The SMAS (Superficial Musculoaponeurotic System) is a supportive layer beneath your skin that maintains facial structure and expression. Over time, the SMAS naturally relaxes and descends, creating sagging cheeks, jowls, and deeper lines around your nose and mouth.
Unlike traditional skin-only lifts, which can sometimes appear unnatural or overly tight, the SMAS facelift lifts and restores the deeper facial structures. The result is a more youthful, naturally refreshed look with smooth, harmonious facial contours.
This cross-sectional illustration shows the five key layers of facial soft tissue, essential for understanding aging and facial surgery. (1) The skin (epidermis and dermis) forms the outer protective layer and defines surface appearance. (2) Beneath it lies the subcutaneous fat, which adds volume and smooth contours but diminishes with age. (3) The SMAS (Superficial Musculo-Aponeurotic System) is a fibromuscular layer that connects facial muscles to the skin and is the primary focus in deep facelift techniques. (4) Below the SMAS is a layer of loose areolar tissue and retaining ligaments, which allow movement but contribute to sagging over time. (5) The deep fat compartments rest against the bone, providing foundational structure and influencing facial shape and aging.
How is the SMAS Facelift Performed?
A typical SMAS facelift takes about 2–3 hours and is comfortably performed either under general anesthesia or local anesthesia with sedation, depending on your preferences and surgeon’s recommendation.
Step-by-step procedure:
Your surgeon will place discreet incisions carefully around your ears and along your natural hairline.
The skin is gently lifted to access the deeper SMAS layer.
The SMAS layer is then tightened using one of several specialized techniques.
Excess skin is carefully removed, and the remaining skin is smoothly repositioned without tension.
Small temporary drains may be placed to manage swelling.
SMAS Facelift Techniques Explained
Several variations of SMAS facelift are used based on your facial structure, skin quality, and rejuvenation goals:
SMAS Plication: The SMAS layer is folded and sutured for support without tissue removal, preserving facial volume.
SMASectomy: A small portion of the SMAS is removed, making it ideal for thinner faces or more significant skin laxity.
Extended (High SMAS): A deeper, more extensive lift targeting the midface and cheekbones for pronounced rejuvenation.
Lateral SMASectomy: A popular variation offering consistent results with lower complication risks.
SMAS vs. Deep Plane Facelift: Key Differences
Both facelift methods address deeper facial structures, but they differ in surgical approach:
Feature
SMAS Facelift
Deep Plane Facelift
Dissection depth
SMAS Facelift Moderate
Deep Plane FaceliftDeeper, under ligaments
Recovery
SMAS FaceliftFaster, less swelling
Deep Plane FaceliftSlightly longer recovery
Complication rate
SMAS FaceliftLower (~4.2%)
Deep Plane FaceliftHigher (~12.1%)
Longevity
SMAS Facelift6–8 years on average
Deep Plane Facelift10+ years in older patients
Best for
SMAS FaceliftAges 45–65, moderate aging
Deep Plane FaceliftAges 65+, advanced sagging
Visual comparison of SMAS vs Deep Plane facelift techniques. The SMAS facelift repositions the superficial musculo-aponeurotic system with an oblique lifting vector, primarily targeting the jawline and lower face. In contrast, the Deep Plane facelift lifts the skin, SMAS, and deeper ligaments as a single unit, enabling vertical elevation of the midface and cheeks for a more natural and comprehensive rejuvenation.
Both techniques deliver effective rejuvenation, but the SMAS facelift is preferred for its lower risk profile and quicker recovery, particularly for patients with moderate signs of aging.
Concerns Addressed by a SMAS Facelift
This facelift effectively improves:
Sagging jowls along your jawline
Drooping or flattened cheeks
Prominent nasolabial folds around the mouth
Mild to moderate neck laxity (often enhanced by an accompanying neck lift)
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What to Expect During Recovery
Recovery timelines vary, but most people follow this general progression:
Days 1–3: Swelling and bruising peak; rest is essential. Sleep with your head elevated to minimize swelling.
Week 1: Swelling significantly subsides; stitches are removed.
Week 2: Comfortable return to social and work activities, often with the aid of makeup.
Weeks 3–4: Mild residual swelling and stiffness diminish steadily.
Months 2–3: Final results fully emerge; scars fade considerably.
Temporary tightness or numbness around incisions typically resolves within a few months. Following your surgeon’s aftercare instructions closely helps ensure smooth healing.
Longevity and Realistic Expectations
Typically, SMAS facelift results last 6 to 8 years, with many patients enjoying noticeable improvement beyond 10 years. While the procedure turns back the clock, it does not halt aging entirely. Your face will continue aging naturally, but from this refreshed point forward.
Potential Risks and Complications
Performed by qualified, experienced surgeons, SMAS facelifts are safe and reliable. However, all surgical procedures carry some risk:
Hematoma: Rare, around 2% (higher in males or patients on blood thinners).
Nerve injury: Extremely rare (<0.3%) and generally temporary.
Skin necrosis or poor healing: Very uncommon; risk increases in smokers.
Visible scars or asymmetry: Rare with skilled surgical technique.
Careful patient selection, excellent surgical technique, and thorough postoperative care significantly reduce these risks.
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Are You an Ideal Candidate?
You may benefit from a SMAS facelift if you:
Are between your 40s to mid-60s
Notice sagging jowls, facial folds, or loss of definition in your jawline
Have good general health and realistic expectations
Desire subtle, natural rejuvenation rather than a dramatic change
Before and after SMAS facelift results in a middle-aged woman.
Skin Resurfacing: Improves skin tone, texture, and fine lines.
Combining procedures can create comprehensive rejuvenation, achieving balanced and harmonious results.
Explore and Compare SMAS and Deep Plane Facelift Specialists Unsure which facelift suits you best? Our providers specialize in both techniques, allowing you to make a fully informed decision. View All Rejuvenation Experts
SMAS Facelift Costs in Belgium
Costs vary depending on your surgeon's experience, specific technique, and combined procedures:
SMAS facelift alone: €6,000–€10,000
With neck lift or additional enhancements: €12,000+
Quality and surgeon experience are always worth the investment—your facial rejuvenation should be safe, satisfying, and lasting.
In Summary
The SMAS facelift remains a gold-standard procedure, delivering significant rejuvenation by precisely repositioning deeper facial layers. It’s ideal for achieving subtle, lasting results without the heightened risks or prolonged recovery of more aggressive techniques.
With a carefully customized approach and skilled surgical hands, a SMAS facelift restores youthful contours and natural harmony, helping you look refreshed, not altered.
Achieve Beautiful, Lasting Results with Top SMAS Specialists Our trusted directory connects you with highly-rated aesthetic surgeons specializing in advanced SMAS facelifts and comprehensive facial rejuvenation. Meet Your Ideal Surgeon
FAQ
What is a SMAS facelift?
A SMAS facelift is a surgical procedure that lifts and tightens the deeper layer of tissue beneath the skin—called the superficial musculoaponeurotic system (SMAS). This layer plays a major role in facial structure and expression. By repositioning it, the surgeon restores youthful definition to the jawline, cheeks, and lower face without pulling the skin tight.
How is a SMAS facelift different from other facelifts?
The SMAS facelift targets deeper structures than a traditional skin-only facelift, making the results more natural and longer-lasting. Compared to a deep plane facelift, it involves less extensive dissection, carries fewer risks, and has a faster recovery time—making it ideal for patients with moderate signs of aging.
Who is a good candidate for a SMAS facelift?
Ideal candidates are in their 40s to mid-60s with moderate sagging in the cheeks, jawline, or neck. You should be in good health, a non-smoker, and have realistic expectations. If you're looking for subtle, natural rejuvenation—not dramatic transformation—a SMAS facelift may be right for you.
What concerns does it treat?
A SMAS facelift effectively improves:
Jowls and jawline sagging
Drooping cheeks
Deep nasolabial folds
Mild to moderate neck laxity
What techniques are used during a SMAS facelift?
There are several variations your surgeon may use:
SMAS plication: folding and suturing the SMAS layer without removing tissue
SMASectomy: removing a small portion of the SMAS before tightening
Extended/High SMAS: targeting the midface more aggressively
Lateral SMASectomy: a commonly used modification with good reliability
Your surgeon will choose the method based on your facial anatomy and aging pattern.
What is recovery like after a SMAS facelift?
Most patients experience swelling, bruising, and tightness for the first few days. Stitches are typically removed after one week. Many return to social or work activities by the second week, and the final results become visible between 6 and 12 weeks. Some numbness or stiffness may persist temporarily.
How long do the results last?
On average, SMAS facelift results last 6 to 8 years. With good skincare and sun protection, improvements may be visible for even longer. It doesn’t stop aging, but it resets the clock by lifting facial structures back to a more youthful position.
What are the risks?
Complications are rare when performed by an experienced surgeon. They may include:
Hematoma (~2%)
Temporary nerve weakness (<0.3%)
Minor asymmetry or visible scarring
Skin healing issues in smokers
Following your post-op instructions and choosing a certified specialist reduces these risks significantly.
Can a SMAS facelift be combined with other procedures?
Yes. Many patients enhance their results by combining SMAS with:
Neck lift (tightening neck muscles)
Fat transfer (restoring lost volume)
Eyelid surgery (blepharoplasty)
Skin resurfacing (for wrinkles and tone)
These combinations create balanced, more complete rejuvenation.
How much does a SMAS facelift cost in Belgium?
Prices range from €6,000 to €10,000 for the SMAS facelift alone. When combined with neck lift, fat grafting, or other enhancements, total costs may rise to €12,000 or more. Deep plane facelifts, if indicated, can cost up to €15,000.
Sources et références médicales
References & Medical Sources
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Awad, Y., Nasr, M., Ahmed El-Sayed, M. (2025). 'Comparison between Superficial and Deep Plane Facelift: Meta-Analysis Study', Zagazig University Medical Journal, 31(3), pp. 1257-1271. doi: 10.21608/zumj.2025.352792.3795
Boyd, C.J.; Ceradini, D.J. Current Trends in Facelift and Necklift Procedures. J. Clin. Med.2025, 14, 4273. https://doi.org/10.3390/jcm14124273
Jacono AA, Alemi AS, Russell JL. A Meta-Analysis of Complication Rates Among Different SMAS Facelift Techniques. Aesthet Surg J. 2019 Aug 22;39(9):927-942. doi: 10.1093/asj/sjz045. PMID: 30768122.
Vayalapra, Sushanth MBChB, BMedSci (Hons), MRCSa; Guerero, Daniel N. MBChB (Hons), BSc (Hons), MRCSb; Sandhu, Vinesh BScc; Happy, Armand AK MD, MPH, HEORd; Imantalab, Delaram BSce; Kissoonsingh, Priyanka MBChBa; Khajuria, Ankur MBBS (Dist.), MSc (Oxford), PhDf. Comparing the Safety and Efficacy of Superficial Musculoaponeurotic System and Deep Plane Facelift Techniques: A Systematic Review and Meta-analysis. Annals of Plastic Surgery ():10.1097/SAP.0000000000004454, July 15, 2025. | DOI: 10.1097/SAP.0000000000004454
Sinclair NR, Coombs DM, Kwiecien G, Zins JE. How to Prevent and Treat Complications in Facelift Surgery, Part 1: Short-Term Complications. Aesthet Surg J Open Forum. 2021 Feb 10;3(1):ojab007. doi: 10.1093/asjof/ojab007. PMID: 34212140; PMCID: PMC8240741.
Ricardo O Amador, Ryoko Hamaguchi, Richard A Bartlett, Indranil Sinha, Limited Incision Facelifts: A Contemporary Review of Approaches and Complications, Aesthetic Surgery Journal, Volume 44, Issue 3, March 2024, Pages NP218–NP224, https://doi.org/10.1093/asj/sjad344
Becker FF, Bassichis BA. Deep-plane face-lift vs superficial musculoaponeurotic system plication face-lift: a comparative study. Arch Facial Plast Surg. 2004 Jan-Feb;6(1):8-13. doi: 10.1001/archfaci.6.1.8. PMID: 14732637.
Gandra, G., Silva, B.S. & Horta, R. Facelift Surgery and Nerve Injury: A Systematic Review and Meta-Analysis. Aesth Plast Surg (2025). https://doi.org/10.1007/s00266-025-04932-7
Medical Disclaimer This article is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. It is based on peer-reviewed medical research, clinical guidelines, and expert-reviewed medical literature to provide clear, reliable, and up-to-date information for patients. Always consult a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. We do not promote any specific treatment, product, or provider, and there are no conflicts of interest influencing the content. All before-and-after photos shown on this page are licensed stock images intended for illustrative purposes only. They do not depict actual patients of the surgeons listed on our site. Results may vary based on individual anatomy and treatment plans.
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