Can SMAS Lift Helps to Fill in Dent in Cheeks, and Jowls?

Im 34 year old female. I had orthodontic work done 5 years ago with 5 teeth extracted. I ended up with a flat profile. I lost support of my cheeks. My jaw and chin area looks like an eldery person without teeth. I also have dents on my cheeks that looks horrible! What kind of procedures helps to restore the dimension of my jaw and chin area?, and can the smas lift helps with the issues that I have? Please help! Thanks.

Doctor Answers 11

SMAS facelift to fill in cheek dents?

SMAS types of facelifts with help to move the available fat you have into a higher more youthful position. IThey do help to restore some fullness in the face. But it sounds like you have a combination of mild aging volume loss and a loss of boney support. You may need a combination of fat grafting (better for the long term) and facelift surgery. Sometimes they can be done together while other times I thinks it's better to separate them. Sometimes if the bone loss is severe enough you might do better with different types of cheek implants. You need to see someone who has enough experience in all these techniques to get the best recommendations. Good luck.

Baltimore Plastic Surgeon
4.9 out of 5 stars 78 reviews

SMAS Lift to Fill in Dents

A SMAS lift will certainly lift and support your cheeks but I doubt that it will improve any dents that you are observing.  Certainly fillers, fat grafting, or an implant may help with the hollowness that you observed.  The appearance of your mouth and chin is concerning.  A chin implant or genioplasty may help your chin area.  If your upper jaw looks like an edentulous elderly person you may require jaw surgery to give you more tooth show and projection of your upper jaw. 

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

SMAS for dents in the cheek

Although tightening the tissue of the cheek will likely fix some of the tissues that have fallen to cause the dents, in my opinion, you likely will need more than that as you likely have lost some bone from your procedures and therefore have a more complex problem. It might entail implants of some sort or even bone grafting. I think it best to see a surgeon in person as it is difficult to tell exactly what you might benefit from without seeing you in person.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Bone Loss with Orthodontia Does Effect Facial Volumes

When you have tooth extractions for orthodontia, the upper and lower jaw do not develop as fully, and this causes some facial imbalance as you age.

A SMAS Facelift serves to tighten up lax structures and re-drape the skin, not replace bone loss. In my practice, I have suggested some of the following to correct for orthodontia-related facial changes:

  • Sometimes a small chin implant can help balance the lower face
  • Sculptra and/or fat grafting can add volume & contour around the mouth and especially in the cheeks.
  • Selective rhinoplasty can be very pleasing.


Edward Szachowicz, MD, PhD
Minneapolis Facial Plastic Surgeon
4.5 out of 5 stars 13 reviews

A SMAS face lift for facial volume deficiencies and jowls...

I'm of the strong opinion that the "gold standard" for treating jowls is a SMAS lift (either cheek lift or face lift). Simultaneously, a SMAS lift will shift facial volume away from the lower face and into the cheek area, The SMAS method is very good at achieving both of these goals, but, depending on the amount of volume improvement required, it may fall short in producing a satisfactory amount cheek volume enhancement. Every patient situation is different in this respect.

When the patient's facial volume deficiency is such that a SMAS lift is unable to deliver the desired volume augmentation, an ancillary procedure, in the form of either a filler, implants or fat transfer may be advisable. These choices should be discussed in advance so they can be included, if necessary, on the day of the SMAS surgery.

The preferred method of cheek augmentation is now somewhat of a "hot topic" in plastic surgery circles, and the choice offered by a plastic surgeon may very well reflect his or her individual experience.

Your's sounds like a very interesting challenge, and I wish you the best of luck!

Charles Gruenwald, MD (retired)
Baton Rouge Plastic Surgeon
5.0 out of 5 stars 11 reviews

SMAS Facelift

Although a SMAS face lift alone may elevate the cheek fat pad and subtly help improve volume in a deflated face, due to aging and gravity, in an older individual.  You, on the other hand,  are quite young and you may want to consider some other options.  A mid face lift, by itself or combined with fat grafting or Sculptra may help to really improve the volume in your face.  The mid face lift  improves the appearance of the cheek area.  The other fillers can be placed diffusely throughout the face to improve overall facial volume, even to the jaw and chin area.  You are absolutely right, a full face is a much more youthful face.


Jenifer L. Henderson, MD
Silverdale Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Can SMAS Lift Helps to Fill in Dent in Cheeks, and Jowls?

       Fat grafting may be necessary to restore the volume that has been lost and a lift may help reposition existing tissues.




Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 reviews

Restoring Dimension To The Jaw Line


Due to the changes that have occurred to your face after your orthodontic work, you may need more then just a SMAS facelift alone. While the SMAS facelift can help with some of the skin laxity and drooping, procedures to increase volume are probably necessary such as the filler Sculptra or fat grafting.  It's possible that even implants may be needed in certain areas. It's best that you consult with a Board Certified Facial Plastic or Plastic Surgeon to discuss the treatment options that will be best suited for you.

Carlo P. Honrado, MD, FACS
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

SMAS lift for jowls and facial indentation

An SMAS lift can fix your facial jowls. However, it is unlikely that an SMAS facelift can fix the indentation. Fat grafting or injectable fillers, such as Sculptra, may be a better option for the indentation.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

Facial Rejuvenation with Fat Grafting

ructural fat grafting is a powerful tool for correcting one of the primary processes of facial aging: the gradual loss of facial soft tissue volume, which primarily represents the atrophy of facial fatty tissue. The importance of restoring facial fullness cannot be emphasized enough, for without it, very few facial cosmetic surgical procedures are truly rejuvenating. As we age the skeletal features of the face become more obvious, and create subtle visual clues that tell the observer 'this is an older person'. Fat atrophy is often very obvious when it appears as hollowness in the temple area and as flattening of formerly full cheeks, but can also exist as more subtle changes that still convey an appearance of advancing age, such as the development of a hollow in the space between the upper lid and eyebrow, or as indentations in a formerly smooth and gently curving jawline.

Lifting skin and trimming the excess has been the standard approach to the treatment of facial aging for centuries, but when performed without some means of restoring the youthful fullness of facial soft tissues, the result is an older-looking person with tighter skin. The word 'rejuvenation' means literally 'to restore youthfulness' or 'to make young again', so if the goal of surgery is to rejuvenate the face then it cannot be accomplished solely by means of redraping the skin and removing the excess.

In my practice fat grafting is not an afterthought that is thrown into the surgical plan for the occasional patient. It is a key component of almost every major facial rejuvenation surgery that I perform. It is in fact that very first part of the surgical procedure for my patients undergoing a full facial rejuvenation surgery.

Fat grafting also gives the surgeon the ability to provide a minimally invasive, quick recovery solution for some of the earliest signs of facial aging, in many patients long before they could or should consider a more involved (and much longer recovery) procedure like a facelift. Most people show evidence of facial soft tissue atrophy in their thirties, long before they develop the degree of skin laxity that warrants skin redraping and removal. So younger patients now have a means for 'turning the clock back' by maintaining or restoring facial fullness through structural fat grafting. These enhancements look beautiful and natural, not like surgery, and over and over I hear fat grafting patients tell me that "none of my friends or co-workers can figure out why I look so great".

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 120 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.