Can a skin only facelift ever be equal to a SMAS lift?

SMAS (superficial musculoaponeurotic system) is the structural layer of the face beneath the skin and enveloping the facial muscles. Most but not all top plastic surgeons utilize the SMAS in one way or another during their face and neck lift procedures. If done properly the risks can be limited and complication rates not much different than that of skin lifts. It does take more time and expertise to perform a SMAS facelift. Most studies have shown that the longevity and duration of outcome is better when SMAS is incorporated. Hope this helps.

Although I am not sure that your Surgeon used those exact words, the basic premise of what was conveyed is  incorrect. Based on my own experience and those of the plurality of my colleagues, the best way to approach a facelift is one that is result driven.  Skin only facelifts don't work very well for very long, and often lead to distortion of facial features.  The gold standard for facelifts is SMAS based and my personal preference is a composite facelift approach. Please seek other opinions before proceeding. I doubt you will receive the same information as on your first consultation.

In short, NO.  Skin only lifts depend on the skin to support it.  No matter how snugly the skin is drawn, in time it will loosen over a fairly short period of time.  This is because the skin is highly elastic and stretches very easily.  Traditional face lifting utilizes sutures placed into the strong sheeting around the facial muscles (SMAS) to achieve a long-lasting result.  The strength of the facelift, therefore, relies on the support of the SMAS, which results in little tension being placed on the skin itself.  There are many variations on SMAS lifts: deep plane, partial deep plane, plication, imbrication, etc...  It's best to meet with a facial plastic surgeon or plastic surgeon that specializes in one of these SMAS techniques and evaluate their pre and post operative portfolio to assess the results and longevity. The money and time invested in skin only facelifts is not well-spent.

skin only facelift does not address most of the changes due to facial aging, almost none of the leaders in the field of facelift perform skin only facelift. 

Skin only facelift may give you a nice result which in other patients a SMAS lift would be more beneficial.  There is a controversy over this ... which is better... Speak to your surgeon, ask for before and after pictures and see how you like the results.  In his/her hands you may get great results while in the hands of another surgeon a skin only facelift would not be great.  There is a great variation in techniques and surgeon preferences.  Results are what matters and so see your surgeon's results and decide if you like them.

Your surgeon has a point.  The SMAS lift has a greater risk of nerve injury and will cause more swelling.  There is still much debate as to whether skin only lifts are as good as deeper plane lifts.  The most important thing is to select an experienced surgeon whom you trust.  Good luck

Hello Smokes-I believe that generously, but safely lifting up a good, healthy SMAS layer is paramount in attaining natural appearing and longer-lasting facelift results. After this foundation layer is repositioned, the skin can be softly redraped and voila... All surgery should be done as meticulously as possible so that bleeding is well controlled and this makes any postoperative course easier and more comfortable. A sub-SMAS dissection is actually less bloody then the subcutaneous dissection, but one needs to be exceptionally comfortable with the facial nerve anatomy. A good SMAS elevation also often precludes the need for a sub-mental dissection and tightening of the plastysmal sling.A skin only lift can also be useful at times, especially in the younger population. Good luck and consider a second opinion. 

Any surgeon who adapts the patient's face to the operation rather than the other way around should be doing facelifts.

Thank you for an interesting question.  There might be some advantages to skin only facelifts.  Most surgeons would agree that recovery course and longevity of results varies greatly between different facelift techniques.  However, there is no hard rules for selecting the best rejuvenation strategy for each particular patient.  It is still a matter of surgeon's clinical judgement and their personal sense of aesthetics.  There are two problems that I almost invariably see with the skin only facelifts:  the skin incisions are too noticeable and results appear a bit too unnatural for my taste.  Having said that, I don't believe there is anything wrong with getting a skin only facelift, as long as YOU like the results. The best thing to do would be to review your surgeon's before-and-after photos.   If you like how the past patients look after a similar type of facelift, he might be the right doctor for you.Best wishes!Dr. Konstantin

The first facelifting operations performed in the United States in the early 1900's were essentially skin-only operations. These operations provided little or no benefit yet were performed for decades- primarily because little was known about the muscular and fascial anatomy of the face and neck. As we learned more about facial anatomy and the superficial musculo-aponeurotic fascia (SMAS), more advanced facelifting techniques were developed (SMAS facelift and deep-plane facelift) and the skin-only operations were abandoned. I would suggest you get a second opinion before making a decision.