You’ll find that many traditional facelift procedures just target the skin alone without lifting the underlying muscles of the face leading to a very tight, pulled look in the face with results that fail to last long. To avoid this, you should use a surgeon that understands how to perform a SMAS facelift.
What is an SMAS Facelift?
The SMAS facelift is a type of facelift that lifts the underlying muscle plane of the face which sits underneath the skin. The word SMAS is an acronym for this muscle plane and stands for the Superficial Musculo Aponeurotic System. As we age, the SMAS layer starts to loosen and descend down the face and into the neck. This causes droopy brows, prominent nasolabial folds, Marionette lines, jowls, and loose skin and muscle bands in the neck.
A SMAS facelift creates very natural results. The skin appears smooth youthful and full rather than pulled tight and thin. Most people who are looking into a facelift want to look younger but do not want to look like they have had a facelift. The SMAS facelift technique can achieve this
Different types of SMAS
There are five main types of SMAS facelift – the plication, imbrication, extended, high, and deep plane. Each of these refers to a slightly different way in which the SMAS layer is lifted and secured. Over the years surgeons have done thousands of each of these types of facelifts. Our current understanding is that the deep plane facelift type of SMAS lift offers the most natural and long-term results with the fastest recovery although in some patients these other types of facelift have produced some excellent results.
Traditional facelifts lifted the skin but not the SMAS. The skin was shortened then stitched in a tight manner. This often created a stretched appearance to the face that appeared unnatural. The corners of the mouth were sometimes pulled sideways in a look that was called a “puppet mouth”. The SMAS facelift avoids these types of issues by lifting the underlying muscle and placing absolutely no tension on the overlying skin.
A SMAS plication facelift involves lifting the SMAS in the face (where it causes jowls) and the platysma in the neck (that creates the folds and bands) then placing stitches to secure it in a higher location. Often the sutures break down after 2 to 3 years leading to a recurrence of the original issues. A SMAS plication facelift is relatively straightforward to perform but Dr Roth generally does not recommend it as he feels that some of the other techniques that produce facelift results that last at least 10 years are best.
Extended and high SMAS facelifts lift the SMAS and platysma muscles high up the face in a vertical direction. Because of the large amount of tissue mobilization that is achieved, redundant SMAS tissue can be removed leading to an overall shorter muscle flap. The Extended SMAS facelift targets primarily the lower face and neck. The High SMAS facelift includes the Extended SMAS facelift but also addresses the cheeks and upper face. A deep plane facelift produces similar or better results than both these techniques and has the advantage of a shorter recovery period and longer-lasting results.
The deep plane facelift addresses the SMAS by lifting it close to the areas that really matter. The SMAS adjacent to the cheek, mouth, and Marionette lines is raised close to these areas. A large skin flap is not required leading to less bruising and swelling. The neck is addressed in a similar manner. The deep plane facelift has been the procedure of choice for all the top United States facial plastic surgeons for some years now and continues to receive high acclaim for its excellent results and longevity.
Who is a good candidate?
Men and women of all ages who develop droopy, saggy facial, and neck skin are good candidates for a SMAS facelift. It is best to be a non-smoker and do not have any medical conditions that impair wound healing. Patients should always be able to have realistic expectations of what surgery can and cannot achieve when this is explained to them.
Healing timeframe for the procedure
After an Azurite SMAS Facelift patients can have some swelling for around 1-2 weeks, with tightness in the neck and face however there is usually minimal discomfort and they are functionally up and about. Social downtime is usually around 2 weeks by which time most of my patients say they can already see they are looking younger than before.
Read also: What is facelift and how much does it cost?