SMAS Facelift
Comprehensive Facial Rejuvenation by Repositioning the Foundation of the Face
Overview
A youthful face is supported by far more than smooth skin. Beneath the surface lies a complex network of connective tissue, muscles, ligaments, fat, and facial support structures that work together to maintain youthful contours and natural facial expression. As we age, these deeper structures gradually weaken and descend, causing the cheeks to lose volume, the jawline to soften, jowls to develop, and deep folds to appear around the nose and mouth.
For many years, facelift surgery focused mainly on tightening the skin. While these early techniques temporarily reduced wrinkles, they failed to address the true cause of facial aging and often produced an unnatural, overly tight appearance that became increasingly obvious over time.
Modern facelift surgery has evolved significantly. Today, the SMAS (Superficial Musculoaponeurotic System) Facelift is considered one of the most established and reliable techniques for restoring youthful facial contours because it addresses the deeper structural layers of the face rather than the skin alone.
At Sketch Plastic Surgery Korea, the Full SMAS Facelift is designed for patients with moderate to advanced facial aging who require comprehensive rejuvenation of the cheeks, jawline, lower face, and lower facial support structures. By carefully lifting and repositioning the SMAS layer, our surgeons restore youthful facial architecture while preserving your natural facial movement, personality, and expressions.
Rather than creating a face that looks “operated on,” our philosophy is to help you look refreshed, rested, and naturally younger—while still looking like yourself.
Understanding Facial Aging
Facial aging is a three-dimensional process. It is not simply the result of loose skin.
Several changes occur simultaneously over time:
- Skin gradually loses collagen and elastin.
- Facial fat pads slowly descend due to gravity.
- The SMAS layer weakens and stretches.
- Retaining ligaments become more lax.
- Bone support subtly changes with age.
- Skin hydration and elasticity decrease.
These combined changes create:
- Sagging cheeks
- Deep nasolabial folds
- Marionette lines
- Jowls
- Loss of jawline definition
- Lower facial heaviness
- A tired or older appearance
Because these changes occur beneath the skin, simply tightening the skin cannot fully restore youthful facial structure.
Why Skin-Only Facelifts Became Outdated
Earlier facelift techniques relied primarily on pulling and tightening the skin. While this initially reduced wrinkles, the tension remained concentrated on the skin itself.
This often resulted in:
- Shorter-lasting results
- Visible tension around the mouth
- A stretched or “windswept” appearance
- Wider scars due to skin tension
- Recurrence of sagging over time
Modern facelift surgery instead places the lifting tension on the deeper facial support system, allowing the skin to drape naturally without excessive pulling.
This produces softer, more elegant, and significantly longer-lasting rejuvenation.
What Is the SMAS?
The Superficial Musculoaponeurotic System (SMAS) is a strong fibromuscular layer located beneath the skin and facial fat. It connects the muscles responsible for facial expression with the overlying tissues and serves as one of the primary structural support systems of the face.
As the SMAS weakens and descends, it contributes to many visible signs of facial aging.
A Full SMAS Facelift restores these deeper tissues to a more youthful position, improving facial support rather than simply tightening the surface.
Because the skin is no longer bearing the lifting force, the result appears natural and ages more gracefully over time.
How Is a Full SMAS Facelift Performed?
Each Full SMAS Facelift at Sketch Plastic Surgery Korea begins with a detailed facial analysis to evaluate skin quality, facial volume, tissue laxity, and overall facial balance.
Carefully concealed incisions are placed around the natural contours of the ear and, when necessary, extend discreetly into the hairline.
The skin is gently elevated to expose the SMAS layer. The surgeon then carefully lifts, repositions, and secures the SMAS to restore youthful support to the cheeks, jawline, and lower face. This deep structural repositioning allows the skin to be redraped naturally with minimal tension.
Excess skin is conservatively removed, and meticulous layered closure techniques are used to promote excellent healing and inconspicuous scars.
Every surgical plan is individualized according to each patient’s anatomy, degree of facial aging, and long-term aesthetic goals.
What Can a Full SMAS Facelift Improve?
A Full SMAS Facelift is designed to comprehensively rejuvenate the middle and lower face.
It can improve:
- Moderate to advanced jowls
- Sagging cheeks
- Deep nasolabial folds
- Marionette lines
- Loss of jawline definition
- Lower facial heaviness
- Facial asymmetry related to aging
- Overall facial contour
- A tired or aged appearance
Patients with significant neck laxity may benefit from combining the procedure with a Face & Neck Lift, which is discussed separately.
Who Is a Good Candidate?
A Full SMAS Facelift is often recommended for patients who have:
- Moderate to advanced facial sagging
- Well-developed jowls
- Significant loss of jawline definition
- Descending cheeks
- Deep facial folds
- Good general health
- Realistic expectations
Most candidates are between their late 40s and 70s, although the decision is based on facial anatomy and tissue quality rather than age alone.
Benefits of a Full SMAS Facelift
Compared with skin-only lifting or limited facelift procedures, a Full SMAS Facelift offers:
- Comprehensive facial rejuvenation
- Natural facial movement
- Long-lasting structural support
- Improved cheek position
- Better jawline definition
- Reduction of deep facial folds
- Minimal tension on the skin
- More discreet scars
- Elegant, natural-looking results
The objective is not to change your face—but to restore the youthful facial structure that has gradually been lost over time.
Can It Be Combined with Other Procedures?
Yes.
Many patients combine a Full SMAS Facelift with additional facial rejuvenation procedures, including:
- Upper Blepharoplasty
- Lower Blepharoplasty
- Brow Lift
- Temple Lift
- Fat Grafting
- Chin Augmentation
- Neck Liposuction
- Skin Laser Treatments
- Botox
- Dermal Fillers
By combining procedures, multiple aspects of facial aging can be addressed during one recovery period while maintaining balanced and harmonious facial proportions.
Anesthesia
At Sketch Plastic Surgery Korea, a Full SMAS Facelift is generally performed under Sleep Sedation with Local Anesthesia or General Anesthesia, depending on the extent of the procedure and whether additional surgeries are performed.
Our experienced anesthesiology team carefully monitors every patient throughout surgery to ensure safety and comfort.
Procedure Time
A Full SMAS Facelift typically requires 4 to 6 hours, depending on the complexity of the surgery and whether it is combined with complementary facial procedures.
Recovery & Downtime
Patients should expect mild to moderate swelling, bruising, and temporary tightness during the early recovery period.
Most patients feel comfortable returning to social activities within two to three weeks, although subtle swelling continues to improve over several months.
Light walking is encouraged early in recovery, while strenuous exercise should be avoided for approximately four to six weeks.
Final results continue to refine over six to twelve months, with scars gradually becoming less noticeable as healing progresses.
Full SMAS vs Mini SMAS vs Deep Plane Facelift
Choosing the right facelift depends on your facial anatomy and degree of aging.
Mini SMAS Facelift
- Best for early facial aging
- Smaller degree of tissue repositioning
- Shorter recovery
- Ideal for mild jowls and early jawline changes
Full SMAS Facelift
- Best for moderate to advanced facial aging
- Comprehensive lifting of the cheeks, jawline, and lower face
- Excellent long-term structural support
- One of the most established facelift techniques worldwide
Deep Plane Facelift
- An advanced facelift technique that releases deeper facial retaining ligaments in addition to repositioning the SMAS.
- Particularly effective for significant mid-face descent and deeper nasolabial folds.
- Often recommended for patients with more advanced aging or those seeking maximal, highly natural rejuvenation.
During your consultation, our surgeons will carefully determine which technique is most appropriate for your facial anatomy rather than recommending the same procedure for every patient.
Why Choose Sketch Plastic Surgery Korea?
At Sketch Plastic Surgery Korea, every facelift is individually planned—not standardized.
Our surgeons combine advanced SMAS techniques, meticulous surgical precision, and artistic facial analysis to create results that are elegant, balanced, and naturally youthful.
Patients choose Sketch because we provide:
- Experienced facial rejuvenation surgeons
- Customized SMAS facelift planning
- Advanced surgical techniques
- Natural-looking, long-lasting outcomes
- Careful scar placement
- Honest treatment recommendations
- English-speaking coordinators and multilingual support
- Comprehensive care for international patients
Restore Your Natural Youthfulness
A Full SMAS Facelift is more than a cosmetic procedure—it is a structural restoration of the face’s natural support system. By addressing the deeper causes of facial aging rather than simply tightening the skin, this procedure delivers comprehensive, elegant, and long-lasting rejuvenation.
If you are seeking meaningful facial rejuvenation with results that look refreshed rather than artificial, we invite you to schedule a complimentary online consultation with Sketch Plastic Surgery Korea. Our experienced surgeons will evaluate your facial anatomy, explain every available treatment option, and design a personalized surgical plan that reflects your unique goals and helps you achieve a naturally youthful appearance.
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.
One of the most significant face support structures is the superficial muscular aponeurotic system (SMAS). It is made up of a tissue layer that exists in the deep inner layers of the skin.
The SMAS lift is a more advanced facelift technique that focuses on the lower two-thirds of the face. The SMAS facelift can deliver excellent, long-lasting cosmetic rejuvenation outcomes by addressing the support layers of facial tissue.
SMAS 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.
Superficial Muscular Aponeurotic System (SMAS) Anatomy
The superficial musculoaponeurotic system (SMAS) is a layer of fibrous tissues and muscles that begins slightly in front of and below the ear and extends down to the neck.
As a continuous fibromuscular tissue, this thin yet strong layer covers and unites the muscles and tissues of the face, midface, and neck. It includes muscular regions, fat pads, and the whole cheek area, as well as adhering to the platysma, a superficial muscle that covers the lower face, jawline, and neck muscles.
As we age, the platysma muscle in the neck produces vertical muscular bands and “turkey neck.” This fibrous layer is subsequently hidden behind a fat (adipose tissue) and skin layer. The SMAS’s function is to keep the mimic muscles, which are vital for facial expressions, in a normal position.
Benefits of SMAS Facelift
Some characteristics of a SMAS Facelift include:
- Surgery time lasts 1½ to 2 hours long.
- Repositioning the SMAS results in vertical elevation of the face and neck.
- Drooping/Turkey Neck and Jowl Removal.
- the appearance of youth and naturalness.
- Deep wrinkle removal with long-term results.
- A simple treatment with few problems.
Who is a Good Candidate?
In general, if you have significant wrinkles and skin laxity, you may be an excellent candidate for this operation. Candidates must have a consultation visit to establish whether their skin condition is suitable for this operation or whether alternative treatments are more appropriate for their cosmetic objectives. Patients considering this surgery frequently express concerns such as:
- Sagging or loose skin.
- Moderate to severe wrinkles.
- Sagging jowls.
- Sunken cheeks.
- Double chin.
- Poor jawline.
Because this is a surgical procedure that will require the use of invasive techniques and general anesthesia, you must be completely qualified as a candidate before your treatment is planned. For others, this may imply that specific labs and blood tests must be completed before your treatment may be scheduled. Some of the qualifications we look at to see whether you are a good candidate for this operation include:
1. Good Health
Patients must be in generally excellent health. This means you don’t have any medical conditions, such as high blood pressure, diabetes, asthma or cardiovascular problems. If you are in good health, you will face less hazards if general anesthesia is required for your procedure. Your overall health will also influence how well you recover from the treatment, since people in excellent condition recover more swiftly and easily.
2. Elastic Skin Condition
Your skin’s condition is also important. Your skin condition should be such that some natural elasticity and flexibility remain in the structure of your skin. Essentially, your skin must still have some “bounce” for this technique to be as successful as possible. Your skin should be free of any suspected pathologies such face moles. The suppleness of your skin may be checked by pinching it and seeing how long it takes for it to smooth out. If your skin still feels squeezed, you may not be a good candidate for this operation.
3. Balanced Bone Structure
It’s easy to ignore, but the ideal candidates for this operation are individuals with naturally balanced bone structure. To get the optimum benefits from your therapy, your bone structure should be symmetrical. Of course, if your underlying bone structure isn’t suitable for this therapy, other plastic surgery techniques can correct asymmetries, or you can use fillers to sculpt your face to achieve the best results.
4. Realistic Expectations
You should also set reasonable goals for yourself. On average, this surgery may remove 10 years from your face, but factors like as your skin condition, genetics, and skin type may influence how much younger you seem following this operation. This technique just lifts and tightens the skin; it does not address other concerns, such as those relating to your bone structure. Please with your provider about the outcomes you may fairly expect from this operation.
5. Commitment To Maintain Results
Patients who want this surgery should ideally be committed to keeping the outcomes of the treatment. Your procedure’s benefits will persist for several years, but you will get the most out of them if you are proactive about your skin health.
When you utilize active skincare products like retinol and protect your skin from UV exposure by wearing SPF during the day, you may be able to keep your results longer.
SMAS Facelift Contraindications
Poor medical health, people who take blood-thinning drugs on a regular basis, patients with unrealistic expectations, and heavy smokers are all relative contraindications. Fine wrinkles that may be effectively treated nonsurgically or conservatively are contraindications to facelift surgery. Secondary facelifts should be performed with prudence as well, because the scar from the previous treatment may alter the original tissue planes, increasing the risk of facial nerve injury.
How do you know if you need a Face Lift?
For most people, cosmetic surgery is a “want” rather than a “need.” However, there may be certain warning signals to look for to assess whether you may benefit from a facelift procedure. For example, you may do a simple at-home “pull” test to see whether or not this technique will help you reach your aesthetic goals. Simply stand in front of a mirror at home and use your fingertips to gently pull the skin around your ears forward; if this movement also raises the skin on your cheeks, you may find this process beneficial.
Naturally, because everyone’s skin needs and goals differ, the signals that this procedure may be suited for you will differ. However, several examples indicate that now is the optimal time for this treatment, such as:
- Deep wrinkles on the lower face.
- Prominent cheekbones.
- Sagging jowls.
- Double chin or sagging neck.
Types of SMAS Facelift
SMAS facelifts are classified into five types: plication, imbrication, extended, high, and deep plane. Each of them refers to a somewhat different method of lifting and anchoring the SMAS layer. Surgeons have performed many of these types of facelifts throughout the years. Our current belief is that the deep plane facelift type of SMAS lift provides the most natural and long-term outcomes with the quickest recovery, however alternative forms of facelift have provided good results in some individuals. The two most prevalent SMAS facelift kinds are described below:
SMAS Plication Facelift
- Procedure
Mitz’s introduction and description of SMAS altered the idea of facelift. This approach was proposed as a new means of manipulating subcutaneous tissues to address senile changes in the face such as surface wrinkles and deep soft tissue sagging at the same time.
The fibrofatty nature of the SMAS layer offers it higher resilience against gravity than skin. The idea of the SMAS plication method was to manipulate a stronger layer that can withstand higher stresses than skin.
In this approach, the dissection plane is supraSMAS. The SMAS layer is visible after dissecting in the subcutaneous plane. The mobile section of the SMAS layer is connected to the posterior relatively immobile layer (i.e., the parotidomasseteric fascia) by three vertical sutures. To prevent bulging, the excess SMAS layer might be cut after suturing. This method is recommended for people in their forties and fifties who have thin skin and moderate to severe laxity. This approach is not appropriate for obese persons with thick skin.
- Advantages
SMAS plication appears to be a simple treatment with minimal risk of facial nerve injury. Despite the manipulation of the SMAS layer, the dissection plane lies above this layer and the facial nerve plane, making this approach generally safe. In this procedure, the operation time is minimal, and the recovery times is favourable.
This approach may produce a more visually beautiful midface outcome than DPFL. SMAS plication, on the other hand, may allow the surgeon to manage skin motions more effectively than MACS lift and is less invasive than subSMAS treatments.
- Disadvantages
This treatment is more challenging than DPFL for resolving neck aging. This problem is caused by an insufficient release of platysma facial attachments. SMAS plication is more invasive than other types of lifting, such as MACS lift. The surgeon is unable to manipulate deeply positioned soft tissues under the SMAS layer, resulting in very short-term effects as compared to DPFLs.
Extended SMAS Facelift
- Procedure
Lemmon’s description of subSMAS dissection was quickly adopted by aesthetic surgeons. The main principle of subSMAS modifications is to support the overlaying skin by modifying deeper soft tissues (i.e., the SMAS layer). Although SMAS plication appears to produce better results when the SMAS layer is thin, dissection of thick SMAS layers produces better results.
The fundamental approach for this method is to dissect and draw skin and SMAS flaps individually. The skin flap is initially dissected in the subcutaneous plane. After incising the SMAS layer, dissection is proceeded in the subSMAS plane.
There are five critical landmarks during performing extended SMAS facelifting:
- The first point is 1 cm inferior to the zygomatic arch, which is the origin of the frontal branch of the facial nerve. The incision to start sub‐SMAS dissection is from this point.
- The second important landmark is the beginning point of releasing and dissecting the platysmal auricular ligament. This second landmark is 3 cm below the earlobe.
- The third point is 5 cm below the mandibular angle, which is the inferior extent of sub‐platysmal dissection.
- Fourth landmark is the anterior border of the sub‐platysmal dissection, which is identified by the facial vein where it crosses the inferior border of the mandible.
- The last landmark is the zygomaticus major muscle, which is the anterior limit of sub‐SMAS dissection in the cheek.
The SMAS layer’s stretching vector differs from that of the skin. The SMAS layer’s retracting vector is more vertical than the skin flap’s. To enhance the jowl and cervical shape, the SMAS and platysma flaps might be adjusted in the postauricular region. The SMAS flap is advanced superolaterally in the malar fat pad region, perpendicular to the nasolabial fold.
- Advantages
By adjusting the skin and SMAS flaps independently, the surgeon is better able to reverse the symptoms of aging. Because the facial ligaments are released and the malar fat pad is repositioned, the results of this method are long lasting. As previously stated, we are capable of replacing the malar fat pad with this approach. A continuous SMASplatysmal flap can be used to provide the best results on the lower face and neck. By separating the skin and SMAS flaps, the strain of the skin flap is reduced, preventing the artificial look of skin found in other facelift procedures.
- Disadvantages
This approach requires more time to perform than other modifications. To split the soft tissue of the face into two different sections, this surgery is technically sensitive and requires a great deal of experience. This approach carries a substantial risk of facial nerve injury. Extensive dissection of skin areas increases the risk of necrosis. In this procedure, the impaired viability of the skin flap is a key problem. In younger individuals with minimal age signs and a youthful lower face and neck, this surgery is not recommended. In these cases, less invasive procedures such as short scar facelift methods are used.
SMAS Facelift Cost
The cost of SMAS layer facial plastic surgery varies based on the individual, their specific needs for their facelift, and the surgeon’s skill. A SMAS facelift might cost anywhere from $10,000 to $15,000 or more on average.
Of course, keep in mind that the money you spend on the facelift is a direct investment in yourself and your self-esteem.
What Happens After SMAS Facelift?
A healthcare practitioner will transport you to a room for observation while you recover from your facelift surgery. Once you’re stable, you’ll be able to leave the hospital. This normally takes a few hours.
A bandage may be wrapped over your face to assist reduce swelling and bruising. Small drainage tubes may also be present.
Your surgeon will give you precise instructions for your facelift surgery recovery, including how to care for your incision site(s) and drains, and will arrange a follow-up visit before you leave. If pain medication is required, your surgeon will write you a prescription.
SMAS Facelift Recovery Time
The amount of time it takes to recover from a facelift depends on the type of surgery and your overall health. You may get bruising and swelling for a few weeks. However, it may take two to three months for your face to feel “normal.”
Complications/Risks Associated with SMAS Facelifts
Facelift-related problems may include, but are not limited to, the following:
- Nerve damage. Along with numbness or alterations in skin feeling, facial nerve damage or weakening may develop. This might be either temporary or permanent.
- Infection and anesthetic response. As with any sort of surgery, there is a danger of infection and anesthetic response.
- Hematoma. A hematoma, or blood collection under the skin, might form. The doctor will usually remove them.
- Slower healing rate. Smokers, in particular, may experience a delayed recovery phase after a facelift. Smoking during the months preceding or following surgery might contribute to skin damage and permanent scarring. If you are actively smoking, your surgeon may refuse to conduct your procedure.
- Scarring. Scars that do not heal correctly may become more prominent or thicker than expected. This may need additional therapy or correction.
Conclusion
The SMAS (superficial muscular aponeurotic system) is the layer of the muscles of facial expression in their own connective tissue envelope. It lies beneath the skin and subcutaneous tissue. It is one of the most important support structures for the face and neck. The manipulation of this anatomic structure changes the appearance of the face and neck.
The SMAS rhytidectomy, also known as SMAS facelift, is a surgical procedure that corrects the sagging appearance of the neck and the lower two-thirds of the face. It is performed to change the appearance of sagging skin, excess fat, jowls, and loss of volume in the cheeks. It is less invasive than a regular facelift, which targets the superficial skin of the face, and recuperation is faster.
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