The article below is a condensed version of Jolene Edgar’s “The SMAS Facelift is Having a Moment,” which originally ran on the reporter’s Substack, Aesthetics Unfiltered.
Last week, Page Six reported that “Dr. Steven Levine did Kris Jenner’s recent work,” amplifying the frenzy around the star’s newly refreshed face. (Known among his peers for eschewing the spotlight, Dr. Levine is a board-certified plastic surgeon in New York City, who has essentially become social media-famous against his will. When Allure called his practice to ask for a comment on Jenner, we were politely told that he would “definitely not” be giving us any quotes.)
According to Page Six, “a rep for Jenner” confirmed the surgeon’s identity. Reading this, I was, at first, dubious, because in what world does a celebrity’s rep even acknowledge plastic surgery rumors, never mind disclose private medical information? Whether this was a generous act of transparency on Jenner’s part or a strategic move to control the narrative, the field of plastics seems to have fully accepted the Page Six report as truth. (People followed up with its own article naming Dr. Levine as Jenner’s surgeon.)
Presuming the report is credible, Jenner almost definitely did not have a deep plane facelift, as many on social media have suggested, but rather, a traditional SMAS facelift—Dr. Levine’s specialty. (The target of every modern facelift, the SMAS, or superficial musculoaponeurotic system, is a fibrous layer of connective tissue that envelops the muscles of the face.) While there are several iterations of SMAS lifts and each addresses the SMAS in its own way, Dr. Levine reportedly performs a lateral SMASectomy—removing a strip of the SMAS before suturing the edges back together—in combination with a deep neck lift, which debulks the anatomy underneath the platysma by sculpting fat pads, salivary glands, and digastric muscles (these are small muscles in the neck that aid in chewing and talking).
In recent years, much of the facelift hype on social media has revolved around the deep plane facelift, with the SMAS lift receiving little airtime. (When it is mentioned, it’s frequently being compared unfavorably—and unfairly, some say—to the deep plane approach.) In reality, however, the majority of American plastic surgeons perform some version of an SMAS lift.
Elizabeth Chance, MD, a double board-certified facial plastic surgeon in Charlottesville, recently filmed a series of educational Instagram stories explaining the key differences between Dr. Levine’s SMAS lift—which she says “garnered really beautiful results” for Jenner—and the extended deep plane facelift that she performs.
Dr. Chance highlights that for someone who has “repeated low-duration facelifts”—and Jenner has reportedly had multiple facelifts over the years (one was included on an episode of Keeping Up With the Kardashians)—the subcutaneous fat of the neck, which provides a cushion between the skin and the muscle, gets thinner and thinner with every intervention, exposing the dynamic platysma as well as any internal scarring left by previous surgery. What does she mean by “low duration”? In her experience, the results of traditional SMAS lifts tend to “start to fade or fall at 3, 4, 5 years out.”
Generalizing SMAS lifts—like the one Jenner likely had—is tricky, because they exist on a broad spectrum. We can divide SMAS facelifts into two main categories, says Pierce Janssen, MD, an aesthetic plastic surgery fellow at the Cleveland Clinic. There are the extended SMAS techniques—which, like deep plane lifts, dissect under the muscle (“sub-SMAS”) and fully release the facial ligaments that tether soft tissue to bone. And there are SMAS procedures that do not go under the muscle or touch the ligaments (these include the SMASectomy and SMAS plication, which involves folding and stitching the SMAS). All methods can yield good results, notes Dr. Janssen, when performed by well-trained, experienced surgeons.
“Any good facelift—and there are many good types—involves opening the skin and doing something to the SMAS,” says Dino Elyassnia, MD, a board-certified plastic surgeon in San Francisco. In his opinion, “treating the SMAS and diverting tension away from the skin is the hallmark of a good facelift.” What’s more, he reminds me, “there is no single study that has ever been published that says a deep plane facelift looks better or lasts longer [than a SMAS lift]. There’s zero data. When surgeons did compare techniques back in the old days—I’m thinking of the twin study from the ’90s, where the big facelift leaders from that time each did a different procedure—the results all basically looked the same.”