Will face and neck liposuction damage the SMAS layer, making a future facelift less effective?

Question

I want to do facial and neck lipo, but I’ve heard that doing liposuction on face and neck will damage the SMAS layer and will make the future face lifts less effective. If they go in from the back (near the ear), it’ll damage SMAS. But if they go in from the front (near mouth), then it won’t damage SMAS. And that neck SMAS is sturdier, so lipo is more ok compared to the face. Are these things true?

Donald Groves, MD · Answer

Hello and thank you for your question. To answer your question, we have to discuss the anatomy of the face and neck. During a facelift, you dissect the skin and subcutaneous fat from the mid/lower face and neck off of the deeper structures (SMAS layer in the face, which is continuous with the platysma muscle in the neck). Liposuction would address and remove fat superficial to the SMAS/platysma layer, thus it should not affect a future facelift/necklift. 
Typically liposuction is performed to the submental/chin or neck region as a standalone procedure or as part of a formal facelift/necklift. This is often because there is fullness in this region resulting in loss of jaw definition- this can develop either with age or with weight gain. Liposuction to this region helps address this and improve jaw definition, resulting in a more youthful appearance. Liposuction is typically NOT done to the face, however, as the characteristic changes that occur with aging result in sagging of facial soft tissue structures and actually volume loss (due to fat atrophy and facial bone resorption with age). Therefore there should not be a need for liposuction in the face. In fact, it is common these days for fat to be grafted to the face to add volume (commonly during a facelift/necklift), which helps restore facial harmony and results in a more youthful appearance. 
With all that said, it is always difficult to provide tentative surgical recommendations in this type of situation. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Stephen Prendiville, MD · Answer

Although it is hard to answer this question without a consultation, facial liposuction is rarely a great facial aesthetic treatment in isolation.  And it can damage the SMAS.

Jonathan Kulbersh, MD · Answer

Thank you for your question. Facial liposuction can effectively remove excess fat from the chin, neck, and face to create a more youthful contour. The areas of fat you’d like to have removed are specifically targeted and superficially excised, so no damage to the SMAS layer should occur, nor will this procedure negatively affect future surgeries. If you’re concerned about surgery but want to diminish submental fat below the chin, you may want to consider Kybella injections.  This treatment option dissolves fat cells under the chin to create a more contoured jawline and reduce a double-chin appearance. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or injector who will answer any questions you may have and help you decide on the best treatment option.

Cory Bovenzi, MD · Answer

Thanks for the question! Liposuction should not damage the SMAS/platysma layer as it is performed superficial to these muscles

Ajaya Kashyap, MD · Answer

Thank-you for your query. Facial liposuction is indeed tricky and should be done very conservatively, otherwise you can have loose, saggy skin and contour deformities. Doing a conservative and limited micro cannula liposuction from the corner of the mouth is better, in my opinion, than from the side of the ear. Neck Liposuction is generally safe but should not be overdone either, to prevent “witch’s chin deformity”.  Please discuss the procedure and its risks with your Board certified Plastic surgeon before you decide to undergo this procedure. All the best!

Mark Glasgold, MD, FACS · Answer

Liposuction of the face and neck will create a scar layer that makes doing a subsequent facelift more difficult. This is much more pronounced if liposuction with some sort of thermal assistance such as ultrasound or radio frequency is used.

Ronald J. Edelson, MD · Answer

You don’t need to worry about having a facelift in the future if you get facial liposuction. It will not cause any issues

William Portuese, MD · Answer

In our practice, we never remove fat from the face, only in the neck. Much more information is needed, such as your age and A full set of facial and neck photographs to make a determination about the correct procedure for you. It's also important to understand there are two compartments of fat in the neck, above and below the platysma muscle. Liposuction can only accomplish removal of the fat deposits above the muscle, while a neck lift procedure is required to surgically extract the fat deposits below the platysma muscle when present.

Will face and neck liposuction damage the SMAS layer, making a future facelift less effective?

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