Last updated date: 17-Apr-2023

Medically Reviewed By

Interview with

Dr. Yong Woo Kim

Medically reviewed by

Dr. Btissam Fatih

Originally Written in English

Smas Facelift Facts - Viewpoints from Expert Doctors



    As we get older, our skin and tissues lose their elasticity. Then we start noticing wrinkles and skin sagging as we age. 

    The cosmetic industry is working on these points, all the products we see in the market lately are anti-aging with vitamin C, hyaluronic acid, and many other components that help people keep their skin integrity. However, some people don’t prefer long-term solutions, rather they prefer instant solutions with quick results. The medical field, especially plastic surgery, has accomplished what they wished for.

    A facelift, also known as rhytidectomy, is a cosmetic surgical procedure that tightens up the sagging and wrinkled face tissues. It creates a younger look and helps improve aging signs on the face and neck. 

    The procedure usually focuses on the lower two-thirds of the face and, sometimes, the neck. It involves removing excess skin, tightening up the skin, smoothing out wrinkles, and reducing the sagging fold of skin on the cheek and jawline. 

    During a facelift, on each side of the face, a flap of skin is pulled back. Then, the tissue under these flaps is changed to return the youthful contour and shape of the face. It doesn’t include eye or brow lift, although they can be done in the same setting. 

    A neck-lift, platysmaplasty, is often done as part of the facelift surgery by removing excess fat tissue and reducing the sagging folds. 

    Facelift surgery is a complicated treatment that involves a significant understanding of face anatomy, a very specialized set of surgical methods, and a highly developed aesthetic eye. Because not all cosmetic surgeons obtain facelift surgery training during their residency, it's critical to complete your research before selecting a facelift surgeon.

    Inquire about a potential cosmetic surgeon's specialized training and experience in facial cosmetic surgery while meeting with them. Find out how many facelift operations each has completed, and be sure to look at lots of before and after images during your appointment to get a sense of a cosmetic surgeon's aesthetic approach. Men seeking facelift surgery should ensure that their cosmetic surgeon has performed facelifts on male patients; the architecture of the male face differs from that of a woman's and necessitates a knowledgeable approach.


    Benefits of Facelift Surgery

    Benefits of facelift surgery

    Facelift surgery

    Benefits of facelift surgery


    These are the things that a facelift would give you. But what facelift surgery can't do? 

    Facelift surgery is considered a restorative surgery, which means it cannot change the fundamental shape of your face or stop aging, instead, it can bring back the youthful appearance you once had. It won’t decrease the fine lines and creases or the damage from sun exposure neither. It can’t change the quality and appearance of the skin itself. Some other procedures can do that. 

    Skin loses suppleness and facial tissues lose volume as we age. This causes "jowls" on the lower face, deep creases, and loose skin on the neck. While this is a normal aspect of aging, individuals who are disturbed by these indicators of age may find that a facelift is a viable option.

    So, as a quick recap, a facelift will:

    • Reduce the sagging appearance of your skin. 
    • Reduce excess skin at your lower jawline.
    • Remove excess skin and sagging folds of your neck.
    • Restore your youthful appearance. 


    Types of Facelifts

    Facelift surgery is individualized to the demands of the patient, and a cosmetic surgeon will modify his or her procedures accordingly.



    Patients with minimal jowling and sagging skin are often good candidates for a mini-facelift. This is a less invasive technique that allows a cosmetic surgeon to tighten deep facial tissues with shorter incisions along the hairline above each ear and/or in the natural creases surrounding the ear. To treat jowling, enhance the jawline, and revive a "tired" appearance, the structural tissues around the cheeks are lifted and tightened utilizing these incisions.

    Depending on the case, a mini-facelift may be performed under local anesthesia with sedation or under general anesthesia; your cosmetic surgeon will advise you on the best approach for your specific requirements. A mini-facelift can help you address unwanted indications of aging before they become too noticeable, delaying the need for more substantial surgery for several years.


    Standard Facelift

    A standard or "traditional" facelift will address moderate to advanced aging around the mid-face and neck more thoroughly. While the operation is more comprehensive than a mini-facelift, and so requires more recovery time, the results are more spectacular.

    A cosmetic surgeon can reposition the deeper tissues beneath the skin and remove excess skin to smooth creases, eliminate jowling and sagging skin under the chin, and restore a naturally youthful contour to the face and neck through incisions hidden in the natural folds just behind the hairline, near the temples, and around the front of the ear.


    Facelift Procedure 

    Facelifts, like other cosmetic procedures, can vary according to your desire. The traditional way includes a skin incision that is made in the hairline near the temples, extending in front of the ear, down to and hugging the earlobe, then backward to the lower scalp behind the ear. Fat and excess skin are then either removed or redistributed, then the surgeon will look at the underlying muscles and connective tissue, then they are redistributed and tightened. 

    If a neck lift is also intended, an incision is done just under the chin, the excess skin and fat will be removed. Then the skin is tightened and pulled up and back. 

    The specific method used by a cosmetic surgeon during a facelift is determined by a variety of factors, including the patient's anatomy and personal objectives, the extent of the facelift (mini vs. standard), and whether or not another surgery is being performed concurrently. Facelifts are usually performed under general anesthesia, while local anesthetic with sedation may be utilized in less invasive operations.

    The skin is separated from the underlying connective tissue and muscles once the initial incisions are made. This enables the cosmetic surgeon to realign the deeper facial tissues, remove jowls, and establish a stronger base for the skin. The excessive skin is then removed, and the remaining skin is delicately repositioned over the newly regenerated facial tissues, creating a smoother, more youthful contour without over-tightening the skin.

    Incisions are usually made to blend with hairline and natural skin creases. They are also sutured with dissolvable sutures. But naturally, incisions of the procedure depend on the technique and patient's preferences, options include: 

    • A traditional facelift incision. And this is the one we explained earlier. 
    • Neck lift incision. An incision that starts in front of your earlobe and continues around the ear backward to your scalp, then an incision is made under the chin. 
    • A limited incision. A shorter incision that starts in the hairline to the front of the earlobe but doesn’t wrap around your ear or reach the scalp. 

    The surgery usually doesn’t exceed two hours unless there is another procedure that will be done. 

    After the surgery, there will be a drain coming out from the surgical site to drain any excess fluids or blood. There will also be a bandage wrapping the surgical incision. before the surgery itself, there must be some steps you need to take to prepare yourself. 

    Initially, you will ask for a surgeon's opinion. Then, if you are going to do it, you will go through the process of preparations. This process consists of some steps including:

    1. Medical history and examination. Your surgeon will ask you about your past and current medical condition, previous surgeries, previous blood transfusions, previous plastic surgeries, previous complications after surgeries, history of smoking, and alcohol use. Then you will undergo a complete physical examination. You may also be asked to bring your latest clinical reports to make sure you can undergo surgery. 
    2. Review of medication. You will have to provide your surgeon with the names of any medications you are currently on including regular medications, over-the-counter drugs, prescription drugs, herbal drugs, vitamins, or even dietary supplements. 
    3. Facial examination. Your surgeon will take photos of your face from different angles and close-up photos. He or she will also examine your face shape, fat distribution, bone structure, and quality of skin to determine the best surgery option for your case. 
    4. Expectations of the surgery. Your surgeon will ask you about your expectations of the surgery, will explain to you the surgery, will tell you the outcomes and in what way your appearance will change, and will tell you what to expect and what not to expect. 

    Facelift procedure

    Facelift procedure

    Facelift procedure


    Risks of a Facelift

    A facelift surgery, likewise, with any other surgery, can cause some complications. Some complications with appropriate care, medications, and surgical correction can be managed. While other long-term or permanent complications, although rare, can change your appearance. 

    Here are some of the possible risks of facelift surgery: 

    • Anesthesia risks
    • Bleeding or hematoma. A hematoma is a collection of blood under the skin that causes swelling, pressure, and pain. This is probably the most common complication of facelift surgery. It collects about 24 hours after surgery and should be dealt with promptly. 
    • Nerve injury. It is a rare complication, yet it can permanently or temporarily affect sensory nerves or nerves that supply face muscles. If paralysis occurs to a group of muscles due to nerve injury, it will give you uneven facial expressions. It may improve with minimal surgical intervention.
    • Blood clots. 
    • Pain or scarring. Rarely, the incision might be raised and red. Corticosteroid injections will help with this situation. 
    • Skin loss. If facelifts interrupted the blood supply of the skin, there will be skin loss and sloughing off the dead skin. Sloughing is usually treated with medications, wound care, and maybe surgical interventions to minimize scarring. 
    • Infection. 
    • Cardiac problems. 
    • Problems with wound healing. 
    • Hair loss. You might find some areas of hair loss at the incision site; it may be permanent or temporary. Permanent hair loss is usually treated by skin transplants with hair follicles.
    • Prolonged swelling. 


    Some major health conditions will pose a higher risk if you want to have a facelift such as:

    • Smoking significantly causes poor wound healing and increases the risk for hematomas. 
    • Weight fluctuation history will affect the shape of your face and the fabric of your skin, so surgery results might not be as satisfactory for you. 
    • Certain medical conditions that cause poor wound healing include poorly controlled diabetes, blood diseases that prevent clotting, and high blood pressure. 
    • Blood-thinning medications. They will stop your blood from clotting and make you at a higher risk for hematomas and poor wound healing. 


    Nonsurgical Facelift

    There are a variety of useful, minimally-invasive solutions to consider if you want to avoid having a standard surgical facelift or if you've previously had a facelift and want to preserve your results. While these non-surgical procedures cannot repair drooping skin or rearrange tissues, they can effectively eliminate years from your look.

    They are an excellent approach to supplement the operation since they provide additional advantages that a surgical facelift cannot. Nonsurgical facelift alternatives that are currently popular include:

    • Laser skin resurfacing. Laser skin resurfacing can enhance skin tone and quality by smoothing fine lines and wrinkles, correcting age spots, acne scars, and discoloration, and smoothing fine lines and wrinkles. Depending on the depth of skin to be treated, laser treatments can be ablative or non-ablative. A variety of lasers can be utilized to revitalize the face.
    • Renuvion. Radiofrequency (RF) radiation and helium plasma are used to tighten loose skin and subdermal tissues. The combination of RF and plasma enables your surgeon to precisely control Renuvion's heating and cooling abilities, ensuring tissues are heated to the ideal temperature for a contraction while maintaining patient safety and comfort. Furthermore, Renuvion's RF radiation promotes collagen formation deep under the skin, resulting in firmer, younger-looking skin. Renuvion can be applied to the brow, lower cheeks, jawline, neck, and eye region to tighten the entire face.
    • Forma. By heating subdermal layers of tissue, radiofrequency (RF) energy is used to lift, tone, and smooth face and neck skin. This heat, like Renuvion, stimulates collagen formation inside the dermis for healthier-looking skin that improves with time. Forma's customized electrode-emitting handpiece allows doctors to observe patients' skin temperatures in real-time and includes a "cut-off" temperature for further patient safety.
    • Ultherapy. In the face and neck, ultrasound energy is used to tighten deep layers of skin and underlying muscle. It works by triggering "neocollagenesis," a process in which the body regenerates collagen proteins to promote healthy new skin development. The majority of patients experience a substantial improvement in their skin condition 2 to 3 months following their Ultherapy treatment.
    • RF microneedling. You're probably aware of the mechanics of microneedling, in which tiny needles are placed to the skin's surface layers to generate "micro-injuries" that cause the skin to repair itself. Radiofrequency (RF) microneedling takes microneedling to the next level by delivering RF energy to the skin on the face and neck, heating the deep dermis, and stimulating new collagen and elastin fiber development deep inside for visibly tighter, smoother skin that improves over time. 
    • Dermal fillers. For decades, injectable fillers have been one of the most popular nonsurgical methods for face rejuvenation, helping patients turn back the hands of time. Fillers are precisely injected beneath the skin to replenish volume lost in the cheekbones, temples, lips, under-eyes, and nasolabial folds, as well as to improve facial symmetry. A professional provider will utilize various fillers to improve various parts of the face. For example, it promotes collagen formation to gradually restore facial fullness and erase deep creases and folds for up to two years; it is perfect for lifting the cheekbones and adding volume to the mid-face, and it is popular for filling in undesirable smile lines. Fillers can also be utilized to enhance the chin for a thinner facial look and to define the jawline, as well as to generate temporary rhinoplasty effects. Filler results normally last 6 to 12 months, however, Sculptra and Bellafill can last up to two years.
    • Botox. Can't be topped for temporarily decreasing the appearance of dynamic wrinkles (those induced by facial movements). Botox is used to treat glabellar lines, horizontal forehead wrinkles, frown lines, crow's feet, and vertical lip lines. It can also be injected into the masseter muscle to shape the jawline and make it seem smaller and more sculpted. Botox is frequently used with dermal filler injections for a complete nonsurgical makeover. Typically, the effects last 3 to 4 months.
    • Fat injection. A qualified surgeon can collect undesirable body fat from the belly, flanks, or thighs via liposuction and inject it into the cheekbones, temples, or under-eyes to restore volume in the face for patients who desire long-lasting results. The fat injection produces semi-permanent effects that can endure for years, making it a suitable therapy for patients who want to avoid facelift surgery but want a more lasting outcome than dermal fillers can deliver.


    What is SMAS Facelift?

    The SMAS rhytidectomy, commonly referred to as a SMAS facelift, is a surgical technique that focuses on the lower two-thirds of the face. It is used to treat sagging skin, extra fat, jowls, and cheek volume loss. It is less invasive than a traditional facelift, which targets the face's surface skin, and the recovery time is shorter.

    SMAS stands for the superficial muscular aponeurotic system which is a layer of tissue deep within the skin and superficial tissue. It is considered one of the most important supportive structures in the face. Any change in this layer would result in changes in the facial appearance. 

    SMAS facelifts are procedures that target the lower two-thirds of the face. They also, just like regular facelifts, address sagging skin, excess fat, and loss of volume in the cheeks. However, they are not as invasive as regular facelifts. 

    The SMAS facelift technique is especially suitable for people seeking to improve cosmetic changes in their faces and necks due to aging.

    SMAS facelifts target specific goals in restoring young facial appearance including: 

    • Midface sagging.
    • Hollow cheeks. 
    • Sagging fats.
    • Jowls.
    • Sagging nasolabial folds.
    • Loose skin or fat under jawline or chin.  


    Who is a good candidate for SMAS Facelift? 

    If you are over 50, still have some elasticity in your skin and you want to correct a sign or two of aging, then you are a potential candidate. However, you must be healthy and a non-smoker. 

    The procedure might take several hours. An incision is made at the temple, above the hairline. Then. it extends down along natural creases of the skin but curve behind the ears. Then, the surgeon will lift and rearrange facial, neck tissue, and muscle beneath the skin into a higher position and remove excess skin. 


    What happens during the SMAS Facelift Surgery?

    • Before the operation, your surgeon will practice the operating steps on your face.
    • They will grab your skin to determine how much skin tightening is required to achieve the optimum outcomes.
    • They will mark your face in order to guide surgical incisions.
    • Your face will be washed with an antiseptic solution, and curtains will be placed over your eyes.
    • You will be given an anesthetic once you have been prepared for the surgery.
    • Because a facelift is a lengthy operation, local anesthetic combined with constant monitoring helps us guarantee that you are comfortable and pain-free during the process. 
    • Your skin will next be surgically sliced by the surgeon.
    • The face tissue and muscle beneath the skin will then be lifted.
    • Excess skin and muscles will be removed, and the elevated muscles and skin will be adjusted into a more acceptable posture.
    • The surgeon will sew the skin on your face together to reduce and conceal scars.
    • Finally, the dressing and drainage tubes are inserted.


    SMAS Facelift Cost

    A SMAS facelift operation might range between $10,000 and $15,000. The cost of a SMAS facelift is determined by the location, board-certified plastic surgeon, and length and complexity of the plastic surgery.


    How quick is the recovery from a SMAS Facelift?

    After a SMAS facelift, recovery is rather quick. During the first postoperative evening, the patient is usually able to shower. The sutures in the front are removed on the fifth day, and those in the back are removed on the eighth day. Even the use of pain killers is typically low.

    With each passing day, the patient's activity level rises. For the first five weeks, the patient will need to see the doctor once a week. Following that, three monthly check-ins are necessary, followed by an annual review.

    SMAS facelift


    How long does SMAS facelift last?

    The facelift will not provide you with long-term results. Despite the facelift, there will be changes in your face as you age.

    Several factors, like your age, general health, and addictions, influence how long the benefits will stay. The effects might endure anywhere from 10 to 12 years on average.


    What are the complications of a SMAS facelift?

    SMAS facelift surgery is a largely risk-free procedure. Complications, while uncommon, are including:

    • Nerve injury
    • Bleeding
    • Loss or sloughing of the facial skin
    • Pain
    • Muscle injury 
    • Fever
    • Infection
    • Scarring
    • Changes in skin color
    • Numbness



    To ensure that you get a comprehensive picture and understand everything regarding SMAS Facelift, we invited Dr. Kim who is a renowned cosmetics surgeon from Seoul, Korea to address any questions you may have from an experienced point of view.

    Dr. Yong Woo Kim


    1. How many kinds of facelifts are there in Korea?

    As far as facelifts, SMAS (superficial musculo-aponeurotic system) is a technique to fix and rearrange the sagging skin areas such as the eye area by pulling and setting to reduce sag. Depending on the focus point, there are a variety of techniques, so many doctors have their own unique techniques, so it is difficult to explain all right now, but focusing on the main incision methods we could say that it can start from above the ear line to the lower hairline to just in front of the ears and below.


    2. What's the difference between those two you have mentioned?

    Well, for the full incision method, we can lift the middle face and lower face including the jowls, while the limited incision method would only lift the middle and lower face area.


    3. How long does this SMAS lift last?

    Generally speaking, many say a facelift lasts 10 to 15 years, but, aging does not stop post-surgery, so when about 10 years pass, the patient also aged 10 years, so it is best if one undergoes additional surgery after that. Getting a facelift does not equate to getting 10 years younger. But when compared to a same-age person who has not undergone a facelift, the one with the facelift clearly looks younger.


    4. What kind of clients should have a facelift?

    Those who lack elasticity in their skin relative to their age, who have sagging skin, for example in their jowls, mouth, neck areas. Also, even for younger patients who have recently undergone sudden dramatic weight loss and thus, have sagging skin as well as those who have undergone contour surgery and need some skin tightening.


    5. What are the side effects of a facelift?

    In facelift surgery, relative to eye or nose surgery, there is a larger area affected, so there might be some bleeding or thrombosis, but those can be controlled or prevented to some degree by careful control of blood pressure. And, long-term, scarring and nerve sensitivity can result. In the case of scarring, we can use triamcinolone or other scar treatment ointments to remedy the condition and in the case of nerve sensitivity, a more careful surgical technique can prevent such conditions.


    6. How do clients take care after a facelift?

    After a facelift, in order to prevent the unraveling of the threads that are holding the SMAS tissue, it is best to avoid opening one’s mouth too wide, for example when eating or when visiting the dentist. Also, losing or gaining weight suddenly dramatically is also not the best. Also, laser lifting should be postponed for about three months.


    7. How long will the recovery period be?

    First, the main inflammation and bruises should subside in about a week. Also, the scarring should subside within two weeks. Thus, after one or two months, any remaining inflammation should disappear, and the face should look natural. At the start of recovery, a proper sleep posture and light exercise for example light walking should help to hasten the recovery process.


    8. What kind of person is not suitable for a facelift?

    Those who have very thin face skin or those who have very thick facial fat layers, while not ideal, can benefit from a facelift for a short period which can be supplemented with fat removal or stronger pull of the SMAS tissue in order to lengthen the facelift effect.



    Dr. Kim, a plastic surgeon at one of Korea's top clinics, adds that while many candidates for SMAS are those of the older age, many younger people also can benefit, for example, those who recently lost a lot of weight. The procedure typically lasts about ten years. Most recover significantly within a week or two after the procedure. And, after one or two months, all inflammation should subside. He also adds that one should not lose or gain too much weight right after the SMAS procedure.