What is the SMAS in a facelift, and how does it differ from a skin-only lift?
The SMAS (Superficial Musculo-Aponeurotic System) is a fibrous layer that supports facial tissues between the skin and the muscles of facial expression.
Addressing the SMAS during a facelift can also treat the deeper tissues responsible for sagging, offering the prospect of relatively natural, longer-lasting results compared with pulling the skin alone.
However, not every patient needs a SMAS lift. The appropriate procedure depends on the cause of sagging.
[ Image placement: frontal view 1 year after facelift + neck lift surgery ]
What is the SMAS?
SMAS stands for Superficial Musculo-Aponeurotic System.
It is a fibrous supporting layer beneath the skin that connects facial muscles to the skin.
The face consists of the following layers.
- 1. Skin
- 2. Subcutaneous fat
- 3. SMAS (superficial musculo-aponeurotic system)
- 4. Muscles of facial expression
- 5. Bone
The SMAS connects the skin and facial expression muscles so that the skin moves with the muscles when smiling or frowning.
Together with the retaining ligaments that support facial soft tissue, it also helps maintain the overall shape of the face.
Why the SMAS is a key factor in facial sagging
Facial sagging is not simply a matter of reduced skin elasticity.
As the SMAS and its supporting retaining ligaments stretch and descend over time, the overlying skin and fat also sag.
The cause of sagging therefore often lies in soft tissues deeper than the skin.
Skin-only lifting versus SMAS lifting
Because skin is elastic, pulling only the skin layer may not adequately correct the deeper tissues responsible for sagging.
Addressing the SMAS also treats deeper soft tissue, which may offer comparatively better durability in some cases.
Types of SMAS lifting
Facelifts that address the SMAS do not all use the same technique. The following approaches are selected according to facial anatomy and the degree of sagging.
- - SMAS excision
- - SMAS imbrication
- - SMAS plication
- - SMAS dissection
More important than whether the SMAS is treated is an accurate assessment of which technique suits your facial structure.
Not everyone needs a SMAS lift
A SMAS lift is not always the answer. The appropriate procedure may differ according to which of the following is responsible for sagging.
- - Reduced skin elasticity
- - SMAS laxity
- - Changes in facial fat position
- - Laxity of retaining ligaments
The most important step is therefore to identify accurately which tissue layer is responsible for your facial sagging.
UVOM Plastic Surgery's diagnostic approach
UVOM Plastic Surgery plans surgery by assessing the following factors together, rather than looking only at skin sagging.
- - Skin condition
- - Degree of SMAS laxity
- - Changes in facial fat position
- - Condition of the retaining ligaments
- - Overall pattern of facial aging
The goal of a facelift is not to pull the skin forcefully,
but to correct the structures responsible for sagging and create a natural facial contour.
[ 90-degree view 1 year after facelift + neck lift surgery ]
Frequently asked questions (FAQ)
Q. Is a SMAS lift always better than a skin-only lift?
A. Not necessarily. The appropriate procedure varies with the degree of sagging, facial structure, and causes of aging.
Q. Does a SMAS lift last longer?
A. Because deeper soft tissues are also corrected, it is generally considered to offer relatively better durability than correction of the skin alone.
However, results vary with individual aging and lifestyle.
Q. Can someone in their 30s need a SMAS lift?
A. The cause of sagging matters more than age.
For example, when soft tissue sagging develops after facial contouring surgery, a facelift that also addresses the SMAS may be considered even at a relatively young age.
Q. Can SMAS sagging be assessed during a consultation?
A. Surgery is planned after a comprehensive examination of the degree of sagging and facial structure. Skin condition and soft tissue sagging are assessed as needed to choose the approach.
The key to a facelift is how the deeper tissues responsible for sagging are corrected, rather than how forcefully the skin is pulled.
The SMAS is a supporting layer connecting skin and facial expression muscles, and it has a substantial influence on facelift technique and durability.
Because the same approach does not suit every patient, it is important to assess both the skin and deeper layers, including the SMAS, before choosing an appropriate procedure.
For questions about facelifts or SMAS lifting, call 02-545-3700 or consult UVOM Plastic Surgery on KakaoTalk to discuss the cause of your sagging.