What constitutes a SMAS facelift?

Shayla,
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.

A SMAS Facelift doesn't really describe a technique, but rather one which manipulates the SMAS.

The “skin only” face lift was the basis for facial rejuvenation for decades. While the results were satisfactory the one complaint is that the effects tended to be short lived. Then, in 1974, Dr. Skoog described a deeper plane face lift in which the muscle and connective tissue layer underneath the fat layer, later named the SMAS (superficial musculo-aponeurotic system) layer, was dissected and tightened. Since Skoog’s initial description the “new era” of face lifting has begun. There have been a dizzying number of modifications to the Skoog method, all of which manipulate in some form or another the SMAS layer. These include SMAS excision techniques such as the short flap lift, the long flap lift, the deep plane, the composite lift and others. Other techniques meant to simply tighten the SMAS layer have also been explored including the MACS lift, Swift lift, thread lift and more.  Few people do skin-only facelifts anymore.

Placement of the incision is very important, but strangely, misplaced by many.  It should go, starting from front to back:


up into the hairline behind the side burn (not in front of it)

at the junction of the top of the ear to the cheek

behind the notch of cartilage in front of the ear canal (not in the creases in front of it)

in the crease where the earlobe joins the cheek (cheating out onto the cheek will pull the earlobe down causing a "pixie ear" deformity)

behind the ear on the cartilage itself.  The incision will migrate back into the crease and if you start out on the crease it will end up visible behind the ear.

Sometimes you can stop behind the ear (mini-lift) and sometimes you need to continue into the hairline behind the ear.  When the latter is necessary, you should to a trichophytic incision in the posterior hairline and not up into the hair.  If you go up into the hair it will result in a stair-step deformity that will prevent your patients from ever being able to wear their hair up again.


Make sure you discuss in detail the planned incisions with your surgeon.  There is really no excuse for a visible incision when there are techniques available that will make them totally hidden.

The incision for a Facelift is the same whether the skin only is tightened or whether a deep plane or SMAS Facelift & Neck Lift are performed - it extends in the crease in front of the ear, around the earlobe, behing the ear, and back into the hairline. A SMAS or deep plane Facelift will give you a better, longer-lasting result, and usually has better scars.

The skin incisions for a facelift do not change that much depending on the type of facelift that is performed. A SMAS, deep plane, lower facelift, neck lift, skin lift procedure can all be done through exactly the same skin incisions. The incisions you describe are the fairly standard incisions for all those types of facelift and neck lift. It is important to realise that the real differences in facelift technique are found in how the deeper tissues are addressed. A deep plane facelift is a type of SMAS facelift that mobilises the SMAS layer close to the mouth and jawline. The skin does not need to be separated for as large a distance off the underlying muscle layer. This leads to longer lasting results, a more natural look and a quicker recovery. 

The type of lifting procedure that is performed under the skin is generally not dependent on the type of incision that is made. A skin-only facelift, a SMAS facelift, a Bi-planar facelift, and a deep-plane facelift can all have the same skin incisions. Skin incisions tend to be very similar from one surgeon to another, but do have small nuances that will vary from surgeon to surgeon. In short, the skin incision does not dictate the type of lift performed under the skin.I recommend facelift techniques that involve tightening the SMAS layer under the skin in addition to the skin itself. I personally perform a Bi-planar SMAS technique that incorporates elements of several different types of facelift techniques. In doing so, we are able to achieve excellent, long-lasting, and natural-appearing results that are also very safe with limited down time.All the best,

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.  

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.

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. 

 

The incisions for most facelifts are just like you've described:  inside the ear (tragus) and down and around the earlobe staying behind the ear and ending in the hairline.  After several months of healing, massage, and allowing the swelling to resolve, you should have scars that are very well hidden.  Talk with your plastic surgeon about scar therapy after your facelift.  Good luck!

Incisions are one important component of getting a successful facelift.  Incision placement is critical to concealing the signs of having had a facelift.  The most important factor in well healed incisions is the surgeon.

This is an access incision that most facelift surgeons use.  A SMAS facelift had nothing to do with the incision on the skin.  A SMAS facelift involves tightening the underlying facial muscles via various methods.  

Dr. ES