Face-lifting and SMAS

SMAS is an acronym which, when used in the context of the aesthetic industry, stands for: Superficial Muscular Aponeurotic System. Aponeurotic is defined as “A sheet-like fibrous membrane, resembling a flattened tendon that serves as a fascia to bind muscles together or as a means of connecting muscle to bone.” (The Free Dictionary).

The SMAS is one of the connected tissue layers in the face that is manipulated during certain types of surgical face lifts. It is targeted by the plastic surgeons when performing a surgical face lift that affects the cheek and jowls, as well as the upper facial areas around the eyes and forehead.

There is much controversy when it comes to the anatomical outline of the SMAS layer. However, a recent publication by Holger G. Gassner, MD; Amir Rafii, MD  et al, ( ) sheds light on the structure and anatomy of the SMAS, and aids in further understanding its effect in surgical face lift and anti-ageing procedures. This publication reveals that there is a variation between different people with regards to the SMAS boundaries and their connection to certain facial muscles, but in general the SMAS layer has minimal variations between individuals in the jaw and the forehead area.

According to Holger et. al. ”the SMAS should be regarded as a facial muscle that does not extend into the midface, but rather connects with the zygomatici and levator labii superioris alaeque nasi muscles to form a functional unit and discontinuous muscle plate with these structures.”

The SMAS consists of collagen fibers, elastin fibers, and fat cells. In certain facial areas there is no clear separation between the muscles and the SMAS. The mesh of SMAS acts as a layer that distributes the force of the different facial muscles and is an important factor in face expressions.

In addition to surgical face lifts that target the SMAS layer, the SMAS is also targeted by non-invasive anti-ageing practices, which are alternatives to face lifts. One of the devices deployed for improving the appearance of sagging jowls by using a non-invasive approach is the recently launched Maximus device.

The Maximus device uses the TriLipo technology which combines Radio Frequency (RF) and Dynamic Muscle Activation for targeting the skin, the SMAS and the facial muscles. The RF affects the dermis by generating heat in the treated area. This heat induces tightening of the existing collagen, leading to an immediate effect of skin tightening along with a long-term effect of generation of new collagen, thereby thickening the dermis and inducing reduction in the appearance of wrinkles.

The Dynamic Muscle Activation stage of the Maximus anti-aging face treatment causes stimulation of the face muscles, thereby increasing circulation in the SMAS and facial muscles layer and improving facial muscle tone, resulting in a non-invasive lift of the jowls and cheek area. Treatments with the Maximus device can provide a pleasant, safe, non-invasive alternative to surgical face lift with no down time and no risk. The Maximus device is ideal for women and men and results can be noticeable immediately after the first treatment.