Definition of SMAS

The Support Structure for the Face

Smiling faces on discs placed in grid formation. Credit: Dimitri Otis / Getty Images

Definition: SMAS (superficial muscular aponeurotic system) is a layer of tissue deep within the skin and subcutaneous tissue. It is one of the most important support structures for the face. The manipulation of this anatomic structure changes the appearance of the face. It is less invasive than a regular facelift, which targets the superficial skin of the face, and recuperation is faster. The SMAS facelift is a surgical procedure that targets the lower two-thirds of the face.

It is performed to address sagging skin, excess fat, jowls and loss of volume in the cheeks.

As facial skin begins to age, there is a loss of elasticity in the epidermis and well as the SMAS membrane. This loss results in sagging cheeks along the jaw bone, creating fleshy jowls and often a double chin. Cheek fat will then sag forward to increase the appearance of the nasolabial folds.

A SMAS rhytidectomy, also known as a SMAS facelift, counteracts the signs of aging by tightening the muscle, removing fat and trimming excess skin. A SMAS facelift is effective in correcting the following:

  • Sagging in the mid-face
  • Hollow cheeks
  • Nasolabial folds
  • Jowls
  • Sagging fat
  • Loose skin and fat under the chin and jawline

A facelift may remove or reduce the signs of aging but, over time, they will gradually reappear.

Candidates for a SMAS Facelift

Patients, over the age of 50, who want to correct one or more signs of aging; have some facial sagging but still have some elasticity in their skin; are healthy; non-smokers; and have realistic expectations of the procedure are ideal candidates for a SMAS facelift.

The SMAS Facelift Procedure

After the patient has been prepared for surgery, they are given anesthesia, usually a intravenous sedation (IV) and a local anesthetic. The patient’s face will be marked for the placement of incisions. An incision is made at the temple, above the hairline. It will extend downward along the natural creases of the skin but curve behind the ears.

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 re-draped 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.

The SMAS facelift may take several hours to complete, depending upon the extent of the procedure. Patients will have a head dressing and drainage tubes after the procedure. They should expect to have some swelling, bruising, numbness and discomfort for a few weeks. Patients should be able to return to work after two to three weeks and resume exercise and daily activities after healing is complete.

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