How the SMAS Facelift Is Done

Facelift on the Support Structure for the Face

The SMAS rhytidectomy, also known as an SMAS facelift, is a surgical procedure that targets the lower two-thirds of the face. It is performed to address sagging skin, excess fat, jowls, and loss of volume in the cheeks. It is less invasive than a regular facelift, which targets the superficial skin of the face, and recuperation is faster.​

The SMAS (superficial muscular aponeurotic system) is a layer of tissue deep within the skin and subcutaneous tissue. It is one of the most important support structures for the face. The manipulation of this anatomic structure changes the appearance of the face.

Plastic surgeon touching woman's face
Hero Images / Getty Images

The SMAS Facelift 

As your facial skin begins to age, there is a loss of elasticity in the epidermis as well as the SMAS membrane. This loss results in sagging cheeks along the jaw bone, creating fleshy jowls and often a double chin. Cheek fat will then sag forward to increase the appearance of the nasolabial folds.

An SMAS facelift counteracts the signs of aging by tightening the muscle, removing fat, and trimming excess skin. An SMAS facelift is effective in correcting the following:

  • Sagging in the midface
  • Hollow cheeks
  • Nasolabial folds
  • Jowls
  • Sagging fat
  • Loose skin and fat under the chin and jawline

A facelift may remove or reduce the signs of aging but, over time, they will gradually reappear.

Candidates for an SMAS Facelift

You may be a good candidate for an SMAS facelift if you are over the age of 50 and want to correct one or more signs of aging. You may have some facial sagging but still have some elasticity in your skin. You must be healthy and a non-smoker. You should have realistic expectations of the procedure.

Risks of Facelifts

The risks of the procedure include the general risks of surgery and anesthesia, such as reactions to medications, breathing problems, bleeding, infection, and blood clots. You may also have nerve damage to your facial muscles, pain, numbness, and wounds that don't heal. Some people are unhappy with the outcome due to scarring, irregular contours, or changes in skin color.


After you have been prepared for surgery, you are given anesthesia, usually intravenous sedation (IV), and a local anesthetic. Your face will be marked for the placement of incisions. An incision is made at your temple, above the hairline. It will extend downward along the natural creases of the skin but curve behind the ears. The facial and neck tissue and muscle beneath the skin will then be lifted and rearranged into a higher position and excess skin will be removed. The skin will be redraped over the face and the incisions will be closed with sutures. Most of the scars will be hidden within the hair and the normal creases of the skin.

The SMAS facelift may take several hours to complete, depending upon the extent of the procedure. You will have a head dressing and drainage tubes after the procedure. You should expect to have some swelling, bruising, numbness. and discomfort for a few weeks. You should be able to return to work after two to three weeks and resume exercise and daily activities after healing is complete.

Was this page helpful?
2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Barrett DM, Casanueva FJ, Wang TD. Evolution of the rhytidectomyWorld J Otorhinolaryngol Head Neck Surg. 2016;2(1):38-44. doi:10.1016/j.wjorl.2015.12.001

  2. Woerner JE, Ghali GE. RhytidectomyAtlas of Operative Oral and Maxillofacial Surgery. 2015:347-354. doi:10.1002/9781118993729.ch40