The superficial musculoaponeurotic system, or SMAS, is the layer of tissue or membrane that connects your face and neck muscles to your skin. It includes muscles, fibers, collagen, and fat. As you age, your skin and the SMAS lose its elasticity.
These changes result in sagging cheeks along the jawbone, excess skin, and often a "double chin". Cheek fat will also sag forward, increasing nasolabial folds or creases on the sides of the nose extending to the mouth (also causing smile or laugh lines).
A SMAS facelift counteracts visible signs of aging by tightening the muscle, removing fat, and trimming excess skin on the lower two-thirds of the face. Most people continue to look 10 to 15 years younger, but over time the results of aging gradually reappear about 10 to 15 years after the procedure.
SMAS facelifts can correct the following:
. Sagging in the mid part of the face
. Sagging cheek fat
. Hollow cheeks
. Nasolabial folds (creases on sides of nose extending to mouth, also caused smile or laugh lines)
. Loose skin and fat under the chin and jawline (jowls)
. Sagging of the neck
. Double chin
You may be a good candidate for a SMAS facelift if you:
. Are over the age of 50
. Want to surgically correct one or more signs of aging on your face
. Still have some elasticity in your skin
. Are a non-smoker (this helps to be able to heal correctly after surgery)
. Are in good overall health
It's important to have realistic expectations of the procedure. Talk to your plastic surgeon to discuss your appearance, healing, and recovery expectations.
The risks of the procedure include the general risks of surgery and anesthesia, such as reactions to medications, breathing problems, bleeding, infection, and blood clots.
Potential adverse events include nerve damage to your face, bleeding under the skin, tissue death, pain, numbness, and wounds that don't heal. Some people are unhappy with the outcome due to scarring, irregular contours, or changes in skin color.
After you have been prepared for surgery, you will be given anesthesia, which is usually intravenous sedation (IV) and a local anesthetic.
Your face will be marked for the placement of incisions. An incision is made at your temple, above the hairline. It will extend downward along the natural creases of the skin and curve behind the ears.8
The facial and neck tissue and muscle beneath the skin will then be lifted and rearranged into a higher position and excess skin will be removed. The skin will be redraped over the face and the incisions will be closed with sutures. Most of the scars will be hidden within the hair and the normal creases of the skin.1
The SMAS facelift may take several hours to complete, depending on the extent of the procedure. You should be able to go home the same day as the surgery.
During recovery, you will have a head dressing and drainage tubes. You should expect to have some swelling, bruising, numbness. and discomfort for a few weeks. Generally, you should expect to return to work after two to three weeks and resume exercise and daily activities after healing is complete.
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.
A facelift may remove or reduce the signs of aging but, over time, they will gradually reappear. The results last about 10-15 years on average.
The SMAS and deep plane facelift both counteract the effects of aging in the lower two-thirds of the face. However, the SMAS technique allows for more customization to the shape of a person’s face. This is because the surgeon can move the skin and SMAS layer separately. The deep plane technique involves moving the layers together in one direction, which makes it difficult to customize the results.