The Art of a Facelift by Dr Jack Zoumaras (Part 2) Why a High SMAS Facelift?

Why a high smas facelift?

My training and experience in Australia and overseas exposed me to many techniques of Facelift and Neck Lift surgery. In New York most Facelifts were short scar or conventional incision but with plication or SMASectomy of the SMAS. In Miami and San Fran (All of California) a SMAS facelift is routine, and in some centres a High SMAS facelift.

In Paris and Europe a SMAS facelift was routine but not as extensive.

My preferred option for a Facelift is the High SMAS Facelift and Neck Lift.

More about this in another blog, but let’s explore the anatomy of facial ageing, the importance of the SMAS and some commonly used Facelift techniques used and available at Artiste.

Anatomy of Facial Ageing

The face ages in predictable ways but different in each individual. The make up of the face consists of specialised tissue of skin, fat, muscle, ligaments, vessels, nerves and bone. Each of these components age in different ways and influence each others ageing. The following processes can occur in isolation or in combination in varying degrees to cause facial ageing.

1. Atrophy of facial fat 
2. Descent of facial fat 
3. Increase skin laxity 
4. Increase wrinkle formation 
5. Recession of bone around the orbit, nose and jaw and cheek bone 

The objective of a Facelift is to reverse the ageing process, make you look younger and rejuvenated.

A SMAS facelift allows a bespoke procedure that is tailor made to the cause of ageing in each individual. A SMAS resection or plication does not offer the same flexibility. Hence the SMAS Facelift (especially High SMAS) is the Platinum standard for reversal of facial ageing. More about the High SMAS Facelift in another blog.

 What is the SMAS?

The SMAS is an acronym for Superficial Musclo-Aponeurotic System founded by a Plastic Surgeon in the 70s. This SMAS is in the third layer of the face. The first layer consist of the facial skin. The second layer consists of subcutaneous fat including the Malar or cheek fat pad, with the underlying SMAS underneath. The fourth layer is a space beneath the SMAS where facial nerves, blood vessels and ligaments that hold the top 3 layers exist. Layer 5 is the deep tissue or bone depending on where you are in the scalp or face or neck. 

The SMAS or 3rd facial layer is where the facial mimetic muscles lie. These muscles are critical for opening and closing the eye and mouth and moving the nose. They are responsible for smiling, animating and demonstrating facial emotion. This is also the layer that shifts down with ageing and affects the overlying fat and skin above it. Only a SMAS facelift lifts this deep layer to a normal youthful position, and is the anatomical correction of facial ageing. Other SMAS techniques to impact facial ageing and are used and offered by Artiste.

What is a SMAS plication and SMASectomy?

These are commonly used Facelift techniques used by the majority of Plastic Surgeons and what I was exposed to in Manhattan, New York. The SMAS plication or resection (SMASectomy) tighten the SMAS to reverse facial ageing. This is acheived without lifting the SMAS layer and is more straightforward in comparison to a SMAS flap and achieves excellent results in the right patient.

A SMAS plication involves suturing the SMAS layer tight with a series of sutures. A SMASectomy achieves tightening of the SMAS by removing some of the SMAS and then suturing the edges together to tighten.

A SMAS facelift in comparison lifts the SMAS as a flap and is more powerful and the preferred technique of Facelift Plastic Surgeons worldwide.

In Summary

 The varying techniques of Facelift surgery I learned overseas include a Skin only, SMAS plication, SMASectomy, SMAS flap, Extended SMAS flap and the High SMAS Facelift. Understanding the anatomy of facial ageing makes it clear that the SMAS layer needs to be elevated, tightened or manipulated in someway to reverse all of the facial ageing process. Tightening of the SMAS through sutures and excision is the start of the spectrum of SMAS manipulation to rejuvenate the face and a High SMAS facelift is the Platinum standard of a Facelift. This is the reason why my preferred option is the High SMAS facelift. 

At Artiste Plastic Surgery I do offer all of the Facelift techniques.

In my next blog (Part 3) we will explore the High SMAS Facelift in more detail.

Disclaimer: At Artiste Plastic Surgery, our Plastic Surgeons led by Dr Jack Zoumaras have been trained to the highest possible degree. All surgery has risks and it is always advised to get a second opinion. Risks are very real and we cannot guarantee any result. Results are illustrated as a guide only. All risks are managed and any need for revision surgery or complications (1-5%) can be managed by our specialist plastic surgeons.

Any statements on how you will feel is based on Level V Evidence:

Level V:  How you will feel after plastic surgery varies between individuals, depending on psychological and physical factors. Our internal research is based on how patients in our practice feel after surgery.

The blogs are not a substitute for a medical consultation and do not form as part of the doctor to patient relationship.