What's the Difference Between a Lower Facelift and a SMAS Facelift?

I have been to two cosmetic surgeons. One says necklift and plastyma muscle that includes midface (Smas). The other says can do necklift with plastyma muscle and fill mid face with fat transfer. Or Necklift with SMAS and cheeklift with suspension system. I am so confused as to the difference between a lower face lift and a SMAS facelift? Help!

Doctor Answers 28

Lower facelift vs. SMAS facelift

It is very difficult for patients to decide on what facelift procedure to choose. One surgeon's SMAS operation is equivalent to another doctor's minilift. It is better to choose an expert facelift surgeon than to choose a particular technique. I think my colleagues would agree that this applies to most procedures in plastic surgery.

Technically SMAS refers to the deep layer or "muscles", even though it is not muscle tissue except for a few fibers at the jawline.

The "lower facelift procedure", however, is specific to the lower face. It does not rejuvenate the upper face. Therefore a dysharmony can be created with a tight neck but medium jowls and drooping upper face in patients who just have a lower facelift done.

Remember this is your face. Do the right procedure, the best procedure, not just what might be the cheapest or the most convenient.

We prefer complete SMAS preservation procedures, not incisions and tightening of the SMAS with removal of SMAS (depleting the face further of volume) or SMAS-ectomy procedures. We believe this maximizes volume retention and redistribution to the upper face. We also do not believe the skin and the SMAS should be tightened in the same direction, or alterations in the hairline occur.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Facelift vs. SMAS Facelift

There are many different types of Facelifts and it is confusing. Between Internet technology and different buzz words it is often difficult to decipher the information. All good Facelifts involve some manipulation of the SMAS. This addresses the underlying muscles of the skin and allows the surgeon the elevate, reposition and lift the face and not just tighten the skin. This allows less tension on the incisions allowing a natural youthful look. You should choose a surgeon based on his/her before and after photographs, patient referrals, your physician patient repore, and not a specified technique. It is often helpful when choosing a surgeon to speak with many of his patients that have undergone the same procedure. I perform a lot of Facelift surgery and I invite my patients to speak directly to my postoperative patients during their various phases of recovery. This allows the consulting patient a better understanding of the process. I am sorry for your confusion and I hope this helps you in your decision making.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 208 reviews

Facelifts - What's in a name?

Wyou are not alone. The terminology in facelifts for the consumer has become very convoluted and difficult to decifer. Very often I see patients coming to see me who 10-15 years minifacelift. To them, this meant theydin'tt have a browlift or their eyes done. So don't geterr therms

Thhink ofthe SMAS as a thick layer under the skin and fat. Tightening this layer helps the entire face and neck. The platysma is the muscle that forms the 2 vertical bands in the neck from the chin down to the chest. Tightening or repairing this will improve the neck and jawline. The incisions like lower face, short scar, S-lift, MACS lift etc. are all ways to redrape the skin to take out the extra skin from tightening the face. Look at the results of his work by seeing photos of patients with mild to severe deformities (aging status) and then decide which results sre the best.

Find a surgeon you trust and listen to what he or she is trying to do. Sometimes a little more incision gives you alot more result. Don't be consumed by the different names. Good Luck

Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 6 reviews

Not all facelifts are SMAS

The SMAS is a complex structure of the face that is the supporting muscle and tissue of the face. Many facelifts are performed by lifting and tightening the skin that gives it a pulled stretched skin appearance. Lifts that tighten this SMAS result in a more natural and longer lasting result.

Andrew Jacono, MD
Great Neck Facial Plastic Surgeon
4.7 out of 5 stars 199 reviews

SMAS and Platysma in a Facelift


The Platysma is the muscle that lies just under the skin in the neck area. The platys ma is typically pulled and tightened to eliminate the sagging skin of the neck. It also takes the tension off the skin incision to prevent healing with stretch marks.

The SMAS ( SubMuscularApenueroticSystem) lies just under the skin in the face. The SMAS is contiguous with the Platysma in the neck. SMAS is also tightened to lift the jowl and sometimes the midface (esp. deep plane facelifts).

If your issue is the jowl and neck, then tightening the platysma and SMAS is the way to go.


Dr. S.

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 272 reviews

What kind of facelift is best? What are the different types of Facelifts and what is the difference between them?

There exist a vast array of facelift techniques, which can make it confusing for the patient. What’s the difference between the deep plane, high SMAS, MACS lift, lateral SMASectomy, short scar, skin only facelift really? The differences mostly have to do with how and what part of the tissue deep to the skin in the face, which is called the SMAS, are manipulated.  So when someone says they are doing a SMAS lift they are lifting that deeper tissue layer to contour the face and not just pulling or lifting the skin that is superficial to the SMAS layer. The topic of which type of facelift is best has been studied, and the conclusion in the vast  majority of these studies thus far has been that it has more to do with the surgeon than the specific surgical technique used. In short, I think a patient should look less at a particular technique but rather a surgeons previous work and whether the result is in line with what they are looking for. 

Jason Roostaeian, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 8 reviews


A well performed facelift includes tightening of the SMAS tissue. There are different SMAS tightening techniques for lower face and neck rejuvenation. I have performed well over 2500 facelifts and found that Double C plication technique will create the most natural and long lasting results. For mid face I recommend fat grafting with PRP to enhance the volume.

Kevin Sadati, DO
Orange County Facial Plastic Surgeon
4.9 out of 5 stars 204 reviews

Difference Between a Lower Facelift & SMAS Facelift

The difference is that a lower facelift includes a lower face and necklift and is synonymous with a SMAS facelift as I do a multiple layer “Lift & Fill” facelift which is both a SMAS facelift  and lower face/necklift. It is sometimes confusing to the consumer, but a real facelift consumes the superficial and deep facial layers with repositioning and shaping, as well as “Lifting & Filling” to correct aging and to restore your natural facial appearance.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 62 reviews

Lower Facelift Versus SMAS Lift

There are many different types of facelifts.  It is sometimes better to focus less on semantics and more on what is anatomically being done.  A lift should focus on the area(s) which require rejuvenation which can include the neck, platysmal bands, jowling, cheek pad, shape of the face, etc.  

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 163 reviews

Facelift semantics

There are no standardized terms for the facelift techniques. Most patients would be better served by focusing on the results they see from different doctors and which they like best than to focus on the "name" of one procedure vs another.

A lower facelift is one that addresses the face from the cheeks to the neck. A SMAS lift is often done at the same time as part of the lower facelift. The SMAS portion is what is done to lift the deeper tissues of the cheek back up to where the descended from in aging.

Again, try to find the doctor whose results most impress you and don't dwell too much on the terminology.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.