How Long Will a SMAS Facelift Last?

After a SMAS Facelift is performed, what prevents the sutures from slicing thru the tissues and the face dropping back down and what causes little fat pouches beside the side of the mouth after Facelift?

Doctor Answers 21

Longevity of cosmetic surgery

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The longevity of cosmetic surgery procedures depends upon the happiness of the patient, not the skill of the surgeon. All of these “lifting and tightening” procedures we perform are dependent upon the patient’s satisfaction with themselves, not the strength of the lift. For example, if we perform a great facelift on one of two aging twins then the “lifted” twin will always be the more youthful in appearance as they both continue to age. But the more youthful twin may still want to be lifted again and again. I have performed many repeat facelifts on patients just as a barber performs many haircuts when the client feels their hair is too long.

Dayton Plastic Surgeon

SMAS Facelift can last forever

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That is a great question. As someone who does approximately 35 SMAS facelifts every month, I feel I have an amazing experience to draw from. I always tell people that a facelift will last forever...if you stop aging. Perhaps a better way to look at it is in how long will your appearance be improved. Typically, people will look anywhere from 7- 20 years younger after my facelift. This, of course , depends on how old they are and how much improvement they needed.. So, I tell them that they will always look 7-20 years younger THE REST OF THEIR LIFE, versus if they never had anything done.

Hope this helps. Good Luck.

Robert F. Gray, MD, FACS

Robert F. Gray, MD, FACS
Bay Area Facial Plastic Surgeon

SMAS Duration varies, but typically several years

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My other colleagues make good points. In adding to the discussion, I would offer several points:

1. Any cosmetic procedure will provide longer-lasting results if you reduce the amount of future insult to the tissues. Typically, we discuss this point with laser resurfacing. You can think of it as waxing your car. If you park it in the sun, it won't last as long as if you park it in the garage. Sun-blocking make up and skin care products will help your investment last longer. Surgery is similar. Don't get a face lift, and then lay out every day for 5 years and complain when you age faster than you wish.

2. The sutures will pull through the tissue when there is a lot of tension on them. For this reason, I prefer to place several sutures deep in order to evenly distribute the downward forces over many points, thereby reducing the amount of tension on any given point of pull or fixation. This reduces the amount that any given suture will tear through the tissue. However, realize that the tissues are elevated and moved, and then simply held in place by the sutures until scarring between the layers develops, which ultimately provides the final "hold". Therefore, it's really only an issue if a suture break or tears in the immediate post-op period, which is another reason to place several so that all your work isn't "hanging" or depending on one suture.

3. SMAS lifting means that the surgeon is doing something with that layer, but is not specific as to what they are doing to it. Some surgeons simply put a pleat or plication in the SMAS folding it up on itself, and call that an SMAS lift. Others actually develop a separate layer of elevated SMAS tissue and remove a section of this layer, shortening it, and increasing the pull.

Since I am an ASOPRS-certified oculoplastic surgeon first, I frequently utilize this technique as it is more consistent with our field's surgical beliefs and principles, and the excised SMAS tissue can be used during endoscopic brow lifts to fill the glabella (between the eyebrows) or round out the lateral orbital rims (under the brow tails). It makes a wonderful filler in these areas, whcih I am typically doing in conjunction with the facelift.

Just beware not all SMAS lifts are the same. Ask your surgeon which approach they use and why. As long as they have a good reason, and good results, you should be fine.

I hope this helps!

David M. Mills, MD, FACS
Pensacola Oculoplastic Surgeon

The type of motion of the face.

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 Unlike a knee or shoulder, there is little tension on the face tissue. The tissue is held with strong sutures. The swelling around the corner of the mouth is due to swelling after a lift and aging before the lift with sagging tissue.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Facelift duration with SMAS

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Face lift results should last several years. Sometimes patient will require touch-up or revision aesthetic procedures earlier. Keep in mind your face & skin continues to age, so you will naturally loose some of the cosmetic results.

Any sutures that are used during facelift surgery generally do not hold tissues permanently. Sutures can slice through tissue over time. The skin & underlying tissues develops fibrous attachements or scars itself in-place a bit after face lift surgery to help maintain cosmetic results.

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

SMAS Facelift Can Last for Up to 10 Years

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As in any surgery, the sutures used to close the wound in an SMAS facelift either dissolve or are removed within a week to 10 days. Therefore, the face is not “hanging” off of thin threads. Rather, the sutures act to seal the tissues together as they heal, allowing them to form scar tissue that can then support the new position of the face for up to 10 years even as the patient continues to age. As for the fat pouches beside the mouth, these will not occur in a facelift that has been performed by a board-certified facial plastic surgeon with deep knowledge of anatomy and facial aesthetics. Lifting the face is not sufficient; all of the elements of the patient's facial structure must be in symmetry and harmony and look perfectly natural. That is the mark of a successful SMAS facelift. I hope this helps.

How long does a facelift last

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First, the longevity of a facelift depends on skin quality, elasticity, genetics, and the type of facelift performed.  If there was a point in time when your skin was stressed with excess UV radiation, or excess inelasticity runs in your family, or if you were engaged in other external activities such as smoking or tanning, the results of the facelift won't last as long as someone who hasn't participated in those activities.  

However, if a proper maintenance program is performed, which includes taking care of your skin with medical grade products and if you support the lifted tissue with volume to address the volume that all of us lose over time, then you can make that lift last much longer. 

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

SMAS Facelifts: Release and Reposition not Stretch and Pull.

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The SMAS is a firm layer of tissue in the face that can be safely mobilized and utilized to hold a facelift. The SMAS layer must be dissected to mobilize it and reposition the face on it. This decreases tension on the SMAS tissue so there is no tearing through the tissue. Not all SMAS facelifts do this, and unfortunately few plastic surgeons are performing a sub-SMAS dissection into the cheek and neck to unload the SMAS for long lasting repositioning.

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 52 reviews

SMAS Facelift Duration

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The longevity of a facelift can vary depending on the initial procedure. A facelift that addresses the underlying descent of facial soft tissues provides the greatest longevity. A facelift that lifts the underlying SMAS will re-elevate descended facial tissues and improves the appearance of the cheeks, jowls and often the neck. In a patient with good skin quality, this facelift should last 7-10 years.

How Long Will a SMAS Facelift Last?

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A SMAS (sub-muscular aponeurotic system) facelift is a face lift technique that tightens the deeper layers of the face rather than just tightening the skin. This technique is similar to a deep plane facelift and a MACS lift in that these procedures all aim to reposition the deeper tissues to get a more youthful look. They are more involved than a skin only facelift. A MACS Lift uses much shorter scars.
All of these techniques will last your lifetime but the deeper tissue procedures seem to stand up a little better according to the comparative studies.

I hope that helps.

Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 64 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.