Facelift
Body area: face
Overview
The SMAS (Superficial Musculoaponeurotic System) facelift is a widely used and well-established facelift technique. The SMAS is a layer of organized connective tissue and muscle that lies beneath the skin and subcutaneous fat, covering the deeper facial structures. By tightening this layer — through plication (folding), imbrication (overlapping), or partial elevation — the surgeon creates a structural foundation for the lift, producing more natural and longer-lasting results than older skin-only techniques.
Who is it for?
Patients in their 40s to 60s with mild to moderate facial aging, early jowl formation, and loss of facial definition who want reliable rejuvenation with a well-established technique.
Technique overview
After making incisions around the ears, the surgeon identifies the SMAS layer and tightens it through plication (folding the tissue onto itself), imbrication (overlapping and securing), or a lateral SMASectomy (excising a strip and re-approximating). The skin is then redraped over the tightened structural foundation without excessive tension.
What this procedure cannot do
A SMAS facelift tightens and repositions the lower face, but on its own it does not address volume loss in the cheeks or temples, fine surface wrinkles, sun damage, brow descent, hooded upper eyelids, or significant neck banding. Patients with those concerns usually need a combination — fat grafting or filler for volume, a brow lift or blepharoplasty for the upper face, and a formal neck lift or platysmaplasty if banding is significant. The procedure also will not change underlying skeletal structure or correct severe skin laxity in patients who have lost a lot of weight.
Scars and incisions
Incisions are placed in the temporal scalp, hugged in front of the ear (often along the tragal edge), under the earlobe, and continued behind the ear into the hairline. A small submental incision is added when liposuction or platysma work is performed. Mature scars are typically thin, pale, and hidden by hair and natural ear contours; they can stay slightly pink and firm for 3–6 months and continue refining for up to a year.
Recovery
Most patients return to regular activities within 2 weeks. Bruising fades within 10 to 14 days. Final results become apparent at 3 to 6 months.
Longevity of results
A SMAS facelift typically holds for 7–12 years, with most patients describing a 7–10 year reset. Aging continues normally afterward — gravity, volume loss, and skin changes don't stop — but the lifted starting point usually means patients still look younger than they would have without the procedure. Maintenance with skincare, sun protection, and occasional non-surgical treatments can extend the visible benefit.
Typical price range
$10,000 - $30,000
Common goals
- Reduce jowl appearance
- Tighten and rejuvenate the lower face
- Improve jawline definition
- Smooth moderate facial wrinkles
Risks
- Hematoma
- Nerve damage
- Infection
- Visible scarring
- Skin necrosis
- Hair loss near incisions
How to choose a surgeon
Choose a surgeon board-certified by the American Board of Plastic Surgery (ABPS) or the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) who performs facelifts as a core part of their practice rather than occasionally. Ask which SMAS technique they prefer for your anatomy (plication, imbrication, or SMASectomy) and why. Review their own before-and-after photos at 6+ months post-op. Operating-room location, board-certified anesthesia provider, and accredited facility are all reasonable to ask about.
Frequently asked questions
How is a SMAS facelift different from a deep plane facelift?
Both techniques tighten the SMAS layer, but they work in different anatomical planes. A SMAS facelift tightens the SMAS as a separate step (folding, overlapping, or excising it) and then redrapes skin over it. A deep plane facelift releases facial retaining ligaments and lifts SMAS plus skin as one composite flap from a deeper plane. In experienced hands, both techniques can produce excellent natural-looking results — the right choice depends on your anatomy, goals, and the surgeon's expertise.
How long is the recovery before I look social again?
Most patients feel comfortable returning to non-public activities within 2 weeks. Visible bruising usually fades by 10–14 days and can be camouflaged with makeup before that. Subtle tightness and minor swelling continue to settle over 3–6 months.
Will my scars be visible?
When closed under low tension and protected from sun, the incisions usually mature into thin pale lines tucked along the natural contours of the ear and hairline. Visibility depends on how you heal, your hair length and style, and how carefully you protect the incisions during the first year. Patients with very short hair or a tendency toward hypertrophic scarring should discuss their specific risk with the surgeon.
Can I combine a SMAS facelift with eyelid surgery, fat grafting, or laser?
Yes — many surgeons routinely combine a SMAS facelift with upper or lower blepharoplasty, fat grafting, and either same-day or staged laser resurfacing. Combining procedures means a single anesthesia session and one recovery period, but it also extends operative time and may add risk. Your surgeon should walk you through the trade-offs for your specific case.
Editorial disclaimer: This page is educational content reviewed by the MDcontour editorial team. It is not medical advice, diagnosis, or treatment, and it does not establish a doctor–patient relationship. Always consult a board-certified plastic surgeon about your individual situation.