- What is SMAS?
The face is composed of four main layers: skin, fat tissue under the skin, fascia and the last layer is muscle. During the aging process, loss of fat tissue and sagging of the fascia occur which creates wrinkles and sagging.
SMAS (Superficial Musculoaponeurotic System) is a layer of fascia which can be imagined as a sheet lying on top of muscles. It is a very tight sheet and it doesn’t stretch much. A layer of fascia (SMAS layer) which is under the skin and the fat tissue will be tightened up together during the SMAS face lift. It will provide much more support for the overlying structures and the results will be more satisfying. The SMAS facelift provides long lasting results so the patient can expect the results of surgery to last for at least 10 years.
- Who are Suitable Patients for a SMAS Facelift?
SMAS facelifts can be used for patients who suffer from deep nasolabial folds, loose jawline, deep wrinkles over their face, and wrinkles on the neck. It is also recommended for all patients who desire longer lasting results. So, if you have major sagging skin on your face or deep wrinkles and want a long term solution, then the SMAS facelift might be the best choice for you.
- The Process of the SMAS Facelift
The length of the incision will depend on the purpose of the surgery. It should be long enough to address all the issues, and to allow for the removal of excess skin.
The full facelift incision usually starts from the top of the ear, then along the front of the ear canal, behind the ear and it ends in the hairline behind the ear. Nowadays, mini facelifts have become a very popular procedure and in that case the incision is significantly smaller. It is placed from the front side to back side of the ear.
After the incision is made, the skin is elevated and the SMAS layer is visualized. After that SMAS layer is released from its attachments (retaining ligaments) and lifted up. There are several techniques for addressing the SMAS layer. In a deep plane facelift, muscles and fascia will be elevated from the bone underneath them and moved up in order to reduce sagging.
In SMAS plication, parts of the muscle will be sutured onto themselves after they are folded. That way the length of the muscle will be reduced and there will be less sagging.
Another technique is SMASectomy, in which part of the muscle is cut out and the two ends are then sutured together.
The lower eyelid muscle is tightened so that under eye hollow is diminished. Muscles in the cheek area are moved upwards, muscles at the corner of the mouth are moved up as well as muscles under the marionette lines. SMAS in the neck and jowl area are tightened.
After the SMAS layer is repositioned and tightened, the skin is retracted and the excess skin is removed. At the end, the wound is sutured in multiple layers to prevent excessive scarring and skin tension.
- Recovery After a SMAS Facelift
The SMAS facelift is an extensive surgical procedure, so the recovery period can last for a few weeks. It is usually associated with bruising and swelling. You should be able to continue doing your daily activities after stitches are removed. Bruising should start reducing after a week, so you might want to avoid going outside during the first week. Most patients don’t have any severe pain. After a week, there will be less bruising and swelling should start to subside.
Two weeks after the surgery, most of the swelling will subside. Your bruises might change in color and they will be less visible. After a month, there should be no more bruising and most of the swelling should subside.
Most surgeons recommend ice and elevation to reduce swelling. You should use higher pillows while sleeping to keep your head elevated.