Hello, I'm Dr. Yoosuk Chung, plastic surgeon at TheLINE Plastic Surgery.
Deep Plane, SMAS, Mini Lift… Why Are There So Many Facelift Names?
When you start researching facelifts, the first thing you run into is the names. Deep plane, SMAS lift, high SMAS, mini lift — similar-sounding terms keep appearing, each promoting its own advantages. But before comparing names, there is something worth checking first: what actually happens during the surgery, step by step, and which parts of the face it is designed to change.
What Stays the Same Across Facelift Techniques?
To get straight to the point: regardless of the technique's name, a facelift follows the same basic flow. It repositions the deeper soft tissue that has descended along with the skin (tissue including the SMAS layer) back toward its original position, secures it there, and then redrapes and trims the overlying skin. The effects are most noticeable in the lower face, the jawline, and the neck. The differences between techniques come down to how deep and how extensively the tissue layers are treated during this process — and even when the published research is taken together, it is difficult to conclude that any one technique is superior to the others.
What Layers Make Up the Face, and What Is the SMAS?
To understand the procedure, it helps to first look at the layered structure of the face. The facial soft tissue has traditionally been described, from the surface inward, as skin, subcutaneous fat, the SMAS layer, a layer containing ligaments and spaces, and finally the deep fascia and periosteum[1]. However, how these layers are divided and named differs among researchers, and anatomical discussion continues to this day[1].
The SMAS layer sits at the center of that discussion. In surgery, the term is commonly used for the layer where facial expression muscles, fascia, and fat are connected — but opinions differ on whether it should be regarded as a distinct anatomical structure, or rather as a name for tissue of variable thickness that is lifted as a flap during surgery[1]. However it is defined, what a facelift works on is the soft tissue that has descended at a level deeper than the skin. Why skincare alone has difficulty reversing sagging in this deeper tissue was covered in an earlier article "Why Doesn't My Firming Cream Work: The part of Sagging Skincare Can't Reach". This is also why facelifting has evolved from a procedure that simply pulls the skin into one that addresses these deeper layers.
What Are the Steps of Facelift Surgery?
Below is a general flow common to most techniques. The specific method at each step may vary depending on the clinic, the technique, and the patient's condition.
① Consultation and assessment — This is the starting point for choosing a technique. Examining the location and degree of sagging, skin condition, and neck structure, and confirming the changes the patient wants, is emphasized as the core of the initial evaluation[1]. Blood pressure and current medications are also checked at this stage, because high blood pressure, male sex, and antiplatelet or anticoagulant medications have been reported as risk factors for postoperative hematoma[1].
② Anesthesia — Several options are used, including general and local anesthesia, and there are reports of growing interest in performing the procedure under local anesthesia alone[1]. The choice is made considering the extent of surgery and the patient's health.
③ Incisions — Incisions generally make use of areas where scars are relatively less visible, such as around the ear. The exact location and length vary with the extent and technique of the surgery, and various shorter-incision and endoscopic approaches have also been reported[1].
④ Repositioning the deeper layers — This is the core step of a facelift. The deeper tissue, including the descended SMAS layer, is moved back toward its original position and secured. How the SMAS layer is handled here is what differs between techniques, and is explained separately below.
⑤ Neck treatment (when needed) — If the neck has also descended, the thin, broad muscle at the front of the neck (the platysma) and the structures beneath it may be addressed as well. However, methods for treating the neck are highly varied, not every patient needs deep neck surgery, and the extent depends on neck anatomy and the degree of aging[1]. The relationship between neck lines and facelifting was covered in an earlier article "Does a Facelift Also Get Rid of Neck Lines?".
⑥ Skin redraping and closure — Once the deeper layers have been repositioned, the skin is redraped over them, excess skin is trimmed, and the incisions are closed.
⑦ Recovery and aftercare — The main complication watched for after surgery is hematoma, a collection of blood under the skin, with reported rates ranging widely from 1% to 14% depending on the study[1]. To reduce this risk, multiple measures such as blood pressure control before and after surgery and compression dressings are commonly combined[1]. Specific aftercare may differ by clinic and technique.
How Are Facelift Techniques Classified?
A 2025 review in the Journal of Clinical Medicine summarized that facelift techniques can broadly be divided into those that treat the SMAS layer on its surface and those that go beneath the SMAS layer and elevate it to varying extents[1]. Following the classification cited in this review, techniques can be grouped into three categories[1].
Skin-level : The layer just beneath the skin is undermined and the skin is redraped.
SMAS manipulation : Techniques that fold and suture part of the SMAS on its surface (SMAS plication), or remove a portion and suture it close (SMASectomy), among others.
SMAS elevation : Techniques that go beneath the SMAS layer and lift the layer itself, including high SMAS, SMAS flap, deep plane, and composite lifts.
The deep plane facelift is one technique within the SMAS elevation group; since it was first described in 1990, numerous surgeons have published various modification[1]. Because each group contains a great many variations, the actual technique may differ from surgeon to surgeon even under the same name[1]. The difference in the plane of dissection between dissection above the SMAS and the deep plane is laid out with a comparison table in "What is a facelift? SMAS and the deep plane".
Deep Plane vs. SMAS Facelift: Which Is Better?
A systematic review published in JPRAS Open in 2023 compared six SMAS-based techniques across 27 studies published between 2000 and 2022, covering a total of 6,086 patients[2]. More than 85% of patients were satisfied with their outcome, and temporary, and permanent injury was rare[3]. Both groups showed significant aesthetic improvement, but because only one study directly compared the two and outcome measures varied between studies, the authors reported that no definitive conclusion could be drawn about relative efficacy[3]. They concluded that technique selection should be individualized[3].
The 2025 review mentioned above also considered it unlikely that the superiority of any single technique will be proven[1]. Citing a study in which identical twins underwent different techniques with excellent results in both when performed by experienced surgeons, it concluded that understanding each technique's strengths and limitations and tailoring the surgery to the patient's anatomy matters more than the technique itself[1].
In summary, current review studies report high satisfaction and generally favorable safety outcomes across facelift techniques. However, complication rates differed by specific technique and reporting was incomplete in some studies, so there is broad agreement that comparative evidence is not yet sufficient to judge any one technique as better.
Where Does a Facelift Make a Difference?
Facelift and necklift procedures are regarded as the principal surgical treatments for advanced aging in the lower face, jawline, and neck[1]. How the jawline breaks down was covered in an earlier article "Is a Sagging Jawline From Excess Fat, or Is Something Else Going On?". As recent techniques increasingly elevate the midface and cheek as well, brow or forehead lifting is sometimes considered alongside to prevent tissue bunching beside the eyes[1]. In other words, the forehead and brow are not areas addressed by a facelift alone, and require separate evaluation.
There are also clear limits to what surgery can resolve. Surgery repositions descended structures and improves soft-tissue laxity, but it does not address the quality of the skin itself[1]. For this reason, energy-based treatments such as lasers, fillers, and skin-regenerating treatments are considered before or after surgery[1]. Where the line falls between what a facelift can and cannot change is covered in more detail in "What Exactly Does a Facelift Change — and What Doesn't It?".
How Is the Right Facelift Technique Chosen for you?
Even at the same age, where sagging began, skin thickness and elasticity, neck structure, and facial bone framework differ from person to person. That means which group of techniques fits, whether neck treatment is also needed, and whether skin treatments should be combined will all differ as well. The authors of the review above also emphasized that there is no single universal approach to achieving optimal results[1]. Rather than the name of the technique, the first step in considering surgery is to find out which layer of your face has descended, where, and by how much.
Three Key takeaways
1. Regardless of its name, a facelift follows a flow of repositioning and securing descended deep soft tissue (including the SMAS layer) and then redraping the skin, with the most noticeable effects in the lower face, jawline, and neck[1].
2. Techniques differ by whether the SMAS layer is treated on its surface or elevated from beneath, and the deep plane facelift is one technique within the SMAS elevation group[1].
3. Large systematic reviews have reported high satisfaction and generally favorable safety outcomes across facelift techniques, but conclude that it is difficult to determine which technique is superior — so the technique is chosen to fit each individual's facial structure[2][3].
Which technique and extent suit your face is best confirmed through an in-person consultation with a specialist.
By Dr. Yoosuk Chung (Board-Certified Plastic Surgeon)
--- Sources
1. Boyd CJ, Ceradini DJ. Current Trends in Facelift and Necklift Procedures. J Clin Med. 2025;14(12):4273. PMC 12193931
2. Evolution of Superficial Muscular Aponeurotic System Facelift Techniques: A Comprehensive Systematic Review of Complications and Outcomes. JPRAS Open. 2023. PubMed 38283861
3. Vayalapra S, et al. Comparing the Safety and Efficacy of Superficial Musculoaponeurotic System and Deep Plane Facelift Techniques: A Systematic Review and Meta-analysis. Ann Plast Surg. 2025;95(5):582–589. PubMed 40600822