SMAS lifting – what is it: facelift procedure

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The number of cosmetic rejuvenation techniques is growing every year, and one of them is SMAS-lifting. Specialists-cosmetologists promise a long and high-quality result, the selection of an individual action plan and the minimum number of complications. How effective is such a procedure, on what equipment is it carried out and to whom is it recommended?

What is SMAS lifting

The name of the technique comes from the English abbreviation SMAS (superficial muscular aponeurotic system), which means “superficial muscular aponeurotic system”. The word SMAS denotes the area of ​​the facial muscles, which:

  • located behind the subcutaneous tissue (yellow layer of adipose tissue) and is formed from aponeurosis (these are layers of connective tissue) and muscles attached to the epidermis;
  • Anatomically lies in the neck and ears, therefore, is responsible for facial expressions and emotions on the face.

The layer of muscles and aponeurosis is a framework that preserves a clear oval of the face. With the natural aging of the body, ptosis occurs – the muscle-aponeurotic layer begins to stretch, which leads to shape changes: under its own weight, the lower part of the face falls, the upper one expands with folds. SMAS lifting is a procedure that reduces collagen and skin elastin to restore the natural contour of the face. The differences from the classic braces are as follows:

  • SMAS lifting can affect not only wrinkles (removes adipose tissue).
  • The effect of the procedure is longer than with standard work exclusively with the skin, since deep tissues are affected.
  • Among the methods of SMAS lifting there are non-invasive (non-surgical), therefore, the rehabilitation period is shorter than with plastic surgery, there are fewer contraindications and adverse reactions.
  • The risk of complications is minimal, since skin lesions do not occur (excluding the classical technique).
  • The effect is provided by the effect on collagen and elastane, the layer of which is compressed, because of which the body is forced to start the accelerated process of their active production, which leads to an increase in skin tone.
  • The SMAS procedure does not change the natural oval of the face, section of the eyes, or mouth lines, as traditional plastic does.



The muscle-aponeurotic layer begins to change as the body ages, which is why experts call the return of those facial contours that were earlier the main goal of SMAS lifting. Due to this, the appearance of the first wrinkles cannot be considered an indication of this procedure – you need to focus on lowering the muscles. The simplest and most explicit markers will be:

  1. The appearance of “brylya” in the cheek area.
  2. The formation of deep wrinkles and wrinkles in the mouth.
  3. The formation of bags under the lower eyelid and a large number of folds above the upper.
  4. The omission of skin tissues and their stretching to the formation of the second chin.
  5. The appearance of wrinkles on the neck.

Any of the methods of SMAS lifting helps to reduce the depth of the nasolabial folds, raise the outer corners of the eyes and lips, smooth the skin of the neck, deep creases on the face, restore the clarity of the lower jaw area, tighten the skin on the cheeks. However, the effectiveness will depend on the amount of excess dermal tissue. The main indications for the session are only 2:

  • A woman has reached the age that allows surgical tightening of the contours (40 years and older), but wants to find a less traumatic way to do this.
  • The need to extend the effect of a surgical operation performed several years ago, but with lower health risks.

According to age indications, a separate recommendation should be made: some cosmetologists mention that laser SMAS lifting can be performed even for a girl older than 18 years, since such a procedure can remove not only early wrinkles, but also neoplasms from the skin. However, most experts agree that before 40 years of age, resorting to techniques of this type is not worth it, especially surgical SMAS lifting. Ultrasound is recommended for women 35-45 years old, and endoscopic – 30-40 years old. It is advisable not to carry out the procedure in patients older than 50 years.

Skin preparation

Before the start of the session, the patient removes makeup with foam. If the face is initially clean, it is treated with micellar water or lotion to remove dust and dirt. After that, an anesthetic is applied to the skin over the entire surface – it is in gel format (application), therefore the anesthesia is only local, the harm is minimal. An exception is the classic surgical lift, where pain relief through general anesthesia. Subsequent actions of a specialist:

  1. After half an hour, the remnants of the gel are removed and the skin is treated with chlorhexidine (or another antiseptic).
  2. On the face, taking into account the features of its structure, markup is carried out – for this, a special ruler is used. Further actions are determined by the selected tightening technique..

How is the SMAS lifting procedure carried out?

There are several methods of influencing the muscle-aponeurotic layer – under the word “SMAS” they mean only face lifting, however, some cosmetologists work with an endoscope, and someone adheres to classical surgical technology. The latter option is more traumatic, but gives the longest effect. The specialist chooses the work scheme based on:

  • source material (with what problems did the client come, which zones should be affected, and with what intensity);
  • patient age (total recommended age range – 35-50 years);
  • the presence of chronic diseases and contraindications for surgical intervention.

The issue of sensations during SMAS lifting requires a separate mention: even with non-invasive techniques, painkillers are always used, this is the application of an application with a gel. In rare cases, anesthetic injection locally or general anesthesia is possible. If the latter is not used, the patient can drink an anti-inflammatory tablet on ketorolac before a facelift session.

SMAS lifting procedure

Classic method

Surgical tightening of the muscle-aponeurotic layer is prescribed for women over 40 years old and has a large number of contraindications, since it has a long rehabilitation period and a high risk of complications. After this procedure, the patient should stay 2 weeks in the hospital, where doctors will monitor his condition and behavior of the skin. A few more shortcomings of this technique:

  • the duration of the session is up to 3 hours, without affecting the time for preparation (another 1.5-2 hours);
  • tissue healing period is 2 months;
  • high cost of the procedure (the most expensive);
  • the risk of damage to the facial nerves, infectious agents entering the wound, blood poisoning;
  • the likelihood of a change in appearance (facial features) is not excluded.

For most patients, these drawbacks of the classical method overlap with a plus that non-surgical technologies do not give: the effect lasts up to 15 years, although this depends on the initial data. Anesthesia for this technique is general anesthesia, which also gives a subjective plus – the person on the operating table does not feel pain even with increased sensitivity. The procedure is as follows:

  1. After preparation, which is already under anesthesia and involves marking areas requiring exposure, the specialist makes an incision from a point in the temporal region to the area behind the ear, bypassing it in front.
  2. Thanks to this incision, the upper layer of the dermis is removed with a scalpel, the patches of the muscle-aponeurotic layer are brought out and tightened.
  3. Excess tissue is excised, excess fat is removed through a puncture with a special needle (if required).
  4. A new position of the surface layer is fixed, sutures are placed along the hairline.

Endoscopic method

Like a traditional lift, an endoscope technique involves general anesthesia, as it is one of minimally invasive surgeries. Its degree of trauma is lower than that of a traditional one, since incisions are not made – they are replaced by punctures performed next to the scalp. The procedure is long, depending on the amount of work it takes 3-4 hours. The algorithm for its implementation:

  1. After standard preparation of the skin and immersion of the patient in general anesthesia, the surgeon makes several punctures in the temporal zone.
  2. Using an endoscope, at the end of which there is a video camera, the doctor exfoliates the skin tissue, stretches and transfers the muscle-aponeurotic layer.
  3. After the fabric, standard stitches are fixed and superimposed.

As after the traditional tightening, the patient will need to wear a compression bandage for 2 days (while in the hospital), and the sutures are removed only after 5 days. At the same time, a massage course is being conducted to accelerate rehabilitation. The disadvantage of endoscopic SMAS lifting is its effectiveness only in patients under 40 years of age, and the pluses include:

  • minimal invasiveness;
  • the final effect is visible after 1.5 months;
  • reduced risk of complications.


The most comfortable version of this procedure is called an ultrasonic lift: it is recommended for women aged 35 years and older. The procedure lasts about an hour, the exact time is determined by the amount of work and the qualifications of the master – some points can be dealt with in 25-30 minutes. The result will be visible immediately, however, to understand the full picture, you need to wait 2-4 months: only then will the muscle-aponeurotic layer complete its formation. The advantages of ultrasonic SMAS lifting are:

  • For each client, you can choose an individual program in which, after assessing the thickness of the skin and the depth of soft tissue, the correct intensity of ultrasonic waves for different areas will be determined.
  • The only sensations during the procedure are a slight tingling and warmth, as the specialist stretches the skin on the treated area.
  • Ultrasonic radiation does not injure the skin, so the patient will not have to deal with scar reduction and suture healing after tightening.
  • You can return to your usual lifestyle the very next day after the procedure, only it is important not to forget about the basic rules of skin care for 1.5-2 weeks.
  • Can be carried out at any time of the year and combined with additional anti-aging procedures.

Ultrasonic SMAS lifting

The disadvantages of ultrasonic SMAS face lifting are also not without: the effect of this technique is short-lived, especially if we compare with the classical surgical one. Natural aging slows down only for a couple of years, and after 1.5-2 years the procedure will have to be repeated, or a replacement should be sought with a more prolonged result. The procedure is as follows:

  1. Doctor does face markup.
  2. An even layer of a special gel is applied on top, with which the passage of ultrasound will be more accurate.
  3. The main stage of work is the operation of the device with different nozzles: often use 2-3 sensors and affect only 2 layers of tissue. First, the doctor will treat one half of the face so that the patient can see the difference. After that, an impact will be made on another.
  4. At the final stage, the gel used for the apparatus is washed off, and the treated areas are lubricated with a cream designed to soothe the skin.

SMAS lifting with Doublo

There are only 3 methods of SMAS-lifting – classical, endoscopic and ultrasound, but the latter has several varieties that differ among themselves with the equipment used in the work. The Korean Doublo device replaced the older Ulthera, which was described by patients as causing a very painful sensation (even taking into account application pain relief). Among the advantages are mentioned:

  • increased radiation power, due to which the severity of the result of the tightening is higher;
  • the image displayed on the monitor is colored by Doublo, which gives the specialist a more complete understanding of the thickness of the affected tissues.

The last nuance makes it possible to assess the response of tissues to each ultrasonic wave, which makes the facelift process more accurate, reduces the risk of the resulting asymmetry. The general algorithm of the SMAC lifting procedure is the same for all ultrasound devices:

  1. Cosmetics removed from the skin.
  2. Anesthetic gel is applied.
  3. 30 minutes later antiseptic is used and marking is applied.
  4. The face is treated with a special gel-conductor.
  5. A point effect is made on 2 layers of soft tissues (depth – up to 4.5 mm) using 2-3 sensors on each half of the face separately. If the patient complains of severe burning, the power of the waves is reduced.
  6. After the main stage is completed (this is 35-40 minutes), the remaining gel is removed, the skin is moisturized with a cream.

How to care for your skin after SMAS lifting

After the classic tightening, the patient spends 2 weeks in a hospital. The first 3 days (according to the doctor’s decision – longer) you will need to wear a support bandage, and the seams will be removed only at discharge. During the rehabilitation period, which lasts 2 months, you will have to take care of your skin, give up alcohol, avoid a sauna, bathhouse, and do not smoke. You can’t go to the solarium either, but the shower is not too hot. The main nuances of recovery:

  • daily application of cooling compresses to help absorb hematomas and relieve swelling;
  • take antibiotics to prevent the development of infection;
  • avoid situations when the head falls below body level (tissue swelling can be provoked) and intense physical exertion;
  • attend physiotherapeutic procedures aimed at reducing the skin;
  • sign up for an endermological massage..

After non-surgical procedures, it is easier to take care of the skin, since antibiotics are not needed, additional anesthesia (by oral drugs) is not required for the healing time of the tissues. 2 weeks after SMAS lifting you need:

  • Do not use makeup;
  • Do not visit the solarium;
  • do not wash with warm water;
  • apply cream with a high SPF factor when going out.

Endermological facial massage

How long does the effect last?

The longest result is the classical surgical SMAS facelift – it can last from 10 to 15 years, and even after the expiration of the period, a woman will have a younger look than her peers. After performing the ultrasound technique, the effect lasts 1-4 years, and after endoscopic – up to 5 years. After that, you will have to adjust the face with a second session, if you do not want to return to the swollen contour. However, together with non-surgical SMAS lifting, you can do additional procedures:

  • blepharoplasty;
  • eyebrow lift;
  • own plasma injections;
  • thread lift;
  • botulinum toxin injections;
  • the use of fillers for contour plastics;
  • mesotherapy, biorevitalization, microdermabrasion.


If the patient does not have a tendency for active growth of connective tissue, and the cosmetologist is highly qualified, there will be a minimum number of problems even after performing surgical SMAC lifting. The skin may swell, but it will pass in a couple of days, turn red, which also quickly eliminates itself. More dangerous complications are characteristic of the classical technique:

  • the appearance of bruises, bruising, bruising;
  • infection
  • scarring;
  • tissue necrosis;
  • suppuration of sutures;
  • damage to the facial nerve (innervation);
  • hair loss in the suture area.

Side effects

With non-invasive techniques, if the patient notifies the cosmetologist about unpleasant sensations during the session, part of the adverse reactions – edema, redness – can be avoided. However, in how much and with what intensity they will appear, depends on the individual characteristics of the organism, the work of a specialist. The most common reactions to SMAS lifting are:

  • facial redness – local or over the entire area (in patients with thin skin);
  • decreased sensitivity of the skin;
  • numbness of certain areas – lasts about a week;
  • soreness of the epidermis (especially in the area of ​​the eyes, lips), manifested when touched – persists for up to a month;
  • headache;
  • skin rash in areas disturbed by the device.


Classical (surgical) and hardware facelift are not without drawbacks, they are forbidden to carry out during pregnancy and in patients over 65 years old – this is due to the deterioration of the regenerative qualities of the body, which increases the rehabilitation period after lifting and increases the risk of complications. The upper age limit is determined individually – in some methods of SMAS lifting it is lowered even up to 50 years. SMAC lifting is also not recommended for:

  • diabetes mellitus;
  • the presence of any chronic diseases, especially the cardiovascular system;
  • oncology;
  • blood diseases;
  • a tendency to scarring the skin;
  • epilepsy and other disorders of the central nervous system;
  • purulent skin diseases;
  • wearing metal implants (dental contraindications are not), pacemaker.

Girl and doctor


The cost of SMAS lifting in Moscow is determined by the methodology by which it is performed, the level of the clinic and specialist, the affected area and the amount of work. The lower limit is 30,000 p., But often a woman such a procedure costs 80,000-150,000 p. An approximate price pattern for different methods and zones:






300 000 r.

190 000 r.

77 000 r.

Submandibular zone

235 000 r.

210 000 r.

45000 r.

Full face (with submandibular area)

430 000 r.

270 000 r.

175000 r.

Photos before and after SMAS lifting

Photo of a woman before and after SMAS lifting

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