Will a SMAS plication type facelift affect my fat cheeks?

Question

I am 53 and had fat grafting to my cheeks about ten years ago. It looks ok but when I smile my cheeks look round and ball-like, kind of youthful actually and not bad looking. My question is : If I get a SMAS plication type of lift will that affect the mid cheek area where the fat is? My understanding is that the SMAS gets folded or plicated. Would that make my cheeks look even bigger?

Arnold Almonte, DO · Answer

Hi, the facelift is a combination of liposuction, treatment of the SMAS, followed by removal of excess skin. The SMAS is the muscle layer right under the skin which can sag with age. Tightening it can improve the jawline and remove jowls. How it is tightened is where surgeons can differ. Some plicate, (fold it on itself), whereas others dissect and trim the excess and suture it back together. I believe the latter approach works best because it doesn't result in a bulkier appearance. If your skin is properly redraped after the SMAS has been repaired, the overall look should remain youthful and blended with your previous fat grafting. I hope this helps. Good luck!

John Renucci, MD, FACS · Answer

Thank you for your question.  Putting a name on a type of surgery helps to convey information on the "general" operative plan, however there are many nuances in performing the procedure.  Every patient is unique with regards to goals, anatomy, and tissue variability.  Combining SMAS lift (+/- plication) with fat grafting can be a very rewarding process.  Restoring contours while maintaining a very natural appearance.  Meet with your surgeon and determine if his/her plan will achieve your goals.BestJohn Renucci MD

Konstantin Vasyukevich, MD · Answer

Thank you for your question.  Sagging cheeks is a major part of facial aging process.   This problem can be reversed either by using fillers (such as fat) or elevation of the sagging facial tissue (SMAS facelift).  With the conventional SMAS procedure it is very unlikely that your cheeks would look bigger, but they will certainly look higher.  When a facelift is performed after patient's cheeks were filled with fat adjustments to the facelift technique could be made to avoid over elevation of the cheek pads.  To get the best possible result I would encourage you to show your plastic surgeon what changes you are looking to achieve with a facelift.  This is best done by pulling the skin of the face up with your fingertips in front of the mirror.  When the surgeon knows what your "ideal" result looks like he/she would be able to make necessary changes to accomplish that look.Best wishes!Dr. Konstantin

Pravin Reddy, MD · Answer

Thank you for the question.
One goal of face lifting is to restore an inverted triangle or almond shape to the face that may have become more square as a result of aging.  Many face lift techniques therefore seek to restore midface, or cheek, volume.  
If the cheeks are already full and you are concerned that plication will lead to exaggerated cheeks, then it maybe worthwhile to consider a SMASectomy technique instead of a SMAS-plication.
I hope this answers your question.

Joseph L. Kiener, MD, FACS · Answer

One advantage of a properly performed SMAS facelift is restoration of volume in the cheek and the lateral orbital rim .  Of course if lack of volume is not an issue your surgeon can modify the technique to suit you. Regards Dr. Kiener

William Portuese, MD · Answer

An SMAS  Facelift procedure should not affect the mid face, just the lateral face in front of the ear. In our practice, we perform a high-SMAS lower face and neck lift which accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing any fatty deposits in the neck along with a platysma plasty. For more information  and many examples, please see the link and the video below

Richard W. Fleming, MD (retired) · Answer

It depends on what type of SMAS lift is done. A high SMAS lift can be used to modify the cheek area more effectively if that is the goal. An experienced rejuvenation surgeon will use the techniques and variations of these techniques to meet the needs and goals of each patient.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Non smiling photos of your face from the front and side would help in the evaluation.  The SMAS is best treated with an "imbrication" method (described below) which means it's dissected, elevated, trimmed and then sutured back together.  This remains the "gold standard" in SMAS facelifts and a stark contrast to "plication" which means the SMAS is merely folded upon itself or "suspension" techniques that use threads or sutures to suspend the SMAS...that will not provide lasting results.
  If you have "jowls” these are sagging facial tissues which are the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 SMAS facelifts alone do not necessarily reduce excess facial fat or shape the face...they tighten the SMAS and remove excess skin from the face and neck.  
 I do combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.  Liposuction is performed to reduce excess fat to further shape the cheeks, neck and face.
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
Hope this helps

Will a SMAS plication type facelift affect my fat cheeks?

Answers (8)

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