger greater auricular nerve (the nerve supplying sensation to the earlobe) is rare.  Such injury potentially results in permanent numbness.  

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.All Facelift procedures have risks to the sensory and motor nerves of your face. This technique does not have the same risks as a deep plane for motor nerve injury.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".

Any facelift, including a SMAS facelift, can injure sensory and motor nerves of the face.  Typically the effects of a nerve injury are short lived.  The technique of a facelift is variable and depends on the goals you seek and what the specific anatomic problems are.

 All facelift techniques including the SMAS  can injure sensory nerves. It is important not to injure the greater auricular nerve, which is rather large nerve located approximately 3-4 inches below the ear. Most patients get some degree of temporary numbness around the ears and underneath the chin which typically resolves in 2-3 months after the procedure. On a rare occasion small amount of numbness may be permanent around the earlobe

With SMAS facelift it is possible to injure the greater auricular nerve. It is very unlikely with an experienced Board Certified Plastic Surgeon (American Board of Plastic Surgery). Knowledge  of the location and course of the nerve is very important as it is important to know the anatomy of the facial nerve branches.

Both of the SMAS facelift in the standard facelift have an equal chance of injuring facial nerves.  The greater a radicular nerve is the most susceptible to injury of all the sensory nerves of the face.  Generally speaking nerve injury does occur in 2.5% of facelift however 75% of these are temporary.