Why Midface SMAS Lifting Is Needed During Lower Blepharoplasty

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The patient’s pre- and post-operative photos were used with consent.

What is the SMAS layer?

SMAS stands for Superficial Musculo-Aponeurotic System, and it refers to the thin fascial layer located just beneath the skin of the face.

As a connective tissue and muscle layer that links the skin, subcutaneous fat layer, and facial muscles, it surrounds the entire face and supports the expression muscles and skin.

Located in the midface areas of the face such as the cheeks, jawline, and lower eyelids, it acts as a support structure that allows the expression muscles and skin to move together.

As elasticity decreases with age, sagging in the cheeks, under-eye area, and wrinkles appear, and this SMAS muscle layer also sags. During lower blepharoplasty, pulling and securing this muscle can help prevent ectropion and provide a lifting effect.

Below is a photo comparing the midface area after lower blepharoplasty.

Why Midface SMAS Lifting Is Needed During Lower Blepharoplasty

1. Prevention of ectropion

When many people think of lower blepharoplasty (under-eye surgery), they imagine only removing or repositioning the fat under the eyes.

However, when the skin is incised, a downward pulling force acts due to gravity. In particular, when skin with many wrinkles must be removed, this downward force can cause side effects such as ectropion.

Therefore, lifting the midface (SMAS layer) is necessary, and by pulling it and fixing it to the periosteum, ectropion can be prevented.

2. Prevention of sagging and improvement of under-eye hollowness

If the midface SMAS layer is lifted and secured, it can support the under-eye area from below and help prevent sagging.

When the midface sags, the under-eye hollowness and tear trough become more pronounced.

SMAS layer lifting raises the entire tissue connecting the under-eye area and the cheeks, creating a natural and smooth contour.

3. Restoring a youthful overall face

The midface SMAS layer affects not only the under-eye area but also cheek sagging and nasolabial folds.

By supporting the lower face through lifting, the under-eye area and cheeks can give a harmoniously more youthful appearance.

Points to consider during lower blepharoplasty

Not all wrinkles can be smoothed out like ironing fabric. If sagging skin is removed or pulled too aggressively, side effects will naturally occur. In addition, for the overall balance of the face, making only the under-eye area tight may actually look unnatural. A certain amount of fine wrinkles is something that should be generously accepted for the sake of overall naturalness.

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#DarkCircleImprovement #PreventionOfUnderEyeSagging #CheekSaggingImprovement #NasolabialFoldImprovement #LookingYounger

#AntiAging #NaturalLifting #MidfaceRestoration

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