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How is an SMAS face-lift performed?

Arthur W. Perry, MD
Plastic Surgery
The SMAS, or superficial musculo aponeurotic system, is a collection of muscles and fibrous tissue stretching from the forehead to the neck. In a SMAS face-lift, the incision begins within the hair above the eyebrow. It continues in front of the ear, goes inside the ear, returns to the front of the ear, continues behind the ear, and ends in the hair. The skin is lifted all the way to the naso labial fold. Under the chin, the skin lifting connects with the lifted skin from the other side. Another incision is sometimes made under the chin. Like a scene out of a horror movie, the skin is lifted under the chin from ear to ear. Through a chin incision, fat can be suctioned and the bands of the neck can be tied together with long-lasting stitches. This portion of the operation is called a platysmaplasty, named for the two platysma muscles of the neck.

The lower layer of tissue, the superficial musculo aponeurotic system (SMAS), is then lifted. The skin is pulled as the surgeon watches the direction of the skin wrinkles and the color of the skin. Too tight, and the skin will die. Too loose, and the patient will complain. Strong stitches above and behind the ears secure the new face. A little tailoring is done, as extra skin is cut and discarded. A dazzling array of stitches and staples is placed. In front of the ear, two layers of fine stitches are used. Dissolving stitches are used behind the ear, because the ear should not be pulled forward to remove stitches after surgery. The stretch of skin behind the ear connecting to the scalp has either Dermabond glue or buried stitches. This telltale area of the face-lift always shows cross-marks if stitches are placed there. Staples are used in the scalp, as they are gentler to the hair than stitches. After the second side is completed, the chin incision is closed and a dressing is placed.
Straight Talk about Cosmetic Surgery (Yale University Press Health & Wellness)

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Straight Talk about Cosmetic Surgery (Yale University Press Health & Wellness)

The public’s recent exuberance toward cosmetic surgery has spurred an unprecedented demand for appearance-changing procedures. But how can an average consumer discern the hype from solid truth? ...

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.