How the SMAS Facelift Is Done

Facelift on the Support Structure for the Face

The SMAS facelift (rhytidectomy) is a surgical procedure that corrects the appearance of the neck and the lower two-thirds of the face. This facelift corrects signs of aging such as sagging skin, excess fat, jowls, loss of volume in the cheeks, or a double chin. It is less invasive than a regular facelift and recovery or recuperation is faster.

The SMAS (superficial muscularaponeurotic system) is a layer that connects face and neck muscles to the skin. It contains fibers, collagen, and connective tissue and plays a key role in facial expression.

This article reviews the SMAS facelift, who is a good candidate, potential risks, and steps of the procedure.

Plastic surgeon touching woman's face
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What Is a SMAS Facelift? 

The superficial musculoaponeurotic system, or SMAS, is the layer of tissue or membrane that connects your face and neck muscles to your skin. It includes muscles, fibers, collagen, and fat. As you age, your skin and the SMAS lose its elasticity.

These changes result in sagging cheeks along the jawbone, excess skin, and often a "double chin". Cheek fat will also sag forward, increasing nasolabial folds or creases on the sides of the nose extending to the mouth (also causing smile or laugh lines).

A SMAS facelift counteracts visible signs of aging by tightening the muscle, removing fat, and trimming excess skin on the lower two-thirds of the face. Most people continue to look 10 to 15 years younger, but over time the results of aging gradually reappear about 10 to 15 years after the procedure.

What Does a SMAS Facelift Correct?

SMAS facelifts can correct the following:

  • Sagging in the mid part of the face
  • Sagging cheek fat
  • Hollow cheeks
  • Nasolabial folds (creases on sides of nose extending to mouth, also caused smile or laugh lines)
  • Loose skin and fat under the chin and jawline (jowls)
  • Sagging of the neck
  • "Double chin"


You may be a good candidate for a SMAS facelift if you:

  • Are over the age of 50
  • Want to surgically correct one or more signs of aging on your face
  • Still have some elasticity in your skin
  • Are a non-smoker (this helps to be able to heal correctly after surgery)
  • Are in good overall health

It's important to have realistic expectations of the procedure. Talk to your plastic surgeon to discuss your appearance, healing, and recovery expectations.

Potential Risks

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.

Potential adverse events include nerve damage to your face, bleeding under the skin, tissue death, 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 will be given anesthesia, which is 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 and 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.

How Long Is The Procedure?

The SMAS facelift may take several hours to complete, depending on the extent of the procedure. You should be able to go home the same day as the surgery.

During recovery, you will have a head dressing and drainage tubes. You should expect to have some swelling, bruising, numbness. and discomfort for a few weeks. Generally, you should expect to return to work after two to three weeks and resume exercise and daily activities after healing is complete.


The SMAS (superficial musculoaponeurotic system) is a layer of tissue that connects face and neck muscles to the skin and plays a key role in facial expression.

The SMAS facelift (rhytidectomy) is a surgical procedure that corrects the signs of aging along the lower two-thirds of the face and neck. It is less invasive than a regular facelift and recovery or recuperation is faster.

If you are over 50, in overall good health, and a non-smoker, you may be a good candidate for this procedure. Potential risks include the usual risks of surgery and nerve damage in the face or undesired results.

A Word From Verywell

Signs of aging can affect your self esteem and confidence. These feelings can negatively impact your career, relationships, or how you are experiencing life. Cosmetic surgery is a form of self-care that helps many people feel better about their appearance, increasing their quality of life.

If you decide you would like to look into a SMAS facelift, find a plastic surgeon who is board-certified and specializes in this procedure. It can be helpful look at their before and after pictures and to get more than one opinion before making a decision.

Frequently Asked Questions

  • How long does a SMAS lift last?

    A facelift may remove or reduce the signs of aging but, over time, they will gradually reappear. The results last about 10-15 years on average.

  • How much is a SMAS facelift?

    The average cost is about $8,000. However, this average cost usually does not include anesthesia, surgical facilities, or other related expenses.

  • Is a deep plane facelift the same thing as a SMAS facelift?

    No, the SMAS and deep plane facelift both counteract the effects of aging in the lower two-thirds of the face. However, the SMAS technique allows for more customization to the shape of a person’s face. This is because the surgeon can move the skin and SMAS layer separately. The deep plane technique involves moving the layers together in one direction, which makes it difficult to customize the results.

10 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.
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By Brandi Jones, MSN-ED RN-BC
Brandi is a nurse and the owner of Brandi Jones LLC. She specializes in health and wellness writing including blogs, articles, and education.

Originally written by Natalie Kita