A female patient being marked by surgeon before her facial plastic surgery

SMAS Facelift: Submuscular Aponeurotic System

Getting a SMAS facelift in New York, NY

There are many types of facelift procedures performed and they are not created equally or create the same results. The SMAS is the muscle of the face that drops with age. Ithas the scientific name superficial (S) musculo (M) aponeurotic (A) system (S). Loose, aging SMAS causes lower face and jawline laxity, forming jowls, marionette lines, and nasolabial folds over time.

SMAS Facelift New York – 59 Year old female patient of Dr. Jacono discusses her SMAS facelift procedure and her results.

SMAS Facelift – Extended SMAS Facelift – New York SMAS Facelift – Natural Facelift Results – SMAS Facelift Before and After

Facelift techniques generally lift the skin of the face. However, how the SMAS muscles under the facial skin are treated differs. A SMAS facelift creates natural facelift results that appear smooth and natural and not “plastic” as will be described below. Everyone who considers a facelift wants to look younger but does not want to like they had a facelift. This can be avoided with the SMAS facelift technique.

SMAS Anatomy

SMAS is an acronym for the superficial musculoaponeurotic system. A layer of fibrous tissues and muscles that start in front of the ear extending down to the neck.

This layer is thin but robust, connecting facial, midface, and neck muscles as continuous fibromuscular tissue. It encompasses muscles, fat, and the cheek, attaching to the lower face muscle (platysma).

The platysma muscle in the neck creates vertical muscle bands in the neck and “turkey neck” as we age. This fibrous layer is then concealed below a layer of fat (adipose tissue) and skin. The purpose of the SMAS is to ensure that they are positioned normally. In order to mimic muscles, which are important for the expressions of the face,

What are the Differences Between SMAS and Deep Plane Facelifts?

SMAS facelifts and deep plane facelifts are similar in that they work on the lower two-thirds, approximately. They both address sagging skin, fat, and jowls, but there are differences between the two. For one, the deep plane facelift also treats the neck, which the SMAS doesn’t. However, the SMAS is a less invasive facelift. Many people say that the effects of a SMAS facelift look more natural than a traditional facelift.

New York Center for Facial Plastic Surgery

Schedule a consultation

Schedule today
New York Center for Facial Plastic Surgery

What Does An SMAS Facelift Cost?

The cost of SMAS layer facial plastic surgery varies depending on the person. Including the specific needs they have for their facelift, and the expertise of the surgeon. The national average cost for a SMAS facelift can vary from state to state. Determine the cost of your surgery, it’s best to consult directly with Dr. Jacono. He can advise you on your surgical path to ensure the very best results.

Bear in mind that what you’re spending on the facelift is a direct investment in yourself and your self-confidence. Also, remember that board-certified plastic surgeon Dr. Jacono is one of the top facial plastic surgeons in his field. He will perform an expert-level surgical procedure.

SMAS Plication Facelift, Extended SMAS Facelift, and High SMAS Facelift Techniques

There are three main types of SMAS facelift treatments. A SMAS plication facelift, an Extended SMAS Facelift, and High SMAS Facelift Techniques. In traditional face-lifting, the skin is lifted but the underlying SMAS is not lifted or supported. This can create an unnatural tight stretched appearance on the face. Often distorting the corners of the mouth (often referred to as a puppet mouth). This is prevented by supporting the SMAS layers to obtain the most natural results.

low smas facelift and high smas facelift

Low SMAS Facelift and High SMAS Facelift

SMAS Plication facelift lifts the SMAS by placing sutures in the SMAS layer that creates the jowls. And the platysma which creates the drooping neck to tighten them. This is a simple procedure, but the suturing technique does not last as long, often creating results that last only 2 or three years. While most surgeons can execute this procedure, Dr. Jacono does not suggest it. He believes facelifts should last 10 years or more, and this can be accomplished by lifting the SMAS.

Low SMAS Facelift and High SMAS Facelift

Extended SMAS Facelift and High SMAS Facelift Techniques do not simply suture the SMAS up but lift the SMAS and platysma muscle. A muscle “flap” is created, lifting the muscle off the structure of the face, and smoothing it out.

Because extra SMAS is created as we age, the redundant excess is removed and then it is secured higher in the face from which it dropped. This is a true structural re-engineering of the face that re-supports the beams of the face that weaken with age. This is why the results have greater longevity.

This supports the deeper layers of SMAS in both the Extended SMAS and High SMAS facelift, but they differ in that the Extended SMAS technique targets the jawline and neck, while the High SMAS technique can lift the cheeks that droop as well as the jowls and neck because the layers of SMAS in the upper face is also lifted. 

The Upper Face and Cheek SMAS are the “High SMAS”. Depending on what portion of your face has aged Dr. Jacono will suggest the Extended SMAS or High SMAS approach.

Some characteristics of a SMAS Facelift include:

  • Surgery time lasts 1½ to 2 hours long
  • Vertical lifting of the face and neck by repositioning the SMAS
  • Removal of Jowls, and Drooping/Turkey Neck
  • Youthful and Natural-looking results
  • Removal of deep wrinkles with long-lasting results
  • Safe procedure with very few complications

SMAS Facelift Recovery

Dr. Jacono, an expert SMAS facelift doctor, usually performs the SMAS facelift under local anesthesia or a twilight anesthetic (sedation) without general anesthesia. You will be asleep for the procedure and will not feel anything but you will not have the additional risks associated with general anesthesia. The SMAS procedure should last approximately 1 ½ hours long. Post-surgery, the majority of patients return home the same day of the procedure.

Patients will need to wear a bandage around their face for a full day and their heads should be elevated with three pillows when sleeping. During a visit on the following day with Dr. Jacono and his staff, they will ensure that everything is looking perfect and healing properly. At that time, the bandages will be removed and some bruising and swelling will be seen.

In general, patients should be able to return to work within one to two weeks following their procedure. There will still be some swelling and bruising but nothing that should prevent patients from returning to work and most normal activities.

For SMAS facelift recovery photos, ask your nurse or Dr. Jacono, and he can show you the kind of bruising and swelling you can expect in your face.

SMAS Facelift Candidate

Men and women who are showing signs of aging with droopy, sagging facial skin are typically good candidates for the SMAS Facelift procedure. It is best that candidates are in good health and do not have any medical conditions that impair the healing process. Patients should have realistic expectations of the surgical outcome and a positive attitude. For best results, Dr. Jacono recommends that patients are non-smokers and should let them know any medications they may be taking.

To learn more about this procedure or to schedule your SMAS Facelift consultation with Dr. Jacono call 212-570-2500 in NYC or 516-773-4646 on Long Island.

SMAS Facelift Before and After Photos


SMAS Facelift Before and After – Patient 1:

Dr. Andrew Jacono performed a SMAS facelift, neck lift, platysmaplasty, lateral temporal lift, fat grafting, and blepharoplasty on a 56-year-old woman who is a successful attorney. She was concerned about looking unnatural after the procedure, but wanted to address her drooping jawline, jowls, sagging cheeks, platysma bands, and tired-looking eyes. Two months after the facelift, the woman’s appearance has been rejuvenated and she looks 15 years younger, while still looking like herself. Her friends and family are amazed at the results.

Before & After
Best SMAS Facelift Results Sideview
Before & After
Best SMAS Facelift Front View


SMAS Facelift Before and After – Patient 2:

Dr. Andrew Jacono performed a SMAS facelift, neck lift, platysmaplasty, and fat grafting on a 62-year-old woman who was unhappy with her turkey neck, platysma bands, dropping jawline, jowls, fallen cheeks, and tired eyes.

Only five weeks after the surgery, her new jawline is noticeably defined. The incisions have almost healed and are barely visible when her hair is pulled back, thanks to the incorporation of hyperbaric oxygen treatments that expedited the healing process.

Dr. Jacono’s extended facelift technique effectively lifted the deep musculature, providing support for the skin and avoiding a tight appearance on the face, cheeks, and jowls. This facelift created a platysma muscle flap known as the “platysma hammock,” resulting in long-lasting neck lifts. To address her lipstick bleed lines, Dr. Jacono added Nanofat fat grafting. The woman’s refreshed appearance makes her look at least 15 years younger.

Before & After
SMAS Facelift Before and After on 62 Year Old
Before & After
SMAS Facelift Before And After Front View


SMAS Facelift Before and After – Patient 3:

This stunning 54-year-old patient underwent facial plastic surgery with Dr. Andrew Jacono, resulting in a balanced and youthful appearance just three months post-surgery. Her concerns regarding a dropping jawline, jowls, fallen cheeks, and platysma bands were addressed through multiple procedures targeting the upper, middle, and lower thirds of her face.

A SMAS facelift, neck lift, and platysmaplasty were performed to recreate her jawline and define her neck, with his facelifting approach utilized to avoid a pulled or tight appearance. Additionally, a lateral temporal lift was performed to address fallen brows, while a lower blepharoplasty targeted eye bags and excess eyelid wrinkles.

To balance the face, a hairline lowering procedure was also completed to shorten her forehead and treat her receding hairline.

Before & After
SMAS Facelift Before and After Side View
Before & After
SMAS Facelift Before and After 54 Year Old Patient


SMAS Facelift Before and After – Patient 4:

This beautiful woman wanted to look refreshed and younger without looking fake or plastic. Dr. Jacono performed a SMAS facelift which included his signature SMAS facelift to lift her drooping cheeks, nasolabial folds, and early signs of jowling. He also performed a lower eyelid lift with a temporal lift which opened up her eyes.

To complete the overall natural rejuvenation, Dr. Jacono also performed a closed rhinoplasty to address her dropping nasal tip and the hump on her nasal bridge.

You can see in her after photos how balanced her facial appearance is. She looks natural and years younger. Best of all, with her hair pulled back, there are no visible scars. She loves her new look and feels like she is back in her twenties.

Before & After
best smas facelift before after photos
Before & After
best smas facelift nyc photos


SMAS Facelift Before and After – Patient 5:

This patient wanted to refresh her appearance while looking natural and younger. Dr. Jacono performed a SMAS facelift and a lower blepharoplasty to address her concerns.

Dr. Jacono also repositioned the lower eye bags to reduce the appearance of her dark eye circles. Her after photos show her cheeks have been lifted to reverse the drooping effect and the hollows under her eyes were smooth and filled. She looks natural and decades younger.

Before & After
SMAS Facelift Before and After Sideview
Before & After
SMAS Facelift Before and After Front View


SMAS Facelift Before and After – Patient 6:

This wonderful patient was worried about her dropping jawline, visible jowls, fallen cheeks, platysmabands, and tired eyes. To reverse these signs of aging, I performed a SMAS facelift, necklift with platysmaplasty, an upper and lower eye lift, and a lip lift. I love how crisp and defined her jawline is and her jowls are gone. I think she looks at least 15 years younger.

Before & After
SMAS Facelift and Necklift Before and After
Before & After
Best SMAS Facelift NYC


SMAS Facelift Before and After – Patient 7:

This beautiful woman is looking 20 years younger after I performed her SMAS facelift procedure. To complete the overall facial rejuvenation process, I also performed a necklift, lateral temporal lift, lip lift, and closed rhinoplasty with tip plasty. She is such an amazing person and I am thankful that she trusted me with her face.

Before & After
Best SMAS Facelift Looking 20 Years Younger
Before & After
SMAS Facelift Results


SMAS Facelift Before and After – Patient 8:

This middle-aged woman was unhappy with her saggy neck, jawline, and cheek area. She elected to have a SMAS facelift with Dr. Jacono to correct those problem areas. Her after photos show a more youthful appearance with a tighter jawline, smoother neck, and fuller cheeks.

Before & After
New York SMAS Facelift Before and After
Before & After
new york smas facelift photos


SMAS Facelift Before and After – Patient 9:

This female patient was unhappy with her jowls and wrinkled sagging neck. Dr. Jacono performed a SMAS facelift on her and the after photos show a defined jawline with a wrinkle-free and tighter neck.

Before & After
SMAS facelift patient Side view before & after
Before & After
SMAS facelift patient photos with tightened neck


SMAS Facelift Before and After – Patient 10:

This lovely woman wanted to reverse the signs of aging that had caused her cheeks to drop and her jowls to begin to bulge. She also was unhappy with the loose skin under her neck that was hanging there.

Dr. Jacono performed a SMAS face lift to correct these issues. You can see in her after photos that her cheeks have been lifted to their natural position and her smooth jawline. You can see that her wrinkles are virtually all gone and her neckline looks amazing. She is very happy with her results and feels like she did 15 years ago.

Before & After
SMAS Facelift Before and After Sideview
Before & After
SMAS Facelift Before and After


SMAS Facelift Before and After – Patient 11:

This wonderful lady was concerned with how the effects of aging were making her look. She did not like her sagging cheeks and her very visible jowls. She also did not like the sagging skin on her neck which showed a lot of wrinkles.

A SMAS face lift procedure was performed by Dr. Andrew Jacono to address all of her concerns. Her after photos shows that her neckline is smooth and looks great, while her drooping cheeks were lifted and her jawline looks smooth with no jowling.

Before & After
SMAS Facelift Before and After Side View
Before & After
smas facelift before and after


SMAS Facelift Before and After – Patient 12:

This patient did not like her sagging double chin and fatty jowls. She decided to have Dr. Jacono perform a SMAS facelift on her trouble areas and the after photos show a more youthful appearance with a defined jawline.

Before & After
SMAS Facelift Results with Defined Jawline
Before & After
SMAS Facelift Before and After with Corrected Double Chin


More SMAS Face Lift Photos

New York Center for Facial Plastic Surgery

Schedule a consultation


Schedule today

Accessibility: If you are vision-impaired or have some other impairment covered by the Americans with Disabilities Act or a similar law, and you wish to discuss potential accommodations related to using this website, please contact our Accessibility Manager at (212) 570-2500 .