What is the SMAS?

SMAS stands for superficial musculoaponeurotic system and represents the deeper tissues in the face. It is a well recognized fact that the SMAS must be tightened to achieve a tight, natural and long lasting facelift.

Some surgeons do not routinely treat the SMAS tissues when performing facelift surgery. These types of lifts simply do not last as long as when the SMAS is treated. BEWARE of a skin only facelift; it may be faster and cheaper, but will not last as long. Dr. Niamtu discusses the importance of treating the SMAS in facelift surgery in his textbook on cosmetic facial surgery.

Although there a numerous ways to treat the SMAS layer in facelift, Dr. Niamtu generally uses a procedure called SMASectomy. In this procedure, a section of the SMAS is removed (middle picture below). This serves to not only slim the facial region, but allows the edge of the SMAS excision to be pulled towards the ear and sewn together. This produces maximum tightening of the SMAS which will serve as the foundation of a long lasting, natural appearing facelift. Dr. Niamtu uses numerous, deep permanent sutures in this region which helps the result last. Some surgeons place 1-2 “purse string” sutures to support the SMAS which can easily stretch or tear and affect the final result.

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The left hand figure shows a representation of the SMAS under the skin. The middle figure shows a SMASectomy where a section of excess SMAS tissue is removed. The right hand figure shows the SMAS tightened and sutured with permanent sutures.

The goal of a facelift is to provide a natural appearance and avoid an “operated look”. Ideally, only the surgeon, the patient and his or her hairdresser should know.