Black Pug and fawn coloured Shar-Pei isolated on a white backgound

The SMAS (superficial musculo-aponeurotic system) is the extremely geeky structure in the face that plastic surgeons love. Tightening the SMAS in various ways can reshape your face during a facelift for a more aesthetic look, and will give you a longer lasting result than just tightening the skin.

The SMAS is a very strong, thin, clear lining of your facial structures, connecting with the outer coating of your neck muscles.  When a facelift is done, the skin is not just lifted and tightened-  the SMAS is as well.  This is what gives you a very powerful lift with the long lasting results.

The SMAS needs to be freed up and released so that the neck muscles, neck skin, your jowls,  and your cheek skin and fat can be repositioned and tightened.  The SMAS extends to large areas of the face, so it can be tightened just at the edges near the ear, or it can be picked up and tightened in areas in the brow areas, jaw line, cheek, or even close to the nose.

There are several strategies that use the SMAS to give the best and  longest lasting lift.  There are several opinions and controversies within plastic surgery about which method is the best.  These methods, in as simple a description as possible, include

–  cutting the SMAS, and then lifting it, and then sewing it to a stronger area, such as near a bone behind the ear, or over the cheek bone area

–  not cutting the SMAS, but tightening it with regular sutures or special barbed sutures

–  a combination of the above

Which method is right for you?  It depends.

The more the SMAS is manipulated, the more swelling you tend to have.  Cutting it, or tightening more of it, or more procedures done will prolong your healing time.

There are differences in the strength of the SMAS, which varies by individual.  Some people have very thin SMAS, whereas others have a thicker and stronger SMAS.  Some patients have simply more loose skin and soft tissue, so you will need more SMAS tightened.  Only after a consultation with your plastic surgeon, can determine the best strategy for you.

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at, or call our office at 415-362-1846.

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