SMAS Facelifte

SMAS — Superficial Musculo-Aponeurotic System

A continuous fibromuscular layer connecting the facial muscles to the skin. As it descends with ageing, the entire face sags. Repositioning the SMAS corrects sagging at its structural origin.

Platysma

The platysma is the cervical extension of the SMAS. With age it separates, forming visible bands in the neck. Platysmaplasty (platysma repair) is frequently combined with SMAS facelift to rejuvenate the neck.

Retaining Ligaments (Osteocutaneous)

Fibrous attachments (zygomatic, mandibular) that anchor soft tissue to bone. As these weaken or stretch, jowls form and the midface descends. SMAS surgery releases and resets these anchors.

Facial Nerve Branches (N. Facialis)

The temporal, zygomatic, buccal, marginal mandibular and cervical branches of the facial nerve must be identified and preserved throughout the SMAS dissection. Experienced surgical anatomy knowledge is essential.

Subcutaneous Fat

Age-related fat compartment descent and volume loss alter facial contour. SMAS repositioning restores natural fat compartment position; fat transfer may be added for volume restoration.

Cervicomental Angle

The chin-to-neck angle (ideally 90–120°) is a key marker of facial youth. Neck component of SMAS facelift restores this angle through platysmaplasty and submental contouring.

SMAS Plication (Most Common)

The SMAS is folded upon itself and sutured in a more elevated position without actually removing tissue. This technique is technically safe, reproducible, and delivers excellent long-lasting results in the majority of SMAS facelift patients.

SMASectomy (SMAS Resection)

A strip of SMAS is excised before suturing the edges together in an elevated position. Provides firmer tissue tensioning. Often selected for patients with heavier or thicker SMAS tissue.

Extended SMAS / Deep SMAS

Dissection extends below the SMAS, releasing the zygomatic and mandibular retaining ligaments. Enables more powerful repositioning of the midface and jowl areas — preferred in advanced ageing or significant ligament-related descent.

Jowls and Lower Face Sagging

SMAS repositioning lifts jowl tissue back above the mandibular border, restoring a clean jawline definition that skin-only lifting cannot reliably achieve.

Neck Laxity and Platysma Bands

Platysmaplasty combined with SMAS facelift addresses platysma banding and cervical skin laxity, restoring the cervicomental angle and a clean neck profile.

Deep Nasolabial Folds

Extended SMAS dissection with release of zygomatic ligaments elevates midface tissue, significantly improving nasolabial fold depth at its structural origin.

Marionette Lines

The vertical lines descending from mouth corners are significantly reduced as the SMAS and lower face soft tissues are repositioned superolaterally.

Midface Descent

Deep SMAS release allows the descended malar fat pad and midface tissues to be repositioned to a more youthful, elevated location — restoring cheek volume position.

General Facial Skin Laxity

After the SMAS is repositioned, excess skin is trimmed with minimal tension — eliminating the "pulled" appearance associated with outdated skin-only techniques.

Stage 1 — Pre-operative Evaluation

Facial anatomy, skin quality, SMAS descent, jowl volume, neck profile, ligament laxity and overall health are comprehensively assessed. SMAS technique selection (plication, SMASectomy, or extended SMAS) is determined based on individual anatomy and ageing pattern.

Stage 2 — Anaesthesia and Patient Preparation

General anaesthesia is administered. Pre-operative markings are made along the hairline, pre-auricular and post-auricular landmarks. A dilute local anaesthetic with epinephrine is infiltrated to reduce bleeding.

Stage 3 — Incision and Skin Flap Elevation

The incision is placed within the hairline, continues around the ear and behind it into the posterior hairline. A skin flap is elevated in the subcutaneous plane to expose the SMAS.

Stage 4 — SMAS Repositioning and Platysmaplasty

The selected SMAS technique is executed: plication, SMASectomy or deep SMAS release. The SMAS is sutured in a superolateral vector. Platysmaplasty is performed if the neck component is included. Submental liposuction is performed if indicated.

Stage 5 — Skin Trimming, Closure and Recovery Start

Excess skin is trimmed without tension and the incisions are closed meticulously. A compression bandage is applied. One night of hospital observation is typically recommended. Detailed post-operative care instructions are provided.

Moderate to Advanced Facial Ageing

Jowling, lower face descent, neck laxity and nasolabial fold deepening are the most common indicators. SMAS facelift addresses all of these at their structural source.

Good General Health

Cardiovascular health, anaesthesia fitness and absence of uncontrolled chronic disease. Blood thinners are stopped pre-operatively. A thorough pre-surgical health assessment is conducted.

Non-Smoker or Willing to Quit

Smoking significantly impairs skin circulation and healing. Cessation at least 4–6 weeks before and after surgery is mandatory for safe outcomes.

Realistic Expectations

The goal is to appear significantly younger and refreshed while looking naturally oneself — not a different person. Understanding this distinction is key to satisfaction.

Stable Body Weight

Significant weight fluctuations after surgery can alter results. Patients near or at their stable weight are the best candidates.

Recovery Time Available

Social recovery requires 10–14 days. Patients who can plan this downtime will achieve the best experience and result.

Addresses the Root Cause

By targeting the SMAS layer rather than the skin, the procedure corrects the anatomical source of sagging — not merely its surface appearance.

Long-Lasting Results

SMAS-based correction typically maintains its effect for 7–12 years — substantially longer than skin-only techniques.

Natural Appearance

Repositioning rather than over-pulling the skin means the face looks younger without the tell-tale "tightened" or "windswept" appearance.

Comprehensive Lower Face Rejuvenation

A single procedure addresses jowls, nasolabial folds, marionette lines, jawline, and neck — simultaneously and in a coordinated manner.

Highly Combinable

SMAS facelift can be combined with fat transfer, eyelid surgery, brow lift or rhinoplasty in the same session to address all dimensions of facial ageing.

Gold Standard Technique

SMAS-based facelifts are the most widely published and validated technique in modern aesthetic surgery, consistently demonstrating superior outcomes over skin-only approaches.

Deep Plane Facelift

An extension of the SMAS approach — when ligament release and deeper structural repositioning provide the optimal result for advanced ageing. Deep Plane →

Neck Lift Surgery

Platysmaplasty and neck skin correction are frequently integrated with SMAS facelift to complete the lower face and neck rejuvenation. Neck Lift →

Facial Fat Transfer

Volume restoration with autologous fat complements structural lifting — addressing both sagging and volume loss in a single session. Fat Transfer →

Eyelid Surgery (Blepharoplasty)

Upper and lower eyelid correction is commonly combined with SMAS facelift to achieve balanced facial rejuvenation. Eyelid Surgery →

EBOPRAS Certification

SMAS facelift requires advanced surgical anatomy knowledge and technical precision. Op. Dr. Urhan holds European Board certification confirming these competencies.

ISAPS Membership

International Society of Aesthetic Plastic Surgery membership ensures continuous access to the latest evidence-based facelift innovations and technique refinements.

Anatomical Expertise

Safe SMAS surgery demands expert knowledge of facial nerve anatomy. Op. Dr. Urhan's training and experience enable meticulous nerve preservation throughout the procedure.

Technique Versatility

Plication, SMASectomy, extended SMAS and deep plane techniques are all performed — the right technique is selected for each patient's individual anatomy, not a one-size-fits-all approach.

International Patient Care — Muratpaşa, Antalya

Multilingual team, video consultation, transfer coordination and remote post-operative follow-up — a complete, comfortable experience for international patients.

Individualised Surgical Planning

No two faces age alike. Every SMAS facelift plan is tailored to the patient's unique anatomy, descent pattern and aesthetic goals — never a template approach.

Haematoma

Blood collection under the skin flap. Risk is minimised by stopping blood thinners pre-operatively and maintaining blood pressure control. Most common facelift complication overall, but managed safely with drainage if needed.

Temporary Facial Nerve Weakness

Transient weakness or altered sensation in a nerve branch area. Resolves in most cases within weeks to months. Permanent nerve injury is rare in experienced hands.

Visible Scarring

Incisions are placed in natural landmarks and typically fade well. Hypertrophic scarring is uncommon; smoking significantly increases this risk.

Skin Necrosis

Impaired skin circulation leading to tissue loss. Strongly associated with smoking. Tension-free closure and optimal flap design minimise this risk in non-smokers.

Asymmetry

Minor asymmetries are common in the early healing phase and typically self-resolve. Significant asymmetry is rare with meticulous intraoperative assessment.

Hair Loss near Incision

Temporary hair shedding (telogen effluvium) around incision lines. Usually self-resolving within 3–6 months.