A SMAS lift in general refers to any facelift technique that tightens the SMAS layer along with the overlying skin in a more youthful position making you look younger. Specifically, the SMAS face lift does its magic by lifting and tightening the jowls, neck, and cheeks to a more youthful position. These techniques generally produce more natural and long-lasting results than the “skin only” face lifts, and now considered by most board certified plastic surgeons as the most preferred method.

Here are some specifics of how this is performed.

SMAS is an abbreviation for a tissue layer called the Superficial Muscular Aponeurotic System. As this is a mouthful, most patients and surgeons use the acronym SMAS. The SMAS is a relatively thin layer of strong fascial supporting tissue that covers and surrounds the deeper tissues and structures of the face and neck, including fat pads and muscles, and the entire cheek area. It also attaches to the superficial muscle covering the lower face near the jaw line and neck called the platysma. As the SMAS attaches to all of these areas of the face, a SMAS lift surgically elevates this layer which in turn elevates the soft tissues and structures of the face. To do this, the SMAS layer can be folded superiorly and attached to itself, called SMAS plication, or it can be tightened and lifted by removing a redundant portion and then reattaching itself in the uplifted position (SMAS resection, or “SMASectomy”).

Now the confusing part:

The SMAS facelift may be part of the traditional facelift type procedures which have longer scars, more undermining of skin than some of the mini-lift procedures. Unfortunately there are a lot of brand names attached (especially to mini face lifts) and not all include the SMAS lift. The mini-lifts may be tough to choose from because of all the brand names such as LifeStyle Lift, S-Lift, Quick Lift, LiteLift, MACS and others. In many cases there are more similarities than differences between these procedures as they share the use of smaller incisions, quicker recoveries, and are often done under local anesthesia with oral sedation. Differences are often more related to the surgeon’s experience and preference of surgical technique. I understand how confusing this must be to the consumer. For example, in my practice we perform the LiteLift™—see below link for further details.

The skill and experience of the surgeon is far more important than the technique chosen. Factors such as the lift directional vector, how tight to lift it, and the skill to not go too deep where underlying important structures could be harmed is essential to the best outcome and longevity of the procedure. After more than a quarter of a century performing face lifts and seeing the results of other less-trained surgeons, my advice is: Always go with the best when it comes to facial rejuvenation.

Remember it is the skill and experience of the surgeon that counts—not the name! Great surgeons get great results, period. The best way to find one is to start with a Board Certified Plastic Surgeon or Board Certified Facial Plastic Surgeon with extensive experience over many years. Ask to see “before and after” photos, especially long term ones. Ask the number of times you will be seen afterwards by the surgeon rather than a medical assistant. A good place to start is “Find a Doctor” on the American Society of Plastic Surgeons or American Society of Aesthetic Plastic Surgeons web sites.

—Dr. Larry Nichter, MD FACS