The SMAS face-lift is a term that has become familiar to those looking into plastic surgery. SMAS refers to the superficial musculoaponeurotic system. The skin on the face is composed of the superficial layers of skin, both the top and lower layer as well as the underlying layer of fat. Beneath the skin, fat, and muscle is a gliding membrane composed partly of connective tissue and partly of muscle. This gliding tissue is the SMAS, which is responsible for our ability to have facial expressions. Realigning this structure is considered a valid option for re-creating a youthful appearance for the face. However, when you cut under the muscle layer you can negatively affect nerve endings, and that is the major risk of this procedure. However, if you pulled only the top layer of skin and the fat layer, the muscle layer (which also sags and causes an aged appearance to the face) would not be corrected. Many surgeons feel that addressing the SMAS layer of skin, along with other procedures, is necessary to avoid giving a flat or unnatural appearance to the face. (Sources: Facial and Plastic Surgery, March 2000, pages 215-229; and Plastic and Reconstructive Surgery, 2000, volume 105, pages 290-301.)
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