SMAS Facelift Technique

Choose the topic:

• What is SMAS?
• Anatomy
• When SMAS facelift is considered?
• Contraindications
• SMAS technique
• Recovery
• Risks and complications

What is SMAS facelift?

The SMAS facelift is one of the most commonly used facelift technique. It is a surgical cosmetic procedure designed to reposition the facial skin in order to make it look younger.


The acronym SMAS stands for the Superficial Musculo Aponeurotic System. The SMAS is a continuous fibromuscular layer of the face which is covered with the adipose tissue (fat) and the skin. The SMAS interlinks the muscles of the face, midface and neck. It extends to the region in front of and below the ear and continues with the platysma muscle in the neck. The SMAS is responsible for the normal position of the mimic muscles which is important for the expressions of the face.

When SMAS facelift is considered?

Natural aging processes weaken the SMAS and descent the facial muscles causing the skin structures to sag. These changes can manifest like a saggy neck, jowls (the excess of the skin which hangs under the lower jaw), sagging cheeks or deep creases around the mouth and lower eyelids. In all these cases, the SMAS facelift is the proper procedure for retrieving the previous look of the face.


First of all, it is crucial to ascertain weather the prospective outcome of the operation matches the individual expectations. An inadequate understanding of the results of the surgery is considered as a contraindication to any facelift procedure.

Moreover, if the person smokes, the operation should be deferred until he or she quits smoking. This is because smoking increases the risk of the complications and worsens the healing of the postoperative wounds.

Furthermore, the SMAS facelift is also contraindicated if the person is prone to keloid formation, has diabetes, bleeding abnormalities, collagen vascular diseases, or prior facial radiation.

SMAS technique

The SMAS facelift is usually performed under the general or combined anaesthesia.
First, the surgeon makes the skin incision. The classic incision begins at the temporal area, then goes down within the hairline and curves within the natural face contours in front of the ear. Finally, it circles around the ear lobe ending behind it. Once, the incision is done, the elevation of the skin flap begins. The surgeon separates the skin from the muscles and other underlying tissues using a scalpel or scissors and fingers (manual method).

When the skin is separated, the excess of fat is removed with liposuction cannulas. After that, the surgeon makes the incision in the underlying tissue and dissects the SMAS flap from the deeper tissues. Then, the SMAS flap is draped up and attached to the temporal fascia with 2 or 3 sutures. Additionally, one suture is applied at the jaw line. The excess of the SMAS flap is removed. Once this is done, the skin flap is re-draped and fixated without tension. The goal is to hide the sutures in the hair line in order to make the surgical scar hidden. The excess of the skin is removed. Drains can be put in the wound in order to remove fluids.

Recovery after SMAS facelift

It is recommended to stay in the hospital for 24-48 hours in order to provide a personal postoperative care. However, there is a possibility to recover at home if the medical assistance is available.

Cold compresses should be used for the first 72 hours after the SMAS facelift in order to reduce the swelling of the face. Moreover, the patient should keep his or her head elevated. Painkillers, sleeping pills and anti-nausea medications can be prescribed, if the patient feels the respective symptoms.
The antibiotic therapy is administered for the first 5 postoperative days in order to prevent the infection. A visit to the doctor is required on the first postoperative day in order to remove the drains, to inspect the wound and to redress it.  On the second day after the SMAS facelift patients are allowed to take light showers. The sutures are removed on the seventh postoperative day.

Risks and complications

The potential complications are cervicofacial (neck and face) hematoma, alopecia, poor scarring, contour irregularities, skin slough, infection, numbness, the need for the revision surgery, the facial nerve injury. However, the experience of plastic surgeons has shown that the risk of the skin flap necrosis, facial nerve palsy and the facial hematoma is lower as compared to the others facelift techniques.