SMAS Facelift – Comparing a Level I, II, and III Reflection Lift

Collection of Reflection facelift before and after photos in Nashville

Dr. Boggess is not a believer in a ‘one-procedure-fits-all’ approach to facial rejuvenation, recognizing that every patient is unique in their anatomy and the effects of aging. Having performed over 3,500 facelift procedures at his Nashville practice, he has developed techniques that optimize results for all of his patients.

What happens in a Reflection Lift facelift?

Dr. Boggess tailors every procedure to each patient’s individual anatomy, concerns, and goals for exceptional, natural-looking results. The Reflection Lift uses his unique approach for lifting and securing the SMAS, the superficial muscular aponeurotic system (which is a layer of tissue deep to the skin and subcutaneous tissue) and the platysma (which is the muscle that extends from the collarbone to the angle of the jaw). Learn more about the Reflection Lift’s benefits in our related blog post.

Performed in an office-based setting using light sedation and local anesthesia, the Reflection Lift eliminates the risks and costs associated with general anesthesia. It is a conservative approach that results in reduced risk of complications and faster recovery compared to traditional facelift surgery.

Most patients show no visibly apparent signs of surgery within 1 to 2 weeks, though patients should allow at least 3 to 4 weeks before any important events.

Reflection Lift Levels

Each Reflection Lift level addresses the individual patient’s needs:

Level I Reflection Lift

This is a conservative SMAS facelift approach for younger patients.  It is intended to address mild to moderate sagging in the jowls and mild sagging in the neck. The SMAS is a web of fascia that encompasses the muscles and fat in the face. This fascial layer is continuous with the platysma muscle in the neck. All properly performed facelift procedures involve some technique for lifting the SMAS to restore a youthful contour to the jawline and neck.

Level II Reflection Lift

This procedure involves a SMAS facelift in combination with liposculpting of the jawline and neck.  It is indicated for moderate sagging in the jowls and mild to moderate sagging in the neck with an accumulation of fat along the jawline and neck. You can see an example of a Level II Reflection Lift in our patient’s before and after pictures below:

Level III Reflection Lift

This procedure is a more aggressive facelift approach for patients that involves a more aggressive mobilization of the SMAS, in combination with tightening of the platysma muscle in the midline of the neck and liposculpting of the face and neck.  It is indicated for moderate to severe sagging in the jowls and neck with associated laxity or banding of the platysma muscle in the front of the neck.

Many men and women who opt for a Level III Reflection Lift often have signs of aging on the upper face and choose to enhance their facelift results with other procedures such as:

Below are two patients before and after Level III Reflection Lifts:

If you’re considering a facelift and want a customized, personalized approach that addresses your unique concerns and goals from an experienced facial plastic surgeon in Nashville, contact us at Youthful Reflections today to schedule your complimentary consultation with Dr. Boggess.

Originally published May 2018; Updated October 2021

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