For patients considering facial rejuvenation, understanding what actually happens during a SMAS facelift can help ease anxiety and set realistic expectations. Below is a detailed, step-by-step look at the surgical process, including what happens in the operating room and how long the procedure typically takes.
1. Preoperative Preparation
Before surgery begins, the patient is administered general anesthesia or local anesthesia with sedation, depending on the surgeon’s recommendation and the patient’s medical profile. The face is then cleansed and prepped in a sterile environment.
2. Precise Incision Placement
The surgeon carefully makes incisions starting at the temples, just within the hairline, extending down around the ear and sometimes behind it into the posterior hairline. The exact placement is designed to conceal scars naturally within the hair and skin creases.
3. Skin Elevation
The skin is gently separated from the underlying SMAS layer. This step creates the access needed to adjust the deeper facial structures without over-tightening the skin itself. The amount of skin elevation varies depending on the degree of laxity and aging.
4. SMAS Layer Repositioning
This is the defining step of the SMAS facelift. The surgeon lifts, tightens, and repositions the SMAS layer (Superficial Musculoaponeurotic System), which includes connective tissue and muscles that support facial structure. The lift is done along natural vectors—usually upward and slightly backward—to restore youthful contours in the cheeks, jawline, and lower face.
The SMAS may be:
- Plicated (folded and sutured)
- Resected (partially removed and reattached)
- Or lifted as a flap (deep-plane variation)
This deep structural adjustment is what allows for natural-looking results without a pulled or artificial appearance.
5. Skin Redraping and Trimming
After the underlying structure is secured, the skin is redraped without tension, and any excess is carefully trimmed. This creates a smooth, youthful surface without distorting facial features.
6. Incision Closure
The incisions are meticulously closed with fine sutures or surgical staples, placed in a way that minimizes visible scarring. Surgical drains may be placed temporarily to prevent fluid buildup, depending on the case.
7. Dressing and Recovery Monitoring
A gentle compression dressing is applied to minimize swelling and support healing. The patient is monitored in a recovery area as the anesthesia wears off, and most are able to return home the same day with post-operative care instructions.
How Long Does a SMAS Facelift Take?
A SMAS facelift typically takes 2.5 to 4 hours, depending on the complexity of the case and whether additional procedures (like eyelid surgery or fat grafting) are performed simultaneously. The duration reflects the precision and care required to lift deeper tissues and ensure natural, lasting results.
