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•January 23, 2026
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Is a SMAS facelift the same as a deep plane? – Different Types of Facelifts Explained

Is a SMAS facelift the same as a deep plane? – Different Types of Facelifts Explained

What Is the SMAS layer?

Before telling apart the facelift types, it’s crucial to understand the SMAS (Superficial Musculo-Aponeurotic System):

SMAS Layer of the skin
  • It’s a fibromuscular layer located between the subcutaneous fat and deep facial muscles.
  • It links facial muscles to the skin and plays a pivotal role in face expression.
  • While aging, the SMAS layer and its retaining ligaments lose elasticity, resulting in sagging in the midface, jowl, and neck areas.

Contemporary facelifts techniques aim to reposition and tighten the SMAS layer, not just pull the skin, to achieve a natural, long-lasting result and minimize tension and scarring.

SMAS Facelift  

How does SMAS facelift work?

A standard SMAS facelift involves lifting and tightening this fibromuscular layer separately from the skin.

  • The SMAS flap is dissected, lifted, and sutured in a more vertical vector to lift the midface and jawline.
  • Tension is placed on the SMAS instead of the skin, minimizing visible scarring and resulting in a natural contour.
Incision site for SMAS faclift

Picture 1: Incision for SMAS Facelift

Advantages

  • Applicable for moderate face sagging.
  • Improves jawline definition, reduces nasolabial folds, and marionette lines.
  • Results in a natural, youthful contour.

Limitations:

  • Limited correction of deep midface descent (possible cheek volume loss).

Best for

Patients with moderate aging changes, primarily in the lower face and jawline, who want durable, natural rejuvenation without extensive midface dissection.

Extended SMAS Facelift

How does the Extended SMAS facelift work?

This is the enhanced evolution of the traditional SMAS lift, as presented by Dr. Hong Dae Kang at JW Plastic Surgery Korea.

It extends the SMAS dissection beyond the zygomaticus major muscle into the malar and nasolabial region.

Extended SMAS Facelift – SMAS flap dissection

Picture 2: Extended SMAS Facelift – SMAS flap dissection

Surgical Details:

  1. SMAS flap dissection includes:
    • Malar-SMAS (perpendicular to nasolabial fold)
    • Cheek-SMAS (perpendicular to the mandibular border)
  2. Major retaining ligaments (zygomatic, masseteric) are released.
  3. Vertical repositioning of the SMAS flap lifts the midface, cheek, and jowl.
  4. Skin is redraped horizontally with minimal tension.

Advantages

  • Addresses midface drooping and nasolabial folds more effectively than standard SMAS.
  • Offers autogenous malar augmentation due to rolled double-layer SMAS fixation.
  • Natural, long-lasting results with limited scarring.

Limitations

  • Technically demanding and requires precise ligament release.
  • Slightly longer recovery than MACS lift.

At JW Plastic Surgery, the Extended SMAS facelift described by Dr. Hong Dae Kang combines precision ligament release and vertical SMAS repositioning to achieve balanced rejuvenation of both the midface and lower face, bridging the gap between the traditional SMAS and deep plane methods.

This approach aligns closely with modern scientific literature emphasizing:

  • Anatomical ligament release for long-lasting lift (Arch Plast Surg, 2022),
  • Vertical vector elevation to counter midface descent (PRS, 2021),
  • Reduced tension and natural outcome through layered approach.

Best for

Patients with advanced facial aging, including significant midface descent, deep folds, and jawline laxity, who want comprehensive, long-lasting yet natural rejuvenation.

Deep Plane Facelift

What is the difference between Deep Plane and SMAS Facelift?

Concept

A Deep Plane Facelift goes under the SMAS layer, mobilizing it together with the overlying skin and fat as one composite flap.
First described by Hamra (1990s), this approach releases deeper ligaments and repositions the malar fat pad and midface.

Technique

  • Dissection occurs below the SMAS, between it and deeper facial muscles.
  • Ligament release (zygomatic, masseteric, mandibular) is extensive.
  • The skin, SMAS, and fat move together, reducing skin tension.

Advantages

  • Strong lifting of midface, nasolabial folds, and jawline.
  • Very natural appearance due to anatomical repositioning.
  • Longer-lasting than most other lifts (10–15 years in literature).

Limitations

  • Technically most complex.
  • Slightly higher risk for nerve injury if not performed by expert surgeons.
  • Longer recovery time.

Best for

Patients with severe facial aging, significant midface volume loss, and deep sagging, who want dramatic and long-lasting correction.

MACS Lift (Minimal Access Cranial Suspension)

What is the MACS Facelift?

Concept

Developed as a less invasive alternative, the MACS lift uses a short scar and limited dissection.
The SMAS is not widely lifted but suspended with loop sutures through a small preauricular incision.

Minimal Access Cranial Suspension (MACS) lift: The incision (red) and skin undermining (black) in the MACS lift. 

Picture 3: Minimal Access Cranial Suspension (MACS) lift: The incision (red) and skin undermining (black) in the MACS lift. 

Advantages

  • Minimal scarring and swelling.
  • Shorter surgery and recovery.
  • Suitable for younger patients or those with mild to moderate laxity.

Limitations

  • Does not correct heavy midface or neck sagging.
  • Results may be less durable (around 3–5 years).

Best for

Younger patients or those with mild to moderate facial laxity seeking improvement with minimal downtime.

MADE Facelift (Minimal Access Deep-plane Extended)

Concept:

An advanced technique that combines the key advantages of the deep plane facelift with the short-scar, minimal access cranial suspension (MACS) lift.

Benefits:

  • Short, discreet incisions
  • The minimal-access method reduces incision length, helping scars remain subtle and well concealed around the hairline and ear.
  • Faster recovery
  • Preserved facial expression

Limitations:

  • Not suitable for severe skin laxity
  • Limited correction of neck laxity.
  • This approach primarily focuses on the face; pronounced neck sagging or muscle banding may require an additional neck lift procedure.
  • Results depend on individual anatomy.
    Outcomes vary based on skin quality, facial structure, and the degree of aging changes present.
  • Surgical expertise is critical.
  • Because the technique involves precise work in deeper anatomical planes, results depend heavily on the surgeon’s experience and skill.

Best for: This procedure is best suited for patients with mild to moderate facial sagging who want natural-looking rejuvenation with minimal scarring. It is ideal for those seeking noticeable improvement without the downtime or extent of a full traditional facelift.

Mini Facelift (Short-Scar SMAS Lift)

Concept:
A simplified, less-invasive variation of SMAS facelift, often confused with the MACS lift, but can include partial SMAS tightening or plication.
Uses a short incision behind the hairline.

Short temporal incision in Mini Facelift
Picture 4: Short temporal incision in Mini Facelift

Benefits:

  • Short surgery time (≈ 1.5–2 hours).
  • Minimal swelling & faster return to daily life.
  • Subtle but visible tightening of the jawline and cheeks.

Limitations:

  • Does not correct neck laxity or deep midface sagging.
  • Results last about 3–6 years.
  • Not suitable for advanced aging.

Best for:
Patients in their 30s–40s with mild laxity who want a “refreshed” look without the downtime of a full facelift.

Types of Facelift Comparison Table

Types of Facelift Comparison Table

DISCLAIMER: Outcomes and their longevity are dependent on user-specific and contextual variables. The data presented represents mean projected values.

Facelifts Summary

  • Mini Facelift, MACS Lift & MADE Lift: short-scar, minimal downtime options for mild aging.
  • SMAS Facelift: classic two-layer tightening; great for lower-face definition.
  • Deep Plane Lift: A powerful deep-tissue approach designed for advanced facial aging.
  • Extended SMAS Lift (JW Technique): An advanced facelift surgery, combining strategic ligament release with vertical SMAS elevation to deliver the most balanced result – natural movement, strong lifting effect, and long-term durability.

What facelift will be the most suitable for your concerns? Get your personalized recommendation by contacting us.

CONSULTATION

References

  • Prado, Arturo M.D.; Andrades, Patricio M.D.; Danilla, Stefan M.D., M.Sc.; Castillo, Paulo M.D.; Leniz, Patricio M.D., Ph.D.. A Clinical Retrospective Study Comparing Two Short-Scar Face Lifts: Minimal Access Cranial Suspension versus Lateral SMASectomy. Plastic and Reconstructive Surgery 117(5):p 1413-1425, April 15, 2006. | DOI: 10.1097/01.prs.0000207402.53411.1e
  • Chopan M, Buchanan PJ, Mast BA. The Minimal Access Cranial Suspension Lift. Clin Plast Surg. 2019 Oct;46(4):547-557. doi: 10.1016/j.cps.2019.06.005. Epub 2019 Aug 2. PMID: 31514807.
  • Rohrich, R. J., Sinno, S., Afrooz, P. (2021). Masters of Cosmetic Surgery – The Video Atlas: The Dallas Cosmetic Model. Germany: Thieme Publishers New York.
  • Tonnard, P., Verpaele, A., Bensimon, R. (2017). Centrofacial Rejuvenation. Germany: Thieme.
  • Tonnard, P., Verpaele, A. M. (2007). Short-Scar Face Lift: Operative Strategies and Techniques. Germany: Thieme Medical Publishers.
  • Nahai, F. (2010). The Art of Aesthetic Surgery: Facial Surgery – Volume 2, Second Edition: Principles & Techniques. United States: Thieme.
  • Neligan PC. The future of plastic surgery. Arch Plast Surg. 2022 Jan;49(1):1-2. doi: 10.5999/aps.2021.02278. Epub 2022 Jan 15. PMID: 35086299; PMCID: PMC8795651.