What Kind of Facelift is Right For You? Doctors Explain the Differences

It’s the era of the facelift. More and more people are requesting the procedure—and at younger ages than ever. According to the 2023 American Academy of Facial Plastic and Reconstructive Surgery survey, the number of facelifts performed annually has increased by 60% since 2017. The number of facelift patients ages 35 to 55 has also increased. So what gives? Dr. Jacob Steiger, a board-certified facial plastic surgeon in Boca Raton, Florida, attributes the popularity boom to both the fear of “filler face” and a general shift in attitudes. “People are scared of ending up puffy, so the pendulum has swung away from filler. And ‘facelift’ is no longer a scary word because we have the technology to create a beautiful, natural, untouched-looking end result,” he says. 

To that point, the advancement of new and more nuanced techniques means that facelifts can now be more tailored to every individual. “There are probably as many ‘types’ of facelifts out there as there are surgeons,” jokes Dr. J. Randall Jordan, a board-certified facial plastic surgeon in Ridgeland, Mississippi. However, most of this variety is, in fact, just marketing jargon and you can really boil down facelifts into four main categories. Ahead, experts explain the differences among them and who is a good candidate for each.

SMAS facelift

Also known as a traditional facelift, this surgery addresses the SMAS, a fascial tissue layer underneath the skin. This technique emerged in the 1970s and changed the facelift game, says Dr. Steiger. Prior to this, facelifts involved simply cutting and pulling the skin, resulting in an unnaturally taut, windswept look. Cutting, lifting, and/or tightening the SMAS lifts the skin and gives a little bit of a lift to the lax ligaments responsible for creating a droopy, sagging appearance, he explains.

The major caveat? SMAS facelifts treat jowling of the lower face and neck but not the midface or cheeks, notes Dr. Jordan. “A good candidate for a SMAS lift is typically a patient in their 40s with mild to moderate jowling and laxity in the neck,” says New York City board-certified facial plastic surgeon Dr. Sam Rizk. If saggy cheeks or prominent nasolabial folds are your concern, this isn’t the right facelift for you. 

Also worth noting: Smokers are not good candidates for SMAS lifts. “Even if someone stops smoking for a month before and after surgery, it’s still too risky to perform a SMAS lift on them. It involves destroying the blood supply to the skin and smokers already have compromised vascularity,” notes Dr. Rizk.

Deep plane facelift

Arguably the most effective of the bunch, deep plane facelifts differ in both the surgical technique and the areas of the face treated. As the name suggests, there’s a deeper dissection and a release of the actual ligaments, allowing surgeons to mobilize and lift up the tissue more aggressively, says Dr. Jordan. “You can achieve more of a lift in general, but the real hallmark of this procedure is that it also allows for an elevation of the midface,” he explains. 

The cheek, jowls, and neck are all addressed—which, according to Dr. Steiger, is what the majority of patients who are good candidates for any type of facelift actually need. For most people, the progression of sagging starts in the cheeks, then manifests around the jawline as jowls, and finally shows up as neck laxity, he says. By the time you have jowling, your cheeks also probably need a little love—and remember, a standard SMAS lift won’t help. “I end up doing a lot of deep plane facelifts on people who’ve previously had a SMAS lift and now want their midface to match everything else. 

The beauty of this surgery is that you’re actually lifting the deep tissue and ligaments and restoring them to where they were,” says Dr. Steiger. Dr. Rizk agrees that these yield the most dramatic results, adding that approximately 80% of the facelifts he performs are deep plane.

Cheek lift

Since the cheeks are the first area of the face to sag, a cheek lift, also known as a mid-facelift, is another, more targeted treatment. In this case, the fat pads are lifted and the underlying muscle may be tightened as well. Endoscopic cheek lifts are also an option. These don’t involve an incision that can result in a scar in front of the ear; rather, a small incision is made near the brow. (Some excess skin can be removed during a standard cheek lift but not during an endoscopic one.)  “It’s rare to find a good candidate for a cheek lift because most people have jowling in addition to midface looseness,” says Dr. Rizk. Additionally, creating too much lift area in this area alone, particularly when not removing skin, can lead to a distortion of the face that makes the eyes slitted, he cautions. 

According to Dr. Jordan, it’s most often people who are genetically predisposed to having heavy, sagging cheeks (but without any jowling) who are good candidates, or those who have what he describes as a “bulldog-like appearance.” Dr. Steiger adds that most cheek lift patients are typically in their mid- to late 30s, but notes this population can also often get by with nonsurgical alternatives, such as filler. In fact, he often suggests people try other modalities and hold off on any type of facelift until they have more sagging throughout the rest of their face. And because a cheek lift involves manipulating the area all the way down to the bone, it can result in a tremendous amount of swelling and downtime—up to six weeks’ worth, which is even more than with a deep plane facelift, he says.

Mini facelift

Fun fact: you’ll never see the term mini facelift in a medical textbook. This is a highly successful marketing term because, says Dr. Steiger, “everyone wants a mini lift with maximum results.” What a mini facelift refers to is the length of the incision (and, subsequently, how much skin is removed). This is why doctors refer to them as short scar facelifts. The incision starts at the same place as with a regular facelift—in front of the ear, at the temple—but stops at the level of the ear lobe, rather than extending all the way behind the ear and toward the hairline and neck. While it may seem somewhat counterintuitive, both SMAS and deep place facelifts can be done with a short scar, says Dr. Steiger. “It’s the level of neck laxity that determines the length of the scar,” he explains. Dr. Jordan agrees, noting that patients who are 35 to 50 without a lot of loose neck skin tend to be the best candidates for short scar or mini facelifts.

What facelifts don’t address

Extensive neck issues

While SMAS and deep plane facelifts do address some level of neck laxity, many people require a simultaneous neck lift (aka platysmaplasty) to address neck banding, says Dr. Rizk. “Creating a small incision under the chin allows access to the deeper structures of the neck so that we can address the separation of the platysma muscles that create these prominent-looking bands or cords.” (For context, he says that approximately 50% of his patients who come in for some type of facelift also need this procedure.) Bulging fat and muscles can also be addressed during this type of neck contouring, he adds, complementing the overall results of a facelift.  

The upper part of the face

No face lift will address your forehead and brow area. “Many patients don’t understand that when surgeons are talking about a complete facelift, they’re only referring to the lower two-thirds of the face. A brow lift is an entirely separate procedure,” says Dr. Jordan, noting that many people need both.

Skin texture

“The technical term for a facelift, ‘rhytidectomy,’ translates to removing wrinkles, so it’s ironic that facelifts don’t actually do that,” says Dr. Jordan. “They’re taking care of the soft tissue and sagging skin, but they’re not addressing textural signs of aging,” he points out. It’s why pairing a resurfacing procedure–a deep chemical peel or CO2 laser–with a facelift can make for such a beautiful end result. “Think of a facelift as redoing the foundation of your walls and that secondary treatment as the final coat of paint on those walls,” he says.