Question 1

What is a SMAS facelift?

Accepted Answer

A SMAS facelift is a type of facelift surgery (rhytidectomy) that lifts and tightens the underlying muscles of the midface, lower face, and neck to restore the cheeks, eliminate jowls, and contour the jawline and neck. It also removes excess skin, while smoothing wrinkles and folds in the skin that remains.

Now considered the standard surgical facelift, a SMAS facelift procedure can produce longer-lasting, more natural-looking results than skin-only traditional facelift techniques because it also lifts and tightens the fascia layer overlying the facial muscles.

The superficial muscular aponeurotic system, aka the SMAS layer, connects the facial muscles to the subcutaneous fat and skin. Dr. Dilip Madnani, a facial plastic surgeon in New York City, explains that the SMAS layer descends with age. “Ligaments attach the overlying skin to deeper structures in the face. As the face ages, the skin and muscles relax and loosen around these fixed ligaments,” which leads to prominent lines around the mouth (like nasolabial folds), jowls, and neck laxity, sometimes called “turkey neck.”

The SMAS in the lower face is a direct extension of the platysma muscle in the neck. This broad, sheetlike muscle is tailored and resuspended during face and neck lifts.

There are several variations of the SMAS lift. The so-called high SMAS facelift, for instance, involves a greater degree of dissection than the standard SMAS lift and does a better job of restoring the soft tissues of the midface to address fallen cheeks for a more youthful appearance.

Question 2

What are the pros and cons of a SMAS facelift?

Accepted Answer

Pros

Most plastic surgeons consider the SMAS facelift technique the modern standard of facial rejuvenation. It provides better, more durable results than the skin-only traditional facelift of the past, which often left patients looking overly taut (the dreaded “windblown” result) and had less longevity.
The SMAS lift typically addresses the neck as well as the soft tissues of the face to correct submental (under chin) fullness, laxity, and banding, for a more youthful appearance.
In addition to smoothing sagging skin and creating a more defined jawline, the procedure can reduce nasolabial folds, jowls, a double chin, platysma bands, and other signs of aging that can be difficult or impossible to treat with nonsurgical methods.
Incisions can be hidden in front of and/or behind your ears. Over time, scars that heal well become barely perceptible.
Results from a SMAS facelift procedure last 10 years or more.
While facelifts are often performed under general anesthesia, local anesthesia with oral or IV sedation is an option for patients who want to reduce their anesthesia risk and expense.

Cons

It's a more significant surgical procedure than a skin-only facelift and comes with approximately two weeks of downtime.
A SMAS facelift won’t address superficial skin concerns (fine lines, age spots, melasma, and so on). Ask your doctor about other skin rejuvenation options, like chemical peels and laser resurfacing, if you’d like to improve the tone and texture of your skin along with your lift.
This type of facelift addresses the lower two-thirds of the face, from the cheeks to the neck, so if you want to lift your brow or eyelids, or improve the shape of your nose, you’ll need additional facial plastic surgery (a brow lift, blepharoplasty, or rhinoplasty, respectively). These procedures are commonly performed at the same time as a SMAS lift.

Question 3

How much does a SMAS facelift cost?

Accepted Answer

Your SMAS facelift cost will depend on your surgeon’s level of experience, their practice location, and the details of your procedure.

A facelift is elective cosmetic surgery, so it’s not covered by health insurance.

You can finance your treatment with CareCredit.

Question 4

SMAS facelift before and after pictures

Accepted Answer

The SMAS facelift photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

Question 5

Who makes a good candidate for a SMAS facelift?

Accepted Answer

Good candidates for a SMAS facelift are healthy nonsmokers who are bothered by sagging, loose skin, jowls, deep folds, neck bands, and other prominent signs of aging in the lower face and neck.

Younger patients with less severe skin laxity may benefit from a mini lift or a nonsurgical facelift.

Question 6

How is a SMAS facelift done?

Accepted Answer

SMAS facelifts are typically performed under general anesthesia, but they can be performed under local anesthesia with oral sedation or under IV sedation, says Dr. Madnani.

The procedure can take under two hours or up to four, depending on your surgeon's technique and the extent of your procedure. Here’s what happens:

First, your surgeon will make the incisions. They typically start in the hairline tuft/sideburn area, follow the natural lines around the front of the ear, and then travel down and around the earlobe, behind the ear.
Then your surgeon will lift the skin and subcutaneous fat off of the SMAS and reposition, tighten, and secure the fibromuscular layer into a lifted position.
A section of SMAS may be removed or the tissue may be folded over onto itself, to shorten and elevate the structure.
Your surgeon will redrape your soft tissues and facial skin to complement the new contours of your face, trimming excess tissue before closing the incisions with tiny sutures.
In some cases, your surgeon will insert small drain tubes, to remove excess fluid that your body produces naturally during the healing process.

You’ll leave the surgical facility the same day, with your face wrapped in bandages. Expect to be groggy from the anesthesia and make sure a trusted friend or family member is there, to get you safely home.

Question 7

How long does SMAS facelift recovery take?

Accepted Answer

Downtime for a SMAS facelift averages 7–14 days.

Your surgeon will give you detailed post-operative instructions for how to take care of your incisions, what issues to watch for, and when to take any pain medications. They’ll also schedule follow-up appointments to remove your stitches and drains (if you have them).

Your face will be swollen and bruised, especially during the first three days. The swelling will lessen significantly over the first two weeks after surgery.

During that time, limit your activity, to avoid elevating your heart rate or sending blood to your face—that means no bending over, heavy lifting, or exercise beyond light walking.

You’ll begin to see the results of your facelift as the swelling and bruising dissipate, but you probably won’t feel ready to go out in public until about two weeks after surgery.

Your face may also feel tight and numb, both of which are considered normal and will resolve on their own within a few months.

Question 8

How soon will you see results?

Accepted Answer

You’ll see a difference in the contours of your face and neck as soon as your bandages come off, but it takes time for tissues to settle and swelling to recede. Normal movement should be restored within two to three months.

“Swelling after a facelift can take many months to resolve completely, but the majority of it is usually gone by about six weeks after surgery,” says Dr. Matthew Richardson, a facial plastic surgeon in Frisco, Texas. “After this point, the changes are more subtle, but swelling does continue to improve slowly over time.”

You’ll see your final results in six months to a year, once all the swelling has resolved.

Question 9

How long does a SMAS facelift last?

Accepted Answer

The effects of a SMAS facelift typically last 10 years or more. It’s considered a permanent procedure, but your face will continue to change naturally as you age.

“I like to explain to my patients that I cannot stop the aging process, but we were able to reset your face about 10-15 years back, and you will start aging forward again from this point,” says Dr. Madnani.

Question 10

What are the risks and potential side effects of a SMAS facelift?

Accepted Answer

Risks include bleeding, infection, hematoma, asymmetrical results, distortion, sensory nerve damage, delayed healing, and poor scarring.

All of these complications are rare, and you can reduce your risk by choosing an experienced, board-certified facial plastic surgeon.

Another risk to consider with any surgery is dissatisfaction with your results. It’s not uncommon for patients to complain of undercorrection—to feel disappointed in their outcomes if they were expecting a greater degree of improvement than they ultimately got.

Have an honest discussion with your plastic surgeon about your expectations and the limitations of the SMAS facelift before undergoing surgery.

Question 11

SMAS facelift vs. deep plane facelift: What’s the difference?

Accepted Answer

A deep plane facelift is actually a version of the SMAS facelift, similarly repositioning the superficial muscular aponeurotic system.

During a deep plane facelift, “the SMAS layer is dissected free from the underlying deeper face anatomy. The ligaments that adhere the skin to the underlying facial anatomy are released, leading to a greater amount of movement and lift possible from the SMAS and skin layers,” explains Dr. Madnani.

The skin and SMAS are lifted together, rather than separately, which some doctors say leads to longer-lasting results and a quicker recovery.

“The skin incisions for a facelift do not change that much depending on the type of facelift that is performed,” says Dr. Roth. “A SMAS, deep plane, lower facelift, neck lift, skin lift procedure can all be done through exactly the same skin incisions.”

However, Dr. Madnani cautions that “with the release of ligaments, there is the potential for increased facial nerve damage, as its branches run right below the level of the SMAS.”

A traditional SMAS facelift may cost less than a deep plane facelift because it takes less time to perform. That can mean lower facility fees and anesthesia costs, though oftentimes a surgeon’s reputation, credentials, and waiting list will influence their fee far more significantly than the style of facelift they perform.

An experienced, reputable surgeon can guide you to the specific procedure that makes sense for you, given your anatomy, concerns, expectations, and budget.

SMAS FACELIFT

Dilip D. Madnani, MD, FACS

Kali Swenson

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Dilip D. Madnani, MD, FACS

Kali Swenson

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