Dr. Buckingham’s Q&A

SMAS stands for Submuscular Aponeurotic System.  The SMAS is a thin fibromuscular sheath that envelopes the muscles of the face and is involved in the bony cutaneous attachments to the skin.  It isn’t really of importance except to the facial plastic surgeon as it related to face lifting and other facial operations.  To the facial cosmetic surgeon it is probably the most important structure to know about and how it relates to the other structures of the face.  The SMAS lies in continuity with the platysma muscle of the neck and is probably the embryonic extension of this layer into the face.  It is important because we use the SMAS to tighten the facial skin and reposition the depressed fat pads of the face, ie. jowls and sagging necks.  A lower facelift is perfomed in our practice by dissecting under the platysma and SMAS for a varying distance, depending on the patient, and then tightening this layer.  This achieves a dramatic and long-lasting result.  The skin is then gently trimmed and replaced without any tension so that the lift look natural and the incisions heal invisibly.