Will a SMAS facelift address the mid face?

And is it ok to have surgery like this if you have Hashimoto's?

Doctor Answers 12

SMAS Facelift Considerations

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.
  1. More natural lifting of the fascial tissue avoids the windblown or pulled look of many other techniques.
  2. Vertical lift adds to the volume of the cheek, removes the jowl and marionette lines to yield a more oval face.
  3. Vertical lift often eliminates the malar depression or tear trough.
  4. The SMAS facelift has a lower risk of facial nerve injury than the deep plane facelift and recovery from swelling is significantly shorter.
  5. 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.
  6. 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 and discuss your Hashimoto's disease. If it is in remission, then you should be fine.

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".

New York Plastic Surgeon
4.8 out of 5 stars 32 reviews

SMAS Facelift and the Midface

As long as your Hashimoto's is under control and you are seeing an Endocrinologist, there should be no concerns about the safety of a facelift.  Regarding the midface, the answer is how the SMAS is manipulated.  A properly performed  "high SMAS" lift as described will be successful in lifting the cheek area.  Release of the zygomatico-cutaneous ligaments allows for cheek mobility and elevation. Frequently, patients who are candidates are also candidates addition of volume to the cheek.  This can be reliably performed with Voluma or Sculptra at the same time as your facelift or at a later date.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 87 reviews

SMAS facelift can improve the cheek but is more effective on the lower face and neck

The SMAS facelift is a very effective facelift technique.  It certainly can lift and restore the malar fat pad which will improve the cheek and can have excellent results on the lower face and neck.

However today most facelift patients eventually require some volume replacement at least with dermal fillers.

You might also like...

SMAS facelift

A SMAS facelift is one of several ways to perform a facelift procedure.  As for your thyroid disease, as long as it is stable and well controlled and your doctor gives you medical clearance it should be ok.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 26 reviews

SMAS Facelift and Midface

The high-SMAS facelift is the best procedure for rejuvenation of the midface and addresses the entire face from the corner of the eyebrow to the neck giving a harmonious restoration of the face.  If your thyroid condition is stable there is no reason that you couldn't have the procedure performed.

Michael Sundine, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 18 reviews

Will a SMAS lift work for the mid-face?

A SMAS lift is most effective in addressing the jowls and the neck. In my experience, the mid face is best addressed with volume replacement using fat or dermal fillers. As long as your thyroid hormone levels are controlled by your endocrinologist or your primary care doctor, Hashimoto's thyroiditis should not prevent you from having a good result from a facelift.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

SMAS facelift and thyroiditis

First it's important to make sure your thyroiditis  is under control by your endocrinologist prior to undergoing elective cosmetic surgery.
In our practice, a comprehensive face/neck lift does not technically tighten the mid face. The jowls are tightened, excess face and neck skin is tightened, the neck muscles are tightened and fatty deposits are removed above and below the platysma muscle in the neck. To augment the mid face area, we perform cheek implants  where there has been a loss of volume that occurs with the aging process.
For many examples, please see  the link below to our facelift photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 139 reviews

Treating the mid face

Thank you for your question. A SMAS facelift can treat the mid face. There are several techniques to allow that to occur. If you have Hashimoto's thyroiditis and maybe prudent to consult with your endocrinologist.  Your thyroid is important and it must be functioning normally or it function must be supplemented by medication before any surgical intervention.

Earl Stephenson Jr MD DDS FACS

SMAS facelift and the Midface

A SMAS facelift does address the midface when it is a HIGH SMAS flap facelift.  This allows the midface to be elevated in a vertical fashion and shortens the lower eyelid tear trough if performed correctly.  The vectors of this operation are very important.

Jay Calvert, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 50 reviews

Will a SMAS facelift address the mid face?

SMAS is a term that is applied to a great number of techniques.
But it is usually more associated with neck and jaws, rather than a mid face and cheeks, as an objects of lift; we need to mention some special techniques like MID FACE LIFTING, HIGH SMAS flap, used for cheek lift and midface correction.
It is ok with having facelift, if you are under control of your endocrinologist. All you need to do having endocrinologist control within the last one month and  not to take your pills even the in the morning on day of surgery if needed.


Ercan Karacaoglu, MD
Turkey Plastic Surgeon
5.0 out of 5 stars 22 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.