SMAS vs Deep Tissue Suture Lift?

In your opinion, which Facelift is better? The SMAS or the deep tissue suture lift?

Doctor Answers 16

Best facelift

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Any subcutaneous facelift will last longer and have better support if SMAS work is done also. I personslly like to plicate the SMAS along the zygoma, in front of the ear and down the neck between the platysma and sternocleidomastoid muscle....this gives excellent support a good pull and above all a natural smooth result. I personally don't care for deep plane facelifting. To me they all have a tell tale look as though there is a slight sneer to the expression which I think is caused release of the lip elevators. So to sum up I am a big SMAS fan but not a deep plane facelift fan

SMAS vs deep plane facelift

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I prefer the SMAS lift because I can move the deep tissues directly up, right back where they came from and then move the skin along more natural lines.  The deep plane lift moves everything more as a unit so I don't think it is as natural.

Facelift types

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The SMAS and deep tissue lift are really quite similar in that they both tighten tissue deep to the skin.  The quality of the result you get depend mostly on your selection of a surgeon with extensive facelift experience.  Good luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 30 reviews

SMAS vs. Deep Tissue Suture Facelift

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A SMAS facelift tends to have a longer lasting result than a lift done with tissue sutures.  However, any deep multi-layer facelift will last longer than a subcutaneous facelift.  The most commonly done facelift is one with at least some manipulation and SMAS involvement.  

Rod J. Rohrich, MD
Dallas Plastic Surgeon

SMAS Facelift

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A sub-SMAS, or sub-muscle-fascia face lift, involves dissection above and below the muscle-fascia layer of the face. The increased amount of dissection allows for movement of the skin and underlying muscle-fascia layer in different directions permitting greater tightening of muscle-fascia layer, less tension of the skin closure, and longer-lasting, natural results. An inconspicuous incision is made along the sideburn, in front of the ear, under the ear lobe, ending in the hairline near the nape of the neck. Various amount of skin are excised and redraped to reduce facial wrinkling, soften the appearance of nasolabial folds, decrease jowling, and better define the neck. The muscle fascia-layer is dissected free of the underlying tissues and tightened to further reduce nasolabial folds and jowling and better define the jaw line. Incisions are meticulously closed with a no-tension technique to ensure barely visible scarring. Ideal candidates for a sub-SMAS face lift have moderate amounts of lax skin, moderate amounts of facial fat, and moderate amounts of muscle-fascia malposition. Proponents of this technique claim that the sub-SMAS dissection provides more dramatic, longer lasting results than a standard skin-only face lift. Critics of this technique feel that the greater amount of dissection poses an increased risk of facial nerve injury, more postoperative edema, and a longer recovery time.

Jaime Perez, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 81 reviews


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A facelift involving the SMAS layer can have several variations just as some of the many "deep tissue suture" techniques.  The time-tested technique that gets the best results is a Modified Deep Plane SMAS Lift.  This is because the layer that supports the face and neck, the SMAS, is stronger than skin alone and when lifted, allows tension-free skin closure that will get the best looking incisions.  This layer has strong hold and gives natural contour to the cheeks, jaw line and neck line.

Also take into consideration that you should not make your decision based on the technique any more than you might choose filet mignon without knowing whether you will get a fry cook or a chef.  The incision placement, experience, training and demonstrated results are most important.  Make sure you get someone with credentials who is not afraid to show you before and after photos from his or her patients.  I even allow prospective patients to contact my recent patients so they can see what their experiences are like.

Paul K. Holden, MD
Phoenix Facial Plastic Surgeon
4.9 out of 5 stars 55 reviews

Facelift techniques

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I agree with the other docs, there are a few ways to do a facelift.  You should look at several surgeons' before and after photos and see which results you like in patients who have similar anatomy.


Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Without question, the SMAS facelift is better.

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The SMAS facelift is the gold standard for facelifts. The fascia is meticulously lifted and pulled to create a lasting result. 

I do not recommend suture lift as it has a high complication and failure rate and has been shown to adversely effect the aesthetic outcome of a traditional facelift at a later date. Suture lifts create unforgiving and unpredictable scarring which disrupts the natural soft tissue facial planes necessary in performing a facelift.

Peter Schmid, DO, FAACS
Longmont Facial Plastic Surgeon

SMAS vs Deeper plane facelift

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I personally feel that the deep plane facelift patients appear to wide in the cheek region. To me this does not looknatural. I prefer a SMAS facelift which I feel gives more control to manuever the soft tissues of the face.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews


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I much perfer a deep face lift which elevates the smas and secures it in multiple location with different vector of pull.  This is a time tested procedure and now is the gold standard.  This face lift also last 8 to 10 years.  The suture lift refers to smas lift with one suture which la-sow's around the smas and tightens it.  Not nearly as good as the other.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 81 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.