smas facelift

What type of Facelift is best for me?

The answer to this question is the technique which most appropriately addresses all the ageing factors of concern while at the same time providing the best and most natural result.

It should be remembered that facelift surgery is not a ‘one technique fits all’ approach.

Faces age differently and this can vary not only according to your age but also as a result of various genetic and environmental influences such sunlight exposure and smoking.

Certain parts of the face may show ageing effects at an early age and other parts at a later age. Hence using the same technique in every individual does not provide an effective approach. Each face must be analysed individually to determine those features that are of concern and which can be positively improved using surgery.

This analysis of the ageing face is very important at the initial consultation since it includes 3 very important factors of ageing:

  1. The descent and laxity of tissues in the face and neck
  2. The volume loss which is often forgotten in facial surgery
  3. The quality, thickness and texture of the skin itself

Of course a facelift on its own cannot correct all three factors and only addresses the facial laxity and descent. Adjunctive treatments are usually needed to improve volume loss and skin quality. These may involve fat transfer for the volume loss and laser or chemical peels for skin quality.

As far as the descent and laxity of tissues are concerned there are a multitude of techniques available and this is further confused by the huge number of surgeon ‘branded’ techniques which serve only to complicate the decision making process for you as the patient.  In my opinion this should all be ignored and the process of which technique is best left to the experience of the surgeon. The experience of the surgeon will determine how an operative plan is formulated and individualised to the patient. Using the same ‘branded’ technique in every patient will not yield the best results in every case. 

For example, performing an extended deep plane facelift in a forty year old with good facial volume, no issues in the neck and only minor jowling is not necessary. At the same time performing a standard SMAS technique on its own in an older patient  with significant volume loss, prominent jowls, skin excess and muscle banding in the neck is unlikely to give the best result.  

Therefore, the selection of technique needs to anatomically target the area of concern whether this be the midcheek, jawline or neck. At the same time adjunctive procedures need to be combined to address volume loss and this may include fat transfer , and other surgical additions such as platysmaplasty for improving the neck where necessary. There is no single or branded technique which encompasses all of the above as one single unifying procedure.

The examples below show very different face types all of whom have had very different procedures to achieve the end result.

40 year old patient with jowls and a chubby neck:

This patient of mine above had jowls and a chubby neck obscuring the youthful contours of her jawline and neck. He volume was good in her face which is quite often the case in this age group. On this patient I performed a technique called a lateral SMASectomy which removes a strip of the deeper layer of supporting tissue in the cheek. Stitching these edges of the SMAS layer together provides a lift to the jowls and no further extensive procedure is required in the face. The neck was simply treated using liposuction. 

50 year old patient with jowls, some neck skin laxity and midcheek volume loss:

This patient had laxity of the tissues in  the cheek, jawline and neck. This was also combined with some descent of the midcheek and some loss of volume in the midcheek. This was corrected using a high SMAS technique which involves a more extensive dissection of the SMAS layer which is the deep supporting layer of the face. This elevation of the SMAS is taken high up onto the cheekbone area and allows elevation of the midcheek and helps provide some volume in this area which is an important youthful feature. These features are instantly noticeable in photos when I ask my patients to bring photographs of themselves from when they were younger in readiness for the consultation. Also, this patient did not have a very heavy neck and there are no platysmal bands and therefore the high SMAS technique has been sufficient to improve all of the visible facial ageing without further surgery to the neck.

Patient in mid 50s jowls, some neck skin laxity and midcheek volume loss:

This is a similar patient to the one just above but in addition to a high SMAS procedure she had fat transfer to the midcheek and nasolabial area. This has provided a great improvement in lifting but also the fat in lifting 'out' the area of hollowness in the midcheek. After surgery she also underwent full face fractional laser resurfacing which has helped enormously with the lines and wrinkles around the mouth and in general improved the overall complexion and quality of her skin.

60 year old patient with jowls and muscle laxity in the neck


This patient complained mainly of her jawline and mucle bands in the neck. She underwent a deep plane SMAS technique which was combined with a necklift (plastysmaplasty) to correct the muscle banding in the neck. THis additional procedure in the neck has made a significant improvement in the jawline and neck contour. This is therefore a very different approach to those patients above.

The next patient in her 60s has extensive lower face skin laxity with a heavy and lax neck

This patient underwent a deep plane facelift to extensively lift the SMAS layer in the face and over the jawline. At the same time she required a platysmaplasty and removal of some of the deep fat under the muscle in the neck. This has provided a very youthful jawline and neck. Despite her age she had good volume in the upper face and therefore unlike some of the patients above no saurgery or fat transfer was required in the midhceek or upper face.

The importance of fat transfer in facial rejuvenation.

The loss of volume in the face plays a significant contributory factor to the ageing appearance. No amount of tightening of the tissues can overcome the hollowness that occurs with age. Where the facelift 'lifts' and tightens the tissues, fat transfer 'fills out' the tissues. It is important to incorporate fat transfer into the facelift plan since this enhances the results and provides a natural and finishing touch to achieving some of the best results.Such an approach is called a 'volumetric' approach to facelift surgery. Fat can be used in other areas of the face at the same time such as the tear trough and temporal hollows. With modern processing methods such as 'nanofat' transfer the fat can also be injected into the skin itself to treat fine lines and wrinkles in a manner which is long lasting unlike dermal fillers. 

Overall combining various adjunctive procedures such as fat transfer with the facelift produces some of the best results. All patients wants the best results possible which are longlasting and look natural. To achieve this the techniques need to be individualised to the patient.








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