What are the different approaches to the SMAS layer of tissue in my face in facelift procedures?

The SMAS is the top layer of tissue which lies below the skin in the face. Many facelift techniques use this tissue to give long-term support to the face with an aim of producing long-term stable results and rejuvenation of the face.

The main surgical techniques used to support the SMAS are the following:

  1. SMASplication
  2. SMAS-ectomy
  3. SMAS flaps.

These approaches all vary slightly in that SMASplication uses stitches from a fixed area in the temple to lift up the SMAS tissue. The stitches in many cases are permanent and add a good support to the lower facial tissue in the jaws and neck region.

SMAS-ectomy is a technique which has been used more recently in which a strip of a SMAS tissue is removed in front of the ear and the two edges on either side are sewn together internally. Proponents of SMASectomy would argue that it gives a longer lasting result than SMASplication alone.

But advocates of the SMAS flap technique argue that this technique lasts even longer than a SMAS-ectomy. This is due to better elevation: in the SMAS flap technique  your surgeon will go underneath the SMAS tissue, elevating it and using it as a sheet of tissue which they will then raise up to a higher position.

The downside, however, is that the nerves which supply the muscles to the face lie under the SMAS tissue and can (in rare cases) be damaged in this technique.

Categories:  Facelift Surgery