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Blog / Facelift & Neck Lift / SMAS and Your Facelift...

SMAS and Your Facelift

February 6th, 2014 Share

Facelift procedures are still very popular today in Toronto and throughout Canada, but the techniques have evolved tremendously over the procedure’s 55-year history.

As you may know from reading my curriculum vitae, my biggest focus during my extracurricular training was in facelift, eyelid lift (blepharoplasty), forehead lift, neck lift, and rhinoplasty. I trained with two outstanding facelift plastic surgeons: Dr Daniel Marchac in Paris and Dr. Bruce Connell in Laguna Beach, California.

What is a facelift?

The technical term for the procedure is rhytidectomy or rhytidoplasty. Its name comes from the Greek words ‘rhytid,’ meaning wrinkles; ‘ectomy,’ meaning excision, and ‘plasty,’ meaning ‘shaping and molding.’ A facelift surgery can involve various parts of the face and neck. Although the forehead is part of the face, we normally refer to the rejuvenating part of the forehead as a forehead lift or browlift.

Not all facelift procedures are the same, just as no one patient is the same. Many variations of facelift and necklift exist, including short-scar, extensive, Hollywood, S-shape, mini, weekend, neck only, MACS, and with or without fat grafting. Some are smaller procedures with less downtime but shorter-lasting results; some are more extensive procedures with slightly more downtime and longer-lasting results. The technique is chosen based on the patient’s anatomy, expectations of result longevity, and desired recovery time. The chosen facelift procedure also depends on whether the patient already had a previous facelift.

How does the SMAS technique improve results?

One important concept to facelift is the superficial musculo-aponeurotic system, or SMAS. The SMAS is a complex facial layer below the skin comprising all the muscles of facial animation, interconnected by a thick collagenous layer of fascia (i.e. aponeurosis). The SMAS also includes the loose hanging bands in the neck commonly seen with aging, often referred to as turkey neck. You can read more about neck rejuvenation in another blog post. The SMAS is also connected to the overlying skin with little fibrous bands, so it is truly a system.

The SMAS can be folded, excised, lifted, suspended or repositioned according to different vectors. The aponeurosis component of the SMAS is a strong tissue that can bear tension more easily than the skin alone can. This is important for the final scars; a ‘no-tension’ skin closure favors finer scars.

Therefore, I commonly but selectively perform SMAS procedures in my Toronto facelift patients. In this procedure, I often repair the hanging bands under the chin, then incise and create various SMAS flaps. The SMAS flaps are then suspended behind each ear with strong sutures; this acts as a hammock, bearing the tension of the repair and bringing the skin along with it (traction) without causing undue tension in the skin closure itself. There is always some skin to be excised, but the skin is rather elevated and redraped, not tensed. Then the excess skin is tailored and gently sutured.

Overall, the SMAS procedure ensures more longevity in the facelift and necklift procedure, and it should produce finer, well-hidden, and inconspicuous scars.

We like to think of it as haute couture facelift by French-Canadian plastic surgeon Dr. Marc DuPéré of Toronto!

You can browse through my facelift patients’ results in our before-and-after photo gallery to see the types of results you can expect. And if you want to learn more about your facelift options, contact us online or call us at (416) 929-9800 to schedule an appointment.