SMAS refers to the superficial muscular aponeurotic system. This is a connective tissue layer superficial to the muscles but deep to the subcutaneous fat layer. When a high SMAS extended facelift is performed, the SMAS is released at or above the malar eminence and extended across the cheek region just past the region of the zygomaticus major muscle. This allows for elevation of the malar fat pad and enhancement of the cheek region. The soft tissue can be suspended in a superolateral vector and even imbricated to augment the cheek region. This is a very versatile procedure and I use it quite often on my patients.