I'd like a smas facelift but my friend had one & complained of flat cheeks & hollowing under eyes. What could have gone wrong?

I 'm 40 and would love a facelift but worry my results would be like my friend with flat cheeks and under eye hollows, what could have gone wrong with her facelift?

Doctor Answers 11

Flat cheeks post #facelift procedures: why is it important to add #FatGrafting to your procedure

Thank you for your question.

A very important point to mention is that a facelift does not replenish lost volumes; it does reposition sagging tissues but it will not give you back volume that was lost.

For this reason, I commonly recommend fat grafting to all my facelift patients.  So you should consider.  And not all plastic surgeon perform this procedure.  Fat grafting require meticuous work.

In the interim, you friend could consider fillers.

Best regards.

Toronto Plastic Surgeon
4.8 out of 5 stars 62 reviews

SMAS facelift

This may have resulted from the tension placed on the SMAS tissues.  An upward vector should result in more cheek apex fullness.  The lower eyelid hollowness is not typically worsened with a facelift and is many times improved at the time of a lift with fat grafting. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

Facelift and under eye hollows

Under eye hollows are not treated by facelifts. This often requires direct treatment hrough a lower lid procedure or with fillers.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

I'd like a smas facelift but my friend had one & complained of flat cheeks & hollowing under eyes.

  Hi, I have performed facelifts for over 30 years.  Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front. Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face. I shape the cheeks, chin and jaw line with every facelift procedure.  Facelifts are designed to lift, tighten and remove excess tissues and skin which by itself will not create a more feminine or masculine and youthful face.

 If you have "jowls" this is sagging facial tissues and an indication for some form of a facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last). The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
Hope this helps.


Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Not All SMAS Face Lifts Are Created Equal: Release and Reposition for Natural Results

The SMAS is a durable layer used to support a facelift. There are numerous types of SMAS facelifts which have variable effect and longevity. Releasing the SMAS with a subSMAS dissection and repositioning the SMAS with a high SMAS technique can help to provide elevation of the cheeks and a defined jawline. A high SMAS technique typically requires a lower eyelid procedure and browlift to help blend the repositioning of the cheek region. This avoids cheek flattening typically seen in a lateral vector facelift.

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 44 reviews

Smas facelift

There are numerous ways to do a SMAD facelift. I think that if you see a board-certified plastic surgeon who can explain to you the methods available and how to apply those to your specific situation you will be well served.Good luck! 

Mark T. Boschert, MD
Saint Louis Plastic Surgeon
4.9 out of 5 stars 30 reviews

Best to see an experienced facelift specialist

Please see a board certified plastic surgeon who specializes in facelift for an assessment.  While there are never guarantees, seeing an experienced plastic surgeon gives you the best chance of getting the results you want

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 457 reviews

Smas facelift at age 40

At age 40 you are certainly younger than average for a facelift. Most women are in their 50s when they have there first facelift, although some do get it in their 40s. I would need to see photos of you to tell you if I thought you were a candidate. I would also need to see photos of your friend, before and afters, to assess why her surgery was not optimal. A SMAS facelift, when done well, should enhance the cheeks, not flatten them. The lower eyelids are not really affected unless a lower blepharoplasty is done. If too much fat is removed, then they will look hollow. I typically take the fat in the lower eyelids and drape it over the orbital rim to fill in the tear trough. I wish you the best of luck.

Paul Wigoda, MD

Paul Wigoda, MD
Fort Lauderdale Plastic Surgeon
5.0 out of 5 stars 28 reviews


  • Hello, and thank you for your question. In many instances patients need to consider fat transfer or something to add volume to their faces during the facelift procedure. These can also be performed with injectables however we most commonly used fat at the time of the surgical rejuvenation. I would recommend that you seek out a qualified board certified plastic surgeon to discuss this in full detail. Best of luck.

John J. O`Brien, Jr., MD
Saint Petersburg Plastic Surgeon
5.0 out of 5 stars 28 reviews

Worried about SMAS face lift effects

Thank you for asking about your SMAS face lift.

  • A SMAS face lift should not affect your eyes -
  • Perhaps your friend had other surgery, such as a lower lid procedure to remove fat, that had this effect.
  • Also if your friend's face lift was not done by a plastic surgeon, it may have been distorted by using an aggressive suture face lift.
  • So please see a Board Certified Plastic Surgeon - to discuss your face lift and your concerns so surgical planning can minimize any look you do not like.

Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 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.