Should you consider a SMAS Face Lift?

If you feel that your face is starting to age but you don’t want to commit to a full face lift, a SMAS face lift may be the solution.

SMAS face lifts target the lower area of the face that typically age first, mainly the sagging jowls and jawline. It tightens and firms up these areas and is a great alternative for those who feel too young for a traditional full face lift. Plus it is less surgery time and therefore takes a shorter time to recover.

So what is a SMAS face lift?

Image © Dr David Hidalgo

Image © Dr David Hidalgo


SMAS stands for the tissue layer known as the Superficial Muscular Aponeurotic System. This is the thin layer of strong supporting tissue in the lower part of the face that that connects the deeper tissues and structures of the face and neck. It also includes areas such as the cheeks, and contains fat pads and muscles.

As the SMAS attaches to all of these areas of the face, when this area is then lifted, it in turn elevates the whole of the lower part of the face. This can be achieved in two ways; the SMAS layer can either be folded and attached to itself (SMAS plication) or it can be tightened and lifted by removing a piece and then re-stitched in a higher place (SMAS resection).

The SMAS face lift can be called different things depending on the surgeon who is carrying out the operation. Typically you’ll hear variations such as the S-Lift, Mini Lift, MACS, etc

There are even brand names attached to SMAS face lifts, but not all involve the SMAS tissue layer, so it is important to ask exactly what will be carried out in your operation.

With an SMAS operation, instead of a long scar running up your hairline and behind your ears, shorter and more invisible ones are used near the creases of the ears and at the temples.

What can an SMAS face lift treat?

pyramind of age youthful triangle

The SMAS lift works on the bottom third of the face, the slacking jawline and jowls. A youthful face resembles a triangle with the point at the bottom.

Typically a young face will have plump cheeks and fat distributed in the upper part of the face. Over time, as gravity begins its pull on our skin, this triangle of youth becomes inverted in what cosmetic surgeons call the pyramid of age. The fat now gathers in the bottom half of the face, giving an ageing appearance.

This jowling effect is the opposite of a youthful face, as the jawline becomes slack, the apple cheeks get flatter and lines begin to crease near the mouth. The SMAS face lift lifts this area up, tightening this loose skin and is often accompanied with fat redistribution into the cheek area.

An SMAS face lift cannot treat crow’s feet, bags under the eyes, lines on the forehead, or anything above the jowl area.

Who is eligible for a SMAS Face lift?

Anyone is eligible for a SMAS face lift but there are some important factors to consider before going ahead with the operation.

Give up smoking – If you are a smoker it is important that you give up at least four weeks before the operation. In fact, many reputable surgeons will not consider operating if they believe you are still smoking. This is because smoking causes the blood vessels in our skin to narrow. When you have the procedure, in order for your skin to heal well it is crucial that the blood is able to travel quickly to the damaged sites.

Check what medication you are taking – anyone who is taking medicine that causes the blood to thin should make sure they tell their surgeon. The face bleeds much more than any other part of the body and if blood thinners have been taken there is a real risk of uncontrollable bleeding during the procedure.

How long does an SMAS face lift take?

The whole procedure should take around 3 – 4 hours.

It an SMAS face lift painful?

Surgery is carried out under general anaesthetic, so you won’t feel anything during the operation. Afterwards there may be some discomfort and you might experience bruising and swelling that can last for up to two weeks.

What will happen after an SMAS face lift operation?

Immediately after surgery you’ll be wearing a compress bandage and will have two small drainage tubes either side of your ears. In the morning these will be removed and a light elasticated bandage will be placed under your chin. This will remain for a week. Aft

er this you’ll only need to wear it in the evenings.

In around a week to ten days your dissolvable stitches should have disappeared.

How much does an SMAS face lift cost?

This varies depending on the surgeon and technique, but as a rough guide you can expect to pay £5-10,000.

What are the risks of an SMAS operation?

All surgery, especially those carried out under general anaesthetic carry a risk. Because the SMAS face lift is less invasive than a full traditional one, the risks are smaller.

Common risks –

Most patients experience bruising, swelling and numbness. This tends to go after two weeks.
Scarring will occur but these should fade in time and will be hidden behind the ears.

Uncommon risks –

Delayed healing can occur in some patients, but this is typically with smokers or those who have diabetes.
There is a chance of infection but this can be treated with antibiotics.

Rare risks –

Facial nerve damage is very uncommon. If this does occur it is likely any numbness in the face should disappear within a few months.

In very rare cases there is a chance of a haematoma (blood under the skin) arising which may require additional surgery. This is something however that is easily rectified.


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