Facelift terminology: SMAS vs. deep plane vs. mini-lift — what does it all mean?

Oct 7

3 min read

Daniel J. Givens, MD · Double board-certified facial plastic surgeon

If you've spent any time researching facelift surgery, you've probably encountered terms like SMAS lift, SMASectomy, deep plane facelift, mini-lift, S-lift, and short-scar facelift. Unfortunately, these terms don't always mean the same thing from one surgeon to another, and they can make facelift surgery much more confusing than it needs to be.

START WITH THE ANATOMY

Historically, facelift surgery primarily involved elevating the skin, pulling it backward, and closing the incision. True skin-only facelifting is not something commonly performed by reputable facelift surgeons today — skin isn't designed to support the weight of the face, and the result can be widened scars and an unnatural pulled appearance.

THE FOUR DRIVERS OF FACIAL AGING

What is a skin-only facelift?

THE SMAS TECHNIQUES, COMPARED

These four techniques all work on the same layer, but differ in how much freedom they give the tissue to move. Tap to expand any one of them.

SMAS plication

A skin flap is elevated and the surgeon places sutures into mobile portions of the SMAS, pulling them in a direction intended to improve the face and neck. The limitation: the retaining ligaments remain intact, so over time sutures can loosen or pull through the tissue — sometimes called "cheesewiring" — allowing some recurrent descent.

SMASectomy

Similar in concept, but instead of folding the SMAS with sutures, the surgeon removes a strip of it and advances the cut edge upward and backward before suturing it into position. The retaining ligaments generally remain intact here too.

SMAS flap facelift

A step further — the surgeon creates a flap of SMAS that can be elevated and repositioned. There's considerable variability here: two surgeons may both say they perform a "SMAS facelift" while actually doing quite different operations.

DR. GIVENS' PREFERRED TECHNIQUE

What makes a Deep Plane Facelift different?

Dr. Sam Hamra first described the deep-plane rhytidectomy in 1990 — entering the deep plane and releasing the ligaments that prevented the composite facial tissues from moving freely. Facial aging occurs largely through movement along this natural glide plane. A facelift is less about how much skin can be removed and more about how adequately the deeper tissues can be repositioned.

My preference is a full ligamentous release because it gives me greater freedom to reposition the tissues in the direction that best reverses that patient's pattern of aging while maintaining a natural appearance.

See real results from Dr. Givens →

"Patients ask for a mini-lift but expect a maximal result"

RIGHT SIZED OPTIONS

These aren't about which layer is lifted — they're about how much of the face actually needs it.

Mini-lift or S-lift

A smaller incision and more limited operation — but the name alone doesn't tell you what's happening underneath the skin. Only appropriate when the aging changes are relatively minimal.

Micro-lift

A very small, focused adjustment to one isolated area — temple, cheek, or jawline — when the rest of the face is still well positioned. Not a smaller substitute for a full facelift.

Isolated neck lift

Addresses neck aging on its own when the face itself remains well positioned. Not the right fit if jowling or facial laxity is also present.

ASK BEFORE YOU DECIDE

Understanding what your surgeon is actually doing

Terms like "SMAS facelift," "deep plane facelift," and "mini-lift" can be helpful, but the name of the operation doesn't tell you everything about how it's being performed. It's reasonable to ask: