According to an abstract published in The Aesthetic Society’s Aesthetic Surgery Journal, the SMAS procedure (the acronym for Superficial Musculoaponeurotic System plication face lifting technique) has been an established medical practice since it was introduced by Swedish plastic surgeon Tord Skoog in the 1970s.
The goal of the procedure is to “suspend the cheek mass securely, leaving the skin and subcutaneous mass attached to the SMAS without placing the skin under greater than normal tension,” explain plastic surgeons specializing in this type of facelift. Like most surgical procedures, this one has evolved over time. Today, plastic surgeons offer several procedure options—three of which are described here.
SMAS procedure choices
- The SMAS folding or “plication” facelift is the least complicated surgery, but it does involve suturing the deeper layer of the Superficial Musculoaponeurotic System. Since a suture elevates the skin layer to fold on itself, deeper fat pads result, and skin is subjected to less tension compared to other SMAS procedural methods. Patients experience limited post-surgical facial movement, and it remains a popular option for surgeons.
- The Extended SMAS facelift allows the surgeon to fold the skin as the SMAS is released with the assistance of a gland located under the layer, making the procedure more precise. This process takes place at the edge of the gland; thus, doctors can assure patients of increased fat layer mobilization and less skin tension. The extended SMAS facelift procedure tends to deliver a better result.
- The Deep Plane Facelift is the latest and most advanced iteration of SMAS-driven facelifts. It’s a more complex surgery but gives the patient the maximum amount of facial mobility, so it outperforms both the folding and extended versions. Further, patients wind up with undetectable scars once they recover. During this surgery, the SMAS is released–as are facial ligaments–at which point, a more sophisticated repositioning of fat pads plus tensionless closure offer patients the look they seek plus longer-lasting results.
You may get a better result with SMAS if your goals are the following:
- This option is considered a more superficial procedure that is less intrusive
- Expect significant aesthetic improvements with less surgical intervention
- Incisions at the temple are hidden behind the ears at the hairline
- This procedure will not lift drooping cheeks without the addition of a fat graft to restore facial volume
- This surgery requires two separate actions: elevating the skin and lifting the SMAS-Platysma complex
- Tissue layers are tightened in different directions, yet the skin is not stretched
- Some surgeons say SMAS procedures give them more control when reconstructing underlying tissue
- Recovery time is faster, and the cost of this procedure is likely to be less expensive.
You may get a better result with the Deep Plane option if your goals are the following:
- You want to improve the look of both your face and your neck
- It’s okay to remove excess skin to tighten and reshape underlying musculature
- You aren’t concerned about cutting and releasing ligaments so the surgeon can reach deep tissues
- Instead of relying on skin pulling and sutures to lift the face, this technique consists of manipulating underlying soft tissue
- Patients can expect volume and cheek restoration without fillers or implants
- The finishing flap is suspended and fixed in place, so scars are less visible
- Deep tissue is especially suited to older individuals whose skin laxity and pronounced wrinkles require deeper manipulation to achieve the best aesthetic result
- This option offers the longest-lasting results and is likely to be more expensive.
When weighing your decision, which is best for you?
For the best result, turn to a practice offering multiple options. Our surgeons are skilled at undertaking these and other facelift procedures, and since they are all performed under general anesthesia, you won’t feel a thing while undergoing this surgery. Further, both take place within the lower two-thirds of the face; thus, sagging skin, excess fat and jowls are all mediated, yet they differ enough to give you a reason to prefer one over the other.