SMAS Facelift Incision?

After speaking with plastic surgeon about SMAS Facelift, and he said he does the SMAS, starting inside the ear, around the earlobe and about halfway up the back of the ear. Is this truly an SMAS Facelift? What can I expect from this? What do you recommend?

Doctor Answers 26

SMAS Facelift incision

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A facelift may involve correcting three layers:

1. Skin

2. Fat

3.SMAS - Superficial Muscle layer

A SMAS facelift tightens and repositions the Superficial Muscle layer.

The scars made to do a facelift result from two needs:

1. A large enough opening to do the surgery under the skin

2. A long enough scar to remove skin excess.

So, you need a scar to get under the skin to tighten and reposition the SMAS, and to allow removal of the excess skin and a smooth closure. By tightening the SMAS layer, the skin does not have to hold up the deeper SMAS layer and thus the skin excess can be removed and closed without over pulling the skin. This will result in a more natural result that will be more long-lasting.

Austin Plastic Surgeon
4.6 out of 5 stars 10 reviews

SMAS Facelift - Mini facelift

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The SMAS refers to the sub muscular aponeurotic system, which is a fibrous tissue that envelops the muscles of facial expression. It is this layer that is tightened and resuspended when performing a facelifting type procedure.

The incisions to access the SMAS vary from a minilift to a full facelift.

The minifacelift insision (short scar, S-lift, minilift) generally starts in the temple area, either in or just in front of the ear and around the ear lobe and behind the ear. The skin is lifted and the SMAS is tightened. Then the excess skin is removed.

It is important to speak with your facial plastic surgeon and explain what your expectations are. Generally, the mini facelift does not help if there is a lot of laxity in the neck- a neck lift or full facelift is then required.

It is important that you express all your concerns during your consultation so that you can have the best result possible.

Julio F. Gallo, MD
Miami Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Minimally invasive Facelift incisions

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A minimal lift for the lower face and neck is a great option with the least downtime for facial rejuvenation. There are many minimally invasive facelift options for the neck and face, which go by several names: s lift, mini lift, short scar lift, macs lift, SMAS, lunchtime lift, etc. These face lift surgery names are confusing. Technically, all these face lift procedures differ a little, but cosmetic results are the same.

The facelift incision may be anywhere from the temple & side burns, around the ear, and upper neck. The incision varies largely based on how much lift an individual needs. The plastic surgeon will minimize the incision but maximize the lift, without creating an unnatural appearance. The incision you describe should heal well. The face lift incision, when performed well, blends and hides from view.

More important than the specific incision or technique is the rapport and relationship you build with your plastic surgeon. He/She will be able to fully explain in-person the appropriate surgical option which is right for you, without a sales pitch or pressure.

Consultation with a face lift surgeon will provide you with a personalized face lift. Speak with more than one plastic surgeon regarding face lift surgery.

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

SMAS Facelift Incisions

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A SMAS facelift elevates the sagging facial tissue that results from aging. The SMAS (superficial muscular aponeurotic system) is a deep connective tissue layer that forms a continuous sheath within the face and neck. A facelift that lifts the underlying SMAS will re-elevate descended facial tissues and improve the appearance of the cheek-bone area (malar area) and jowls.

The typical incision starts in the sideburn, travels behind the tragus, around the earlobe and behind the ear. The incisions give the surgeon access to the SMAS, so that it can be elevated. The incisions also allow the surgeon to remove excess skin.

A facelift that elevates the SMAS is treating the underlying sagging facial tissues. A skin-only facelift relies on pulling the skin taught to support the underlying tissue. This can lead to an undesirable “pulled” appearance. A SMAS facelift should have excellent results that last about 7-10 years.

SMAS facelift incision

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The SMAS facelift is a type of facelift that describes the manner in which the tissues are lifted and tightened underneath the skin.  So, a small incision can be made and the SMAS can be tightened or a large incision can be made and the SMAS tightened.  The real question is if the type of lift you are having will address the amount of skin excess or fatty tissue you have.  In general, a facelift incision starts at the top of the ear and continues around the earlobe onto the back of the ear to get a good improvement for excess skin.  

Mike Majmundar, MD
Atlanta Facial Plastic Surgeon
4.5 out of 5 stars 50 reviews

Different Options Exist

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There are a number of different incision approaches to SMAS facelift procedures.  We tend to favor making the smallest skin incision possible during any facial surgical procedures, and utilize short scar/limited incision approaches in most cases.  That said, the foundation of any surgical facial rejuvenation is SMAS tightening.  The goal in our facelift approach is to utiliize the smallest incision possible that allows us complete access to SMAS, and the ability to elevate and tighten the SMAS in a comprehensive, natural fashion.  We always utilize an "inside the ear" (aka post-tragal) incision, and extend it only as necessary.  Commonly this requires extension to the upper ear/hairline, and behind the ear to the midpoint of the back side.  This allows complete facial rejuvenation with minimal placement of skin incisions.



Alan J. Durkin, MD
Vero Beach Plastic Surgeon

All Facelifts should be a SMAS lift but incisions will vary

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All types of facelifts have on thing in common : they must address the SMAS layer by one technique or another.

The SMAS is a layer of tissue and muscle that is below the skin and is what causes jowling. It needs to be elevated / moved in order to get good results. This is done in a number of different ways depending on a surgeon's training and preferences.

The incisions used will be designed for your case to make sure they provide enough exposure for the surgeon, allow enough loose skin to be removed and are aesthetically pleasing.

So same goals for all facelifts but different incisions used to accomplish each unique case.

Kamran Jafri, MD
New York Facial Plastic Surgeon

SMAS facelift incision

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SMAS stands for superficial muscular aponeurotic system.  This is the fascial layer or gristle layer underneath the skin.  To perform a SMAS facelift the incisions are not in the skin but in the fascial layers underneath the skin.  The best incisions for a facelift is just what you described, which is inside the tragus of the ear and at the temporal tuft and postauricular tuft of hair so as not to raise the hairline.  The skin incision is just as important as a SMAS facelift incision to give a very natural result.  The SMAS facelift addresses  fatty deposit removal in the neck, tightening the platysmal muscle in the neck, the fascial layer in the cheek, and gently tightening the skin layer. For many examples, please see the link below to our SMAS face lift  photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

SMAS Facelift Incisions and Explanation

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A full or "traditional" facelift addresses the sagging upper and lower neck skin and (platysmal) vertical neck bands, jowls, lower and mid nasolabial folds and marionette lines. It involves incisions from the temple scalp, along the front of the ear (inside the mid part for women), behind the ear in the crease then along or into the scalp hair behind the ear towards the back of your neck with undermining of the skin and  tightening of underlying support tissues. SMAS mini-facelifts can do much of the same with smaller procedures.

A SMAS lift in general refers to any facelift technique that tightens the SMAS layer along with the overlying skin in a more youthful position making you look younger. Specifically the SMAS face lift does its magic by lifting and tightening the jowls, neck, and cheeks to a more rejuvenated position. These techniques generally produce more natural and long-lasting results than the "skin only" face lifts, and now considered by most board certified plastic surgeons as the most preferred method. Incisions can be large or small depending on if it is a traditional facelift or mini-facelift approach. Both can be SMAS lifts.
A  SMAS mini-facelift, or "short scar facelift" or as I call it in my practice the LiteLift addresses all of the above except for the lower neck. The difference is that the incisions are shorter - basically the same description in front of the ear and temple scalp but ending at the level of the earlobe (in front or in back) - as much as 40% less scarring. We prefer the Lite Lift procedures as it allows us to do most of these procedures with oral sedation and local anesthesia without IV's or general anesthesia. 


SMAS Facelift Incisions

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It seems that you are confusing the incisions in the skin compared to the incisions in the SMAS layer.  The skin incisions are ideally carefully hidden around the ear and hairline.  The skin is then elevated from the deeper layers through these incisions.  Subsequently the SMAS layer is opened and elevated and resuspended.  I believe that the SMAS facelift is the best method available to reposition the facial fat, restore softness over the cheekbones, and to get rid of jowls.

Michael Sundine, MD
Orange County Plastic Surgeon

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.