So if you’re following my blog and not in the medical field you’re probably wondering what in the world my title is talking about. Facelift surgery is hands down my favorite Aesthetic procedure and the SMAS is a crucial portion of that procedure. Facelifts come in many shapes sizes and under many names these days. The “weekend lift” “S lift” “Short scar lift” “thread lift” just to name a few. What many of these lifts promise is a great result with no down time and consistently happy patients. While this may prove true for the first 6 months the majority of these lifts fail to address a crucial anatomical structure, the Superficial Musculoaponeurotic System… Now you see why we call it SMAS!! Check out this image to see the SMAS outlined in a live patient.

Historically the SMAS term was used to describe a fibro-fatty tissue plane that lies between the subcutaneous fat and the deeper structures of the face. Where the SMAS comes into play in facelift surgery is its ability to be tightened and thus lift portions of the mid face, jowl and jaw line. Facelifts that ignore this important plane are known as “Skin Only”. While these lifts look good immediately and in the short term, failure to tighten up the underlying planes of the face result in early relapse and unhappy patients. See the images below to observe the SMAS plane outlined and then resected in preparation for imbrication. By treating more than just the skin an outstanding and long lasting result is achieved!!


This important plane can also be used to control the direction of the lift being applied to the face. This is known as “Vector”. Vector is another crucial component of facelift surgery. I spend half my consultation time often explaining to patients why so and so’s face lift looks terrible. The answer usually is either:  1) they were pulled to tight or 2) they were pulled in the wrong vector! Below is an example of the SMAS being excised and tightened in a anti-aging vector! At the end of the day, an outstanding facelift will only remain outstanding if your surgeon takes the time to manipulate these deeper tissues and provide a sustained lift of the facial structures! The image below show the SMAS layer imbricated for a long standing lift of the face!!

Dr J Marshall Green III DDS

Cosmetic and Reconstructive Facial Surgery

Hampton Roads, Virginia