The SMAS lift is a safe procedure that can be performed in the office under a special type of local anesthesia, called tumescent anesthesia. After carefully examining the areas with skin excess and planning the incisions, a very dilute mixture of local anesthesia is used to inflate the skin.  This provides excellent anesthesia as well helps separate the skin from the underlying SMAS. Another added benefit of this method is that the anesthesia fluid helps constrict the superficial blood vessels, so that the surgery can be performed almost bloodlessly.  The incisions are made and the skin is separated from the SMAS. The SMAS is resuspended to the upper cheekbone area and a strong fibrous layer behind the ear with strong absorbable suture.  The skin is re-draped without tension and carefully trimmed along the planned incision lines that hide naturally in the creases that surround the ear. The skin is carefully sutured with self-absorbing suture and dressing are applied.