SMAS stands for “Superficial Musculo Aponeurotic System.” This is known as the “muscle layer” of the face, which is a thin layer of muscle and fibrous bands that cover the muscles and deep fat pads of the face. The SMAS extends from the very top of the head down to the bottom of the neck. When the SMAS becomes loose and sags with age, it creates laxity along the lower face and jawline, creating jowls, marionette lines, nasolabial folds and neck bands.
The SMAS Facelift is also called a “lower facelift” since it focuses on tightening the loose skin of the jawline, jowls, and drooping “turkey” neck. It helps to define the jawline and create a smoother and sharper neck contour while softening the corners of the mouth. It is different from a traditional “full facelift” or the Deep Plane Facelift because it centers on the lower 1/3 of the face and the neck, which are very common problem areas.
SMAS facelifts are some of the most commonly performed facelift surgeries. Popularized in the 1970s, SMAS facelift surgery involves tightening and repositioning the SMAS layer to create a more youthful appearance. The SMAS facelift focuses more on the lower portion of the face and neck to better define the jawline and remove the presence of jowls. It also allows for improved definition on the neck contour, creating a sharper angle on the neck and removing neck bands. A SMAS facelift will create a natural-looking facelift result that does not appear “plastic.”
The SMAS is a layer of fibrous tissues and muscles that start in the jawline region as the platysma muscle transitions to the face. It extends up towards the cheeks and temples. This thin yet sturdy tissue layer covers and connects the muscles and structures of the face and neck. Below the SMAS we find the facial muscles and fat pads.
Types of SMAS Facelift
There are 4 main types of SMAS facelifts:
- SMAS Plication Facelift lifts the SMAS by placing sutures in the jawline, jowls neck to tighten the layer. This is a relatively simple procedure with minimal downtime. However, similar to the Mini Facelift, the suturing technique does not last as long as other types of SMAS facelifts where the muscle is mobilized and repositioned.
- SMAS Excision Facelifts lift the SMAS by excising a strip of tissue and closing the gap with sutures. The excision typically extends from the angle of the jaw to the corner of the eye. Similar to the Plication Facelift, this is a relatively simple procedure that involves minimal downtime. The results tend to last longer than Plication Facelifts, in some cases 3-4 years. Dr. Antunes will occasionally recommend this procedure for patients that have mild to moderate laxity of the SMAS layer.
- Extended Sub-SMAS Facelift lifts the SMAS and platysma layers to create a more youthful appearance in the jawline and neck. A muscle “flap” is created by elevating the tissues underneath the SMAS and lifting the layer off the face and smoothing it out. The excess tissue is removed and then secured in the new position. This is a true structural re-engineering of the facial tissues. The Sub-SMAS will focus the lift mostly on the lower face and neck, correcting jowls and neck laxity. This procedure has greater longevity than other types of facelifts, around 8-10 years.
- High SMAS Facelift similar to the Extended Sub SMAS Facelift, the High SMAS technique lifts the muscle layer and creates a structural re-engineering of the facial tissues. Similar to the Sub-SMAS Facelift, the High-SMAS will lift the lower face and neck, improving jowls and neck. The biggest difference is that the High-SMAS will lift the cheeks by repositioning the layers of SMAS in the mid-face. The results of this procedure can be expected to last around 8-10 years.
Dr. Antunes usually performs the SMAS Facelift under a twilight anesthetic (sedation) or general anesthesia. The SMAS procedure should last approximately 3 to 4 hours. After surgery, the patient returns home the same day of the procedure. In general, patients should be able to return to work within 2 weeks following their procedure. There will still be some mild swelling and bruising but nothing that should prevent patients from returning to work and most normal activities. Men and women who are showing the signs of aging with sagging on the cheeks, jawline and jowls are typically good candidates for the SMAS Facelift procedure. Ideal candidates are in good physical and mental health and should have realistic expectations regarding the surgical outcome and a positive attitude.