Can a skin only facelift ever be equal to a SMAS lift?
Doctor Answers 33
SMAS Facelift vs Skin Only Facelift
‘SMAS’ is an acronym used to describe the sturdy, collagen-rich connective tissue layer of the face that resides between the skin and deeper structures such as the parotid gland and the muscles of facial expression. One must have a keen understanding of facial anatomy in order to be comfortable with performing surgery on the SMAS, but if one knows the anatomy well and has experience with SMAS elevation then the surgery can be performed quite safely, and with a recovery that is no more significant than a skin facelift.
Most surgeons tend to do what they’re comfortable with, and I think many surgeons who don’t operate on the SMAS leave it alone because they aren’t comfortable or experienced with dissection of the deeper soft tissue layers of the face. And that probably is a good thing, as the facial nerve and its branches are just below the SMAS so you absolutely must be confident about what you are doing. In discussing facelift techniques with colleagues, I have not yet run across a surgeon experienced in SMAS surgery who has gone back to performing skin-only facelifts.
It is worth pointing out that some younger patients with mild jawline and neck skin laxity are reasonable candidates for limited, skin-only facelifts (primarily to treat the jawline and neck), and that may apply to you. But if you have more significant aging changes and want to achieve a lift of the midface, correct deepening nasolabial folds, lift the corners of the mouth and improve marionette lines, then a SMAS facelift is the best approach.
The advantages of SMAS elevation and tightening are numerous:
- SMAS is made primarily of collagen, which has extremely strong tensile strength. In other words, it doesn’t stretch out – like skin does. Skin-only facelifts tend to produce shorter-lasting results, as the skin always stretches out over time. If it’s the skin that is holding the facelift, the face will tend to look unnaturally postop, and the lift is not going to last as long.
- Putting the tension on the SMAS layer allows the surgeon to do a tension-free skin closure around the ears. This results in much more favorable scars, and a much more natural appearance, than when the tension is placed on the skin.
- The SMAS layer is continuous with the platysma layer in the neck, so tightening the SMAS in the face has the effect of tightening the platysma and enhancing neck definition simultaneously.
- No facelift lasts forever, and a high-SMAS flap can be mobilized and elevated again in the future without distorting facial appearance. Repeated skin-only facelifts will widen the mouth, produce a ‘windswept’ appearance, and ultimately make a patient look like a plastic surgery casualty from the cover of Us magazine.
Regarding facelift recovery, SMAS surgery is not the most relevant issue. A state-of-the-art facelift surgery involves restoration of facial volume by means of structural fat grafting, and in my experience it is fat grafting that contributes more to postop to mid-facial swelling than surgery on the SMAS layer. However, even with diffuse facial fat grafting most SMAS facelift patients have recovered to the point of being prepared for social interaction by 10 to 14 days postop. It is the ancillary procedures with greater recovery issues that tend to prolong the total facelift recovery – procedures such as a major subciliary lower blepharoplasty, skin resurfacing, dermabrasion, etc.
May a skin-only facelift look as good as a SMAS facelift in some cases? Maybe in a few, but the improvement won’t last as long, and the patient will not look natural if another skin-only facelift (or two) is done later in the patient’s life.
SMAS lift vs Skin Only Facelift
Can a skin only facelift ever be equal to a SMAS lift?
You might also like...
SMAS vs. skin-only facelift
Robin T.W. Yuan, M.D.
SKin only lift
Thank you for your question.
Unfortuantely I have to disagree with your consultant. It actually has been proven time and time again that a skin only facelift, while technically easier and faster, fails to give long lasting results. The results may only last as few as 3-6 months dependent on your skin type! :(
I would recommend consultation with a facial plastic surgeon in your area who can evaluate you and discuss the benefits of the various approaches and surgical options.
The AAFPRS website has a surgeon locator.
Why Skin Only Facelifts Do Not Work
- Loss of elasticity in the skin
- Sagging of the deep tissues of the face including fat, muscle and fascia (SMAS)
- Loss of soft tissue volume
- Loss of bony support and volume.
Ideal procedures address the deep tissues ( I prefer a vertical lift to the SMAS structures and volume enhancements when necessary with fat grafting). When the deep tissues are tightened as the primary therapy, the results will be more natural (less pulling) and more durable. The incision in the skin will be under less stress and the scars will heal better and become much more difficult to see.
If you want more information about facelifts, please read my book "A More Beautiful You - Reverse Aging through skin care, plastic surgery and lifestyle solutions".
Skin-only facelift lasts a few months
The lack of bruising and swelling is always attractive but like all short-cuts in life, the results will disappoint you. You will need the SMAS to be tightened to get a good result.