Types of Facelift: SMAS, Deep-Plane, Mini, MACS and Neck Lift

The types of facelift differ mainly in how they treat the SMAS, the deeper layer under the skin: it can be folded and stitched, partly removed, lifted as a flap, or, in a deep-plane lift, moved together with the fat and skin as one unit. Shorter-scar options (a mini, short-scar or MACS lift) do limited SMAS work for milder laxity, and a neck lift is frequently added for the neck¹.

When I started reading about this I assumed a facelift was one operation with one name. It is not. It is a family of techniques, and the names get thrown around as if one is plainly better than the rest, which is not what the evidence says. This is the plain map I wish I had had. If you want the whole picture first, start with the facelift pillar; if you have already narrowed it to the two most-compared options, jump to SMAS versus deep-plane.

What actually varies between the types?

What varies is the depth and the handling of the SMAS (the superficial musculoaponeurotic system), the continuous sheet of tissue that sits under the skin and above the muscle. Every modern facelift works on this layer rather than pulling skin alone, because lifting the SMAS is what gives a natural result rather than a tight, pulled look¹.

So the “types” are really different answers to one question: how do you reposition that deeper layer? Some lift the skin and the SMAS as two separate layers; one (the deep-plane) lifts them as a single unit. Some use long incisions to do a lot; others use short incisions to do less. That is the whole map, and the rest is detail. The honest headline, which I will keep coming back to, is that large reviews have not shown any one of these to be clearly better than the others².

SMAS techniques

In SMAS techniques the skin and the SMAS are lifted as separate layers, and the SMAS is then folded and stitched (plication), partly removed (SMASectomy), suspended with sutures, or lifted and repositioned as a flap. These are the common, well-tested approaches, and they are what most people picture when they think of a facelift¹.

The differences between them are real but modest: plication folds the layer without cutting it, a SMASectomy removes a strip and closes the gap, and a flap frees the SMAS more fully before repositioning it. A surgeon will often use whichever suits the face in front of them, and the same surgeon may do it slightly differently on two different patients. When I asked mine why, the answer was essentially “because your tissue is your tissue”, which was less of a dodge than it first sounded.

The deep-plane facelift

A deep-plane facelift lifts the SMAS, fat and skin together as one unit and releases the retaining ligaments that tether the face, rather than lifting the skin and SMAS as separate layers. It is often marketed as longer-lasting, and it is the technique people tend to ask for by name³.

The theory is appealing: by moving everything as a block and releasing the ligaments, the mid-face and the fold beside the nose can be repositioned more fully. But “often marketed as longer-lasting” is exactly the phrase to keep in mind, because marketing and evidence are not the same thing. Any facelift is commonly said to last about 10 years, yet objective study found jowl relapse of roughly 21% at about 5.5 years regardless of the fashionable label, and large systematic reviews have not shown the deep-plane, or any single technique, to be clearly superior to the others². I go into that specific claim in the deep-plane facelift and set it head to head in SMAS versus deep-plane.

Mini, short-scar and MACS lifts

Mini, short-scar and MACS (minimal access cranial suspension) lifts use shorter incisions and limited SMAS work, and they suit milder, earlier laxity rather than heavy jowls or a sagging neck. A MACS lift in particular suspends the deeper tissue with purse-string sutures anchored high near the cheekbone, mostly through incisions in front of the ear¹.

The important thing to understand is that a shorter scar means a smaller operation, not a smaller version of the same result. These lifts do less, on purpose, for a face that needs less. If the jowls are heavy or the neck has gone, a mini lift will disappoint, and pushing a short-scar technique to do a full lift’s job is where people end up unhappy. I look at who they genuinely suit, and where they fall short, in mini facelift.

The neck lift

A neck lift (platysmaplasty) treats the vertical neck bands and under-chin fullness, and although it is usually described as its own procedure, it is frequently combined with a facelift rather than done alone. A facelift handles the jowls and jawline; the neck often needs the neck-lift work added, sometimes through an extra incision under the chin⁴.

This overlap confused me for a while, because “facelift” in ordinary speech tends to mean the whole lower face and neck, while surgically they are separate pieces of work that happen to be done together. It matters because the neck is also the area that satisfies least: across studies more than 85% of patients are satisfied overall, but satisfaction is highest for the jawline and cheeks and lower for the neck and under-chin, which is also where correction tends to relapse first⁵. So it is worth being specific about what is being lifted. See neck lift and, if the neck is your main concern, facelift for a sagging neck.

So which type is best?

No single type is proven best: large systematic reviews have not shown one technique to be clearly superior, so the right choice depends on your anatomy, your laxity, your goals and the surgeon’s judgement, not on a brand name. A technique that suits one face can be the wrong choice for another, and the more you add on (a neck lift, other procedures at once) the higher the risk climbs, roughly 3.7% for combined work versus about 1.5% for a facelift alone².

This was genuinely freeing to learn, because I had walked in half-expecting to have to demand the “best” one. What actually mattered was finding a surgeon whose judgement I trusted and who did a high volume of whichever technique they recommended, rather than choosing the technique first and the surgeon second. That order, technique after surgeon, is the point of choosing a facelift surgeon, and it feeds directly into the questions to ask before a facelift.