During an SMAS lower facelift, is the skin,muscles, and tissues pulled upward or back?

During an smas lower facelift, is the skin,muscles, and tissues pulled upward or back? I would like to achieve a more sculpted jawline and noticed that it looks much better when the skin is pulled upward rather then pulled back or laterally. Is this possible?

Doctor Answers 6

Directional Pull of a Lower Facelift

Thank you for your great question. Since the lower face and neck tend to "sag south" due to gravity, as a general statement, the proper direction of tightening is more in a vertical direction. Sure there is a sideways/lateral component as well, but the majority of the "lift" should be vertical for both the muscles (platysma and SMAS) and the associated skin. The evolution of facelifting has shown this to be the better approach, for many "old school" facelifts had too much of a lateral pull leading to stretched lips and unnatural windswept appearances. Probably the best advice I can give so to seek a surgeon with lots of experience with lower facelifting/necklifting to give you the best chance of a successful procedure.


Las Vegas Facial Plastic Surgeon
4.9 out of 5 stars 53 reviews

During an SMAS lower facelift, is the skin,muscles, and tissues pulled upward or back?

  Hi, I have performed many facelifts over the past 30 years.  The skin and SMAS muscle layers are dissected separately and each lifted upward and back at about 45 degrees, trimmed and then sutured back in the elevated position.  In addition, I shape the cheeks, chin and jaw line making a woman face more feminine and beautiful or a mans face more chiseled and handsome.  This avoids the dreaded over-pulled, "wind swept" appearance which is a telltale sign of a poorly done facelift.

 If you have "jowls" this is sagging facial tissues and an 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 and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • 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
  • excess skin removed
  • 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
I combine whatever facial shaping that's necessary 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.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Smas face lifts

very good question. Over the past 30 yrs I have found by doing many smas lifts that it needs to be lifted in 3 directions, that is the SMAS, skin and muscle. this provides a very youthful look with nice contours,BUT maintains a natural look. nobody should have that "facelift pulled " look. so the 3 directions should be vertical, back and obliquely. best of luck! 

Pulling vectors in SMAS Facelift

Very good question. The real anwser is that it depends on who preforms the surgery and how. Since its a lower facelift it can only be backwards, but if you preform a full facelift, the pull should be a combination of both upward and backward. The way I do it in a regular facelift is I pull the SMAS in a mostly vertical vector since this is what pulls all the muscles and skin sagging upward, but you still need to remove this excess skin and I can do this by pulling this tissue backwards.Hope this resolves your question.

Luis Pedroza, MD
Colombia Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

SMAS face lift - what is the direction of the pulll

Thank you for asking about your face lift.

  • Certainly one does not want that sideways 'wind swept look'.
  • In the face, the lift is as vertical as possible.
  • In the neck, the pull is both up and back, as this is the direction of the plastysma muscle fibers.
  • Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

SMAS lower facelift candidate

 In our practice, the goal of a lower SMAS facelift is to tighten loose facial and neck muscles, remove the fatty deposits in the neck (above and below the platysma muscle), lift the jowls, and tighten loose facial and neck skin. For many examples  and more information, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 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.