Direct answer
The SMAS is the superficial musculoaponeurotic system, a supportive layer between the facial muscles and skin. Facelift techniques differ in whether this layer is folded, tightened, repositioned or released from below.
The SMAS (Superficial Musculoaponeurotic System) is the connective-tissue layer just beneath the facial skin that envelops the mimetic muscles and supports the soft tissues of the face. With ageing it loosens: the cheeks descend, jowls blur the jawline, and the neck-chin angle softens.
Modern facelift planning may address the skin, SMAS, fat compartments and neck structures according to the individual. “SMAS facelift” is not one standardized operation; plication, SMASectomy, imbrication and high-SMAS describe different scopes.
Incisions follow the hairline and natural creases around the ear. After the skin is elevated, the SMAS layer is either folded (plication) or partially removed and re-anchored (SMASectomy/imbrication). This restores the jawline and cheek, allowing excess skin to be removed without tension. The operation is performed under general anaesthesia and is frequently combined with a neck lift (platysmaplasty). Recovery is typically 2–3 weeks to social activities.
In the high-SMAS variant the flap is released and suspended from a higher level, above the zygomatic arch, which gives stronger midface (cheek) elevation than the classic approach.
The difference is whether the surgeon works on top of or underneath the SMAS:
Comparative reviews indicate that both approaches can help selected patients; they do not establish that one is safer, more natural or longer-lasting for everyone. The plan depends on anatomy, the distribution of laxity, the neck component, health status and expectations.
How long does a SMAS facelift last? A facelift does not stop ageing. How the result looks and how long it remains visible vary with anatomy, technique, healing, sun exposure, smoking and weight change.
Which is better, SMAS or deep plane? Neither is universally better; the degree and location of laxity decide. Pronounced midface descent favours deep plane; milder laxity is well served by SMAS techniques.
Can it be combined with a neck lift? Yes — combining a SMAS or deep plane facelift with platysmaplasty in one session is common when neck laxity coexists.
*This content is for information only; the treatment decision is made with your surgeon after examination.*
SMAS techniques may tighten or reshape the layer from its surface. A deep plane approach enters below the SMAS in selected areas to release retaining ligaments. No single technique is superior for everyone; the choice depends on anatomy and surgical goals.
These sources support general medical information and do not replace an individual assessment.
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Facelift in Istanbul: assessment, technique and recovery
ENT Specialist & Head and Neck Surgeon
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