What is a SMAS facelift?

The SMAS facelift (also known as Rhytidectomy) is a surgical procedure where the Superficial Muscular Aponeurotic System (SMAS) is tightened. The SMAS is a strong, elastic sheet of muscle and fibrous tissue that allows our face to move that connects to bones of the skull. This continuous fibro muscular layer of fascial supporting tissues covers and surrounds your deeper facial and neck tissues. The SMAS attaches to the superficial muscles along your jaw line and neck (the platysma muscles).

Over 100 years ago, when facelifts were invented, all they did was to tighten the facial skin. While this was effective, the results were not long lasting or natural looking. Over the last few decades, the development of SMAS facelift surgery has resulted in natural looking results. This type of facelift surgically elevates all the underlying layers of muscles as well as the skin. A SMAS facelift will lift and tighten your neck, jowls and cheeks, to make you look younger and fresher.

Why you may be considering a SMAS facelift

SMAS facelift is an option for people who feel that their face is ageing, where non-surgical treatments are not sufficient, and where they are in good health and of a healthy weight. It’s important to note that most Cosmetic Surgeons will not perform a SMAS facelift on active smokers.

People who are most likely to benefit from a facelift have one or more of these signs of ageing:

  • You have deep folds in your skin on the sides of your nose and mouth,
  • You have wrinkling skin that has lost shape,
  • Your eyes are tired looking,
  • Your cheeks and/or mouth have begun to sag, or
  • You have developed a double chin or folds in the skin of your neck.

The way your face ages is largely genetic but is also influenced by your weight, health and fitness, sun exposure, smoking, and chronic over-expression (such as squinting in outdoor workers).

Facial ageing happens in the following areas:

  • Gravity: Over time the effects of gravity pull your brow, jaw line, neck tissue and cheeks downwards. There may also be laxity or loosening of tissues around the folds of your mouth or eyes.
  • Structure: When your underlying bone and facial soft tissue lose shape, it can prematurely age you. For example, a small chin may lead to an early loss of jaw line definition.
  • Texture: During the ageing process your skin texture changes. This results in wrinkling, loss of elasticity, pigment changes, broken veins and dry patches due to sun damage. Textural skin changes are usually more prominent in fair skin.
  • Volume: When you were younger, your face had full and plump facial tissue. Over time, the loss of volume in parts of your face like the cheeks or lower eyelids can result in a drawn or tired appearance.

Who is SMAS facelift for?

A SMAS facelift is an option for people who feel that their face is ageing, where non-surgical treatments are not sufficient, and where they are in good health and of a healthy weight. It’s important to note that most Cosmetic Surgeons will not perform SMAS facelift on active smokers.

Good candidates for SMAS facelifts are struggling with a saggy neck and face that have caused by the natural ageing process. Ideal patients also have some elasticity in the skin and a well-defined bone structure. If you’ve got signs of ageing in other parts of your face, your Cosmetic Surgeon may suggest that you consider treating these first or at the same time as the SMAS facelift.

How is a SMAS Facelift Surgery performed?

Under a general anaesthetic in hospital, a SMAS facelift surgery usually takes between 2 to 3 hours. Most patients stay in hospital for at least 1 night. To make your skin look smoother and younger, your Cosmetic Surgeon will lift and tighten the subcutaneous SMAS. Any excess skin will be removed after the SMAS has been lifted and fixed in place. To achieve a natural look and avoid looking ‘stretched taut’, your skin will be sutured without any tension.

Because every face is unique, your Cosmetic Surgeon will customise your SMAS facelift to suit you. They may choose to surgically ‘fold’ the SMAS layer superiorly and surgically attach it to itself (known as SMAS Plication facelift). Alternatively, they may tighten and lift the SMAS by surgically reducing the muscles and then reattaching them in a more uplifted position (known as SMAS Resection facelift). It is important to note that SMAS facelift procedures usually result in long scars and a lengthier recovery time with more bruising and swelling.

What happens during SMAS facelift recovery?

During recovery from the SMAS facelift, you will need to wear a special bandage around your face. This bandage assists the healing process and will minimise any swelling and bruising. Your Cosmetic Surgeon will advise how long you need to wear the bandage for.

To remove any excess blood or fluid that have accumulated during the SMAS facelift, some patients will need to have thin cannulas (tubes) left in place. Your Cosmetic Surgeon will provide you with more information on how to take care of these drains once you leave hospital.

Most patients will need to take prescribed medications to aid healing, prevent infection, or reduce discomfort that may result from SMAS facelift surgery. To assist in your recovery, it is important to practise preventative skin care by using sun protection and not smoking.

Key facts about SMAS facelift

  • A SMAS facelift is a big cosmetic procedure and will usually involve up to a month of recovery time.
  • All patients having any facelift procedures where the skin is undermined will become numb in the cheek and temple area, in front of the ears, and sometimes in the upper neck. This numbness may last for weeks or months, but will generally improve over time.
  • SMAS facelifts can change the hairline around the temple area. Not all hairstyles are compatible with this type of facelift.
  • Men considering a SMAS facelift need to be aware of the potential visibility of the incisions, the changes in sideburn position, and the scar position in relation to their ears.
  • After SMAS surgery, you will be able to resume driving once you are comfortable, can react quickly if necessary, are not taking strong painkillers and can see normally. For most patients this is 7 to 14 days after surgery.
  • It is important to avoid heavy exercise 3 to 6 weeks after SMAS surgery.
  • A period of psychological adjustment is common after SMAS facelifts. Patients often go through a variety of moods postoperatively. As they recover, and the postoperative period of swelling, fresh wounds and bruising passes, most people feel positive.

What are the risks and complications of a SMAS facelift procedure?

Any surgery where general anaesthesia is used has possible risks and complications. To reduce any risks and complications with your SMAS facelift surgery, it is very important to use a Cosmetic Surgeon who is highly trained and performed many of these procedures.

General complications of every general surgery include:

  • Pain. Your healthcare team will give you medication to control the pain. To reduce discomfort and prevent headaches, it’s important that you take the medication.
  • Blood clot in your leg (deep-vein thrombosis – DVT). This can cause pain, swelling or redness in your leg, or the veins near the surface of your leg to appear larger than normal. Your healthcare team will assess your risk. They will encourage you to get out of bed soon after the operation and may give you injections, medication, or special stockings to wear. Let the healthcare team know straightaway if you think you might have a DVT.
  • Blood clot in your lung (pulmonary embolus). If a blood clot moves through your bloodstream to your lungs. If you become short of breath, feel pain in your chest or upper back, or if you cough up blood, let the healthcare team know straightaway. If you are at home, call an ambulance or go immediately to your nearest Emergency department.

Specific risks and complications of a SMAS facelift include:

Swelling, numbness, bruising: You may also feel tightness or tension in the face and neck area. Immediately after the procedure, your face may look distorted, swollen and uneven.

Scarring and bleeding: Scars may look ‘angry’ initially (red, raised, lumpy or even itchy) as they heal. For most patients they will fade over time, with full scar settling occurring around the 12-month mark.

Temporary and permanent nerve damage: This usually recedes over time; there will always be some numbness and alteration of sensation after surgery. In rare cases, the damage is permanent.

How to find the best Australian Cosmetic Surgeons who specialise in SMAS facelifts?

It is important to note that in terms of facial anatomy, skeletal structures, muscles, fat, nerves, tendons and other structures, SMAS facelift surgery is quite a complex surgical procedure. Only a highly skilled Cosmetic Surgeon should perform this type of surgery.

Before deciding if SMAS facelift surgery is suitable, your Cosmetic Surgeon will carry out a detailed assessment. This may include taking photos for your medical records and asking you questions about your medical history. For the operation to be successful it’s important that you have good bone structure and that your skin has elasticity. If you’re planning on losing a lot of weight, your Cosmetic Surgeon may delay the surgery.

Find the best Australian Cosmetic Surgeons who specialise in SMAS facelifts here.

It is important to note that SMAS facelift results vary from patient to patient and Cosmetic Surgeon to Cosmetic Surgeon. SMAS facelift success depends on the skill, expertise and experience of the Cosmetic Surgeon, the patient’s health and their facial structure.

Important to know

So you can make an informed decision, your elected surgeon will discuss the possible risks associated with SMAS facelifts. Some complications related to facial rejuvenation surgery include bleeding, requiring return to the operating theatre (haematoma), infection, skin or wound breakdown, small lumpy blood clots or scar tissue under the skin, nerve injury resulting in temporary or permanent loss of movement of part of the face, poor or obvious scarring, development of new wrinkles or creases in the skin on expression, and asymmetry. 

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