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SMAS facelift technique provides natural look that lasts


The skin of the cheek and anterior neck is made up of an interconnected three-layer unit.

Chicago - For John Owsley, M.D., the key to a successful, long-lasting facelift lies in the underlying anatomical details of the face.

Dr. Owsley, an aesthetic plastic surgeon who practices in San Francisco and is clinical professor of plastic surgery at the University of California, San Francisco, pioneered the SMAS-platysma multi-vector facelift and malar fat pad lift technique. He discussed these procedures at Plastic Surgery 2005, a conference sponsored by the American Society of Plastic Surgeons.

"The focus of my presentation is the details of the anatomy of the SMAS layers and malar fat pads and how they change with aging," Dr. Owsley says.


Dr. Owsley tells Dermatology Times that the skin of the cheek and anterior neck is made up of an interconnected three-layer unit. This facial skin unit is comprised of the superficial epidermal-dermal layer, the underlying subcutaneous fat, and a membrane composed of fibro-elastic connective tissue and muscle.

This is the superficial musculoaponeurotic system, or SMAS, and it has multiple fibrous extensions that attach through the subcutaneous fat to the superficial epidermal-dermal portion of the skin, which causes the three layers to move together as a unit. The SMAS attachment to the epidermal-dermal layer is visible at the nasolabial crease.


In the neck, the SMAS membrane incorporates the platysma muscle, which extends from the lower jaw area to the collarbone. The platysma functions in certain expressive movements involving the lower face and neck.

Constant contraction of the platysma muscle produces neck cords, which with aging can gradually create persistent vertical folds of skin beneath the chin and on the upper anterior neck.


As facial skin ages, it loses its elasticity, as does the SMAS membrane. Gravity produces sagging of the cheek skin along the jaw, creating fleshy jowls, and often a double chin develops due to the drooping of the fatty portion of the lax skin unit along the anterior and lateral jaw area.

"Sagging of the subcutaneous fat and the gliding SMAS membrane contributes as much to the appearance of facial aging as the loss of elasticity in the superficial epidermal-dermal layer," Dr. Owsley says.

"Older facelift techniques pay more attention to the skin without repositioning all of the underlying muscles, facial fat and so on, so that when the skin is finally closed after a procedure, all the tension is on the skin and thus you get that tight look that indicates you've had a facelift.

"If the SMAS and malar fat pads are repositioned appropriately, that's where the tension should be, and then the skin can be draped over them and a more natural look is obtained."

Dr. Owsley says that follow-up observation indicates that the benefits of this surgery can last 10 to 15 years - significantly longer than the traditional facelift. And there's another benefit, he says.

"I've found that since this operation offers natural-looking results, we can offer it to patients at a younger age - say, the mid-40s as a maintenance facelift - so that a 45-to 50-year-old can look like they're in their mid-30s," Dr. Owsley says.

"When that 45 or 50 year-old gets to the age of 60, they still look like they're middle-aged, and then we can redo a maintenance procedure if required. What we can achieve is a subtle, rather than a radical change in their appearance and a prolonged period of youthful appearance."

Dr. Owsley says the SMAS-platysma facelift and malar fat pad lift technique attain what he considers the chief goals for a facelift.

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