Every Type of Facelift, Explained: A Surgeon's Guide to What Actually Works

A facelift is one of the most searched cosmetic procedures in the world, and it's also one of the most confusing. If you've spent any time researching, you've probably come across a dozen different names: SMAS, deep plane, extended deep plane, preservation, mini lift, S-lift, composite lift. It can feel overwhelming, and I think a lot of that confusion is by design. The more complicated it sounds, the easier it is to sell.

I want to simplify this for you. In this guide, I'll walk through every major facelift technique, explain what each one actually does, and help you understand the differences in a way that makes sense. Not every technique is right for every patient, and understanding what's out there is the first step toward making an informed decision..

What Is a Facelift, and Why Are There So Many Types?

A facelift is a surgical procedure designed to address sagging skin, volume loss, and structural changes in the face and neck that happen with aging. The reason there are so many variations comes down to one thing: fundamentally different philosophies on the best way to address these areas of concern.

Your face has layers. Skin on the outside followed by a thin layer of subcutaneous fat, then a layer of muscle and connective tissue called the SMAS, then deeper fat pads and facial nerves, and bone underneath all of that. Different facelift techniques work at different depths within these layers. Some only tighten skin. Some apply tension to the SMAS layer. Some go beneath the SMAS entirely and release this layer in order to lift and reposition

The technique a surgeon chooses and the execution determines how natural the results look, how long they last, and what the recovery involves. Here's a look at each approach, starting with the oldest technique and working forward to what's most commonly performed today.

How Did Facelifts Start? The Skin-Only Facelift

The skin-only facelift, sometimes called a cutaneous facelift or subcutaneous facelift, is where facial rejuvenation surgery began. In this approach, the surgeon separates the skin from the underlying tissue, pulls it tighter, removes the excess, and closes the incision.

It sounds logical, and for decades it was the standard. But there's a fundamental problem: skin stretches. When you only tighten skin without addressing the deeper structures underneath, the results tend to fade quickly. Worse, over time the tension on the skin alone can cause poor incisional healing and a pulled, windswept look that all patients want to avoid.

This technique is largely considered outdated today, and most experienced facelift surgeons have moved on to approaches that address the deeper layers. But it's worth understanding because it explains why modern techniques exist. Every advancement in facelift surgery has been, in some way, a response to the limitations of the skin-only lift.

What Is a SMAS Facelift?

The SMAS facelift is the technique that changed everything. SMAS stands for Superficial Musculoaponeurotic System, which is the layer of muscle and connective tissue that sits just beneath the skin. By working at this level, surgeons can tighten this deeper layer of the face rather than just pulling on skin.

There are several variations within the SMAS family, and they all involve this same layer but handle it differently.

SMAS Plication

In this approach, the surgeon folds the SMAS layer upon itself and sutures it into a tighter position without actually cutting into it. It's a somewhat conservative technique, and in many cases it works well for patients with mild to moderate laxity.

SMAS Imbrication

Similar to plication, but the SMAS is incised and then overlapped rather than simply folded. This can provide a bit more lift than plication while still keeping the dissection relatively limited.

SMASectomy

Here, the surgeon removes a strip of the SMAS tissue and then sutures the remaining edges together. This creates tightening by reducing the volume of the SMAS layer itself. It's a straightforward technique that many surgeons use as their primary approach.

High SMAS and Extended SMAS

These are more aggressive versions of SMAS surgery where the surgeon mobilizes the SMAS further up into the midface or further back toward the ear. The goal is to get more lift and repositioning out of the SMAS layer without going beneath it. You'll sometimes hear "high SMAS" and "deep plane" used interchangeably, but they are technically different approaches.

The SMAS facelift in its various forms is still the most commonly performed facelift worldwide. It produces good results, has a well-established safety profile, and in the hands of an experienced surgeon can look very natural. For some patients, particularly those with moderate aging changes, a SMAS-level procedure is a good choice.

Learn more about facelifts with Dr. Harris →

What Is a Deep Plane Facelift?

The deep plane facelift takes things a step further. Instead of working on top of the SMAS for tightening, the surgeon goes beneath it. This means releasing the ligaments (tether points) that hold the SMAS in place and lifting the entire layer, along with the fat pads attached to it, as one continuous unit.

The advantage of this approach is that the deeper tissues of the face are repositioned rather than just tightened. This produces a more natural result because the risk of creating tension lines and a windswept look is greatly reduced as the SMAS tissue is lifted more easily without the tension of these tether points pulling it back down with time.. It also means there's less tension on the skin itself, which typically leads to better healing incisions.

The deep plane technique does require more surgical skill and experience because the facial nerves run close to this area. A surgeon who performs deep plane facelifts regularly knows the anatomy intimately and understands how to work safely in this space. It's not inherently more dangerous, but it does demand precision and familiarity.

I perform deep plane facelifts regularly, and in my experience, the results are consistently more natural and more lasting than what I see with SMAS-level techniques alone. That said, it's not the right choice for every single patient, and I always evaluate each person individually.

What Is an Extended Deep Plane Facelift?

The extended deep plane facelift is exactly what it sounds like: a deep plane technique with more comprehensive ligament release. Where a standard deep plane addresses the lateral portion of the retaining ligaments around the cheek, an extended version provides a more complete release.. This allows the surgeon to mobilize tissue further and create a more comprehensive lift in a single continuous layer.

The result is typically better correction of the nasolabial folds, the jowls, and the neck all at once. Because everything is being lifted as one unit rather than in separate stages, the outcome tends to look more harmonious.

This is the technique I use most often in my practice because I find it gives patients the most complete and natural-looking rejuvenation. It allows me to address the midface, the jawline, and the neck in a way that feels cohesive rather than piecemeal.

Dr. Andrew Jacono is one of the surgeons most associated with popularizing and pioneering the extended deep plane approach that Dr. Sam Hamra originally developed in the 1990’s, though select facial plastic surgeons now perform several variations of this technique.

Learn more about extended deep plane facelifts with Dr. Harris →

What Is the Preservation Facelift?

The preservation deep plane facelift,represents a further refined version of the deep plane facelift.. The concept is to elevate as little skin as possible while still performing a deep plane facelift. . The idea is to keep the natural skin attachments intact as this gives better vibrance to the skin and achieve skin improvement simply through deep plane tissue lifting. The deep plane-skin flap (composite flap) also has a better blood supply than a skin flap alone so this reduces risk of ischemia or lack of blood supply in healing tissue.

I think what matters most is not the name of the technique but whether the surgeon performing it truly understands facial anatomy and has deep experience with their chosen approach. Patients sometimes come in asking specifically for one technique or the other based on what they've read online, and I always appreciate that research. But I also think it's important to have an honest conversation about what your specific anatomy needs rather than committing to a technique name before the consultation.

What Is a Mini Facelift?

The mini facelift goes by many names: short-scar facelift, MACS lift (which stands for Minimal Access Cranial Suspension), S-lift, quick lift, and weekend facelift. These are all variations on the same basic concept: a less invasive facelift with shorter incisions, however, a mini lift can mean very different things depending on the surgeon using the term.

The mini facelift has typically been intended for patients with early to moderate signs of aging who may not need as much lifting. The question really comes down to what underlying technique is being used for this “mini-facelift”. In my clinic, a deep plane technique is used for a mini-facelift, but the incisions will be shorter and typically the level of dissection and tissue contouring will be more limited with a shorter downtime.

I think the mini facelift gets both oversold and undersold depending on who you talk to. Some practices market it as a solution for everyone because it sounds less intimidating and has a quicker recovery. The reality is that it works beautifully for the right patient, but if you have significant laxity in the neck or deep jowling, a mini lift typically won't give you the result you're looking for. During a consultation, I'll always be straightforward about whether a mini facelift can achieve your goals or whether a more comprehensive approach would serve you better.

Learn more about mini facelifts with Dr. Harris →

What Is a Revision or Secondary Facelift?

A revision facelift is a facelift performed on someone who has already had one and is typically used to correct an issue with the surgery or to revise the result within 5-6 years from first surgery. This is its own category because the surgical landscape is fundamentally different the second time around. The tissue has been dissected before, scar tissue has formed, and the anatomy is altered from the previous procedure.

Revision facelifts require a surgeon who is comfortable working in tissue that doesn't behave the same way as it would in a first-time patient. The plane of dissection may need to change, and the surgeon needs to carefully evaluate what was done previously, what worked, and what needs to be corrected.

Some patients seek revision because their original results have naturally aged over time. Others come in because the first procedure didn't produce the outcome they hoped for. In either case, a thorough evaluation and honest conversation about what's achievable is essential.

I perform revision facelifts in my practice, and I find that these patients benefit the most from a detailed consultation where we can look at what was done before and build a plan based on their current anatomy.

A secondary facelift is a facelift performed on someone who has had a previous one, but is 8-10 years or more out from this surgery and is interested in a refresh due to normal aging continuing to occur.

Learn more about revision facelifts with Dr. Harris →

How Do You Choose the Right Facelift?

This is the question I hear most often, and the honest answer is that the right facelift depends on your anatomy, your goals, and your surgeon's experience and skill with a given technique. There's no single "best" facelift for everyone.

Here's a general framework. If you have mild laxity, mostly in the lower face, and good skin quality, a mini facelift may be all you need. Remember, this can mean very different things depending on the surgeon. It offers real improvement with a shorter recovery and smaller incisions. If you have moderate to significant aging in the midface, jawline, and neck, a deep plane or extended deep plane facelift will typically produce the most natural, longest-lasting result. This is where the technique really shines, because it addresses the root cause of aging rather than just the surface. If you've had a previous facelift and need further improvement, a revision facelift with a surgeon experienced in secondary procedures is the right path.

My Approach to Facelift Consultations

When a patient comes to see me, I don't start by recommending a procedure or technique. I start by listening. I want to understand what's bothering you, what you see when you look in the mirror, and what kind of result you're hoping for. From there, I evaluate your anatomy: the quality of your skin, the position of your fat pads, your bone structure, the condition of the muscle and connective tissue, and how your neck is aging relative to your face.

Only after that assessment do I recommend a specific approach. In many cases, I recommend the extended deep plane technique because I find it consistently delivers the most natural and comprehensive result. But I've also told patients that a mini facelift is all they need, or that addressing the with a Holiday Neck Lift® would give them the improvement they're looking for.

I think the most important thing I can offer in a consultation is honesty. If I don't think surgery is the right answer for you right now, I'll tell you. If I think you're asking for a technique that won't address what's actually going on with your anatomy, I'll explain why. My goal is for you to leave the consultation feeling informed and confident, whether or not you decide to move forward.

Frequently Asked Questions About Facelifts