Are there any non-surgical ways to tighten and lift the SMAS?

Question

I do not see any non-surgical machines that actually address the SMAS layer, am I correct? I have heard of something called Ultralift (not Ultherapy) but I see some doctors on here do not think it is reputable.

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

In our practice, we perform a non-surgical face lift / skin resurfacing treatment using Renuvion Helium Plasma Radiofrequency. To get the most improvement with skin tightening, we combine Renuvion (formerly J-Plasma) with lasers (Fraxel, Clear + Brilliant, CO2), microneedling/PRP, Ultherapy and InMode FaceTite. I suggest getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Kimberly Butterwick, MD · Answer

In my practice, I perform the Silhouette Instant Lift, which offers a non-surgical option for patients that require subtle lifting for a more youthful appearance. The Silhouette Lift involves the placement of sutures that contain biodegradable cones below the dermis, lifting connective tissue fibers attached to the SMAS to place tissue and skin into a more aesthetically pleasing position. The material used for the thread lift is dissolved by the body over time. However, their placement also stimulates the body’s own collagen production to maintain the lifted position naturally and for much longer.  Another option, which can be tried alone or with InstaLift, is Ulthera. This device heats tissue as deep as 4.5 mm in the vicinity of the SMAS.
When the Silhouette InstaLift and /or Ulthera are performed by an experienced, board-certified dermatologist, the results are both dramatic and long-lasting. While the procedure does not replace a facelift in terms of correction or longevity, it is an excellent choice for patients that are not ready for surgery but want to turn back the clock on their appearance.

William Groff, DO · Answer

I am glad you asked that question. Yes, there are options for tightening and lifting the SMAS without surgery, particularly in the early stages of the aging process. While we offer a variety of skin tightening treatments, to work into the deeper structure where the SMAS is located, I would recommend a Silhouette Lift. This minimally invasive procedure uses sutures to lift the tissue to a more youthful position right away, while stimulating collagen production for longer-lasting results. 
The outcome of a Silhouette lift is comparable to a surgical lift, with improvements that often last two or three years. The procedure is still relatively new, so make sure you find a board-certified cosmetic dermatologist with training and experience in the procedure to ensure the best possible results.

Elham Jafari, MD · Answer

Hi and thank you for your question! There are a number of non-surgical energy-based treatments that target SMAS and induce stimulation of new collagen and other components of extracellular matrix. My personal favorite and recommendation is Ultherapy as it is FDA-cleared and visualizes the deeper layers of skin during treatment, guiding your clinician to target the right depth and layers of skin for best results. I hope it helps and good luck!

Andrew Campbell, MD · Answer

Ultherapy targets the SMAS. The SMAS is the fibrous layer under the skin, and that is exactly what the Ultherapy energy hits. The energy causes the breakdown of the natural collagen which stimulates the healing response. Ultherapy causes hundreds of these small injuries in the SMAS, each of which slightly tightens with the healing which causes a lift of the lower face. Everyone heals these points of injury differently and the device can only create a very small amount of lift, so it is subtle. If you want more than that, a surgical lift is your best bet. Ultherapy can lift by millimeters, surgery can lift by centimeters (ten times the amount). Many patients are good candidates for we call a minilift, which can easily be performed in the office setting using local anesthesia. The incisions are extremely well hidden in and around the ears. Sutures are removed in a week, and downtime is minimal.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa

Douglas M. Stevens, MD · Answer

The SMAS layer is visualized in when using ultherapy but the results were very variable and I had many patients that went on to have "mini" in office facelifts to get the results that they were truly looking for.  I feel that facial volumization with fat or bellafill ( a long acting biostimulator) can give very good results in the face when volume loss is an issue (as it is in most aging faces) however when suspension is truly the issue nothing beats a well done facelift.  Threadlifts can be useful but are temporary and without release of the facial ligaments results are limited.

Andre Berger, MD · Answer

Yes. Any device that heats up the tissue at the level of/or in close proximity to the SMAS may cause SMAS tightening. Potential technologies are certain radio frequency devices, ultra sonic, hi-frequency ultra sound, and certain lasers that can work both on the surface as well as internally to accomplish this.

Leonard Grossman, MD · Answer

In my opinion of ultherapy which uses ultrasound and other devices which use radio-frequency frequently will tighten the SMAS somewhat but in the process a great deal of facial fat will be literally cooked, making the face look years older a year later or so. In my opinion if a person has been at the same weight more or less their whole life, they should have autologous fat grafting which will provide them with natural results that will be extremely long lasting if not permanent. With fat grafting you can look like yourself 20 or more years younger. Good luck from New York City

Benjamin C. Paul, MD · Answer

Thanks for your question. To lift the SMAS, you have to move the SMAS.  Any non-surgical technique is trying to "tighten" the SMAS, which is just not the same. Tightening is never going to be as significant as an actual reposition. A lift will reposition and tighten the SMAS. I would consult a facial plastic surgeon to discuss if you are a candidate for a lift. The result will be much more reliable and lasting.