As we age, loose skin and reduced skin elasticity become more noticeable, leading some to explore facelift options. Two techniques—the SMAS facelift and the Sub-SMAS facelift—target deeper tissues for a lifted look. While similar in name, they differ in approach, depth of tissue manipulation, and recovery. Here’s what you need to know when considering your options with a qualified professional.

Understanding Facial Layers

Our face is made up of five distinct layers, each playing a unique role in how we look and move. Here’s a simple way to understand them:

Layer 1: Skin – This is the outermost layer that we see and touch. It’s thicker on the cheeks and nose but thinner around the eyelids and temples, making these areas more delicate.

Layer 2: Fat – This layer provides volume and softness to the face. It’s more noticeable in the cheeks, giving them fullness, but almost absent in the eyelids. (The puffy “bags” under the eyes actually come from a much deeper layer.)

Layer 3: SMAS – This is a thin but strong muscle layer that helps us make facial expressions. Smiling, talking, and even whistling all rely on this layer.

Layer 4: Ligaments, Nerves, and Blood Vessels – Think of this layer like a support system for the face. Ligaments hold everything together, while nerves and blood vessels help with movement and circulation. The ligaments act like tree branches, attaching the upper layers to the deeper structures below.

Layer 5: Bone and Deep Fascia – The foundation of the face. In areas like the cheeks and jaw, bones support facial structure. In places without bone, like the neck, a strong fascia (connective tissue) provides support instead.

Understanding these layers helps explain how different facelift techniques work. Some focus on tightening the skin and muscle (SMAS facelift), while others go deeper to reposition fat and ligaments (Sub-SMAS facelift) for a more comprehensive lift.

Surgical Approach and Depth of Tissue Manipulation

• SMAS Facelift: This technique focuses on the SMAS layer, a fibrous network beneath the skin that supports facial muscles. Surgeons lift and tighten this layer to address loose skin in the lower face and neck. The procedure involves repositioning the SMAS without extensive dissection beneath it.
• Sub-SMAS Facelift: In contrast, the sub-SMAS approach, otherwise known as deep plane facelift, involves a deeper dissection. Surgeons separate the SMAS layer from underlying tissues, allowing for more comprehensive repositioning. This approach targets deeper facial structures, potentially offering more significant changes.

Target Areas and Expected Outcomes

• SMAS Facelift: Primarily addresses loose skin in the lower face and neck, aiming to improve the jawline and reducing jowls.
• Sub-SMAS Facelift: By accessing deeper tissue layers, this technique can also make changes in the midface, including the cheeks. 

Recovery Time

• SMAS Facelift: Generally involves a shorter recovery period, with many patients resuming normal activities within 2 to 3 weeks. Swelling and bruising are typically less pronounced.
  
• Sub-SMAS Facelift: Due to the more invasive nature of the procedure, recovery may take longer, often around 3 to 4 weeks. Patients might experience increased swelling and bruising during the initial healing phase.

It is important to remember that everyone has different experiences. Recovery varies from person to person. It is best to consult a qualified surgeon to determine recovery time for each facelift technique based on your situation.

Suitability for Different Patient Needs

• SMAS Facelift: Might be ideal for individuals with mild to moderate facial ageing.
• Sub-SMAS Facelift: Might be suited for those with significant loose skin or deeper wrinkles, as it allows for more substantial tissue repositioning.

Individual suitability for each procedure varies. Factors such as specific facial anatomy, skin elasticity, and personal goals play crucial roles in determining the most appropriate approach. Obtaining a GP referral and consulting with a qualified health practitioner is essential to receive personalised advice tailored to your unique needs. 

If you like to know more about facelift techniques, reach out to Artiste Plastic Surgery. Our Specialist Plastic Surgeon, Dr Jack Zoumaras, is a highly-skilled and peer-reviewed surgeon offering different kinds of facelift techniques, including the High SMAS facelift, deep plane facelift and more. Schedule a consultation today. 

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.