1901 · Eugen Hollander, Erich Lexer
Skin-only facelift
Layer. Skin, freed from the tissue beneath
The surgeon frees the skin from the tissue beneath, pulls it tight and removes the excess. The sagging tissue underneath stays where it was. Skin closed under tension relaxes and loses the effect.[1][2][3]
Suits. Now a small share of facelifts: 8% among plastic surgeons tracked by their certifying board.
Trade-offs. Known drawbacks include a tight, mask-like look, a distorted earlobe or hairline, widened scars and skin loss at the flap edges. Skin-only lifts did nothing for the sagging midface.
SMAS plication facelift
Layer. SMAS, folded with stitches and left on the deeper layer
After the skin flap is raised, the surgeon folds the SMAS on itself with stitches. The SMAS is not lifted off the deeper layer, which keeps the work away from the facial nerve. It is the most common SMAS method among board-certified plastic surgeons.[1][2][3]
Suits. Jowls, a softened jawline and loose skin of the lower face and neck. Plication with neck tightening can be done under local anesthesia, going home the same day.
Trade-offs. In cadavers, extended dissection added only a little lift over plication except in the lower face. A 2026 cohort found the same satisfaction, recovery time and complication rates after plication and deep plane.
1997 · Daniel C. Baker
Lateral SMASectomy and SMAS imbrication
Layer. SMAS, cut: a strip removed, or cut and overlapped
In a lateral SMASectomy a strip of SMAS over the front edge of the parotid gland is removed and the edges are sewn together. In imbrication the SMAS is cut, overlapped and sewn, which can add fullness over the cheekbone.[1][2][3]
Suits. Lateral SMASectomy is a quick, reproducible operation for carefully selected patients. Rohrich chose SMASectomy or stacking for each side of the face by how flat the cheek had become.
Trade-offs. SMASectomy combines the pull of a flap with the speed and safety of plication. Major hematoma was most frequent after imbrication, at about 2 in 100 in pooled data.
2002 · Fritz E. Barton Jr., Timothy J. Marten
High SMAS facelift
Layer. SMAS flap, cut along the cheekbone arch
The SMAS flap is cut along the cheekbone arch so it lifts the midface, cheek and jawline as one unit. Over the arch the forehead branch of the facial nerve lies under a separate deeper fascia, which leaves it covered.[1][2][3]
Suits. Sagging of the midface, cheek and jawline together. A deeper fold beside the mouth led to a longer dissection.
Trade-offs. Temporary weakness of a facial muscle followed about 2 in 100 high lateral SMAS and composite lifts, more than after plication. In a randomized trial, high SMAS, deep-plane and plication lifts lowered perceived age by a similar amount.
1990 · Sam T. Hamra
Deep plane facelift
Layer. Under the SMAS, just above the deep fascia
The surgeon enters beneath the SMAS, releases the cheek ligaments and lifts skin, cheek fat and SMAS together as one flap. The dissection stays just above the deep fascia, under which the facial nerve branches run. Most surveyed facial plastic surgeons perform it.[1][2][3]
Suits. Jowls, a blurred jawline and a deep fold beside the mouth. The extended version adds the jaw angle and the neck.
Trade-offs. No study has shown that it lasts longer than other SMAS facelifts. Major hematoma followed about 1 in 80 deep-plane lifts in pooled data, more than after plication. Surveyed surgeons reported more temporary nerve weakness with deep-plane lifts.
1992 · Sam T. Hamra
Composite facelift
Layer. Deep plane flap that also carries the muscle around the lower eyelid
A deep-plane lift that adds the muscle around the lower eyelid to the flap, so the neck muscle, cheek fat and eyelid muscle move with the skin. Hamra later changed the eye-area step to stop the prolonged swelling it sometimes caused.[1][2][3]
Suits. Hamra used it to correct the hollow eyes and lateral sweep left by conventional lifts.
Trade-offs. In a split-face study the composite side looked better on the operating table, and no difference was visible at 6 and 12 months. Temporary nerve weakness followed about 1.5 in 100 composite lifts in pooled data.
2002 · Patrick Tonnard, Alexis Verpaele
Short scar facelift and MACS lift
Layer. SMAS, suspended with purse-string sutures, or a SMASectomy or deep plane release through the short incision
The incision runs in front of the ear and along the sideburn, without the extension behind the ear. In the MACS lift, two or three permanent purse-string sutures woven through the SMAS are tied to the temple fascia. They pull the neck, jowl and cheek straight up.[1][2][3]
Suits. Jowls and sagging cheeks with good skin and limited loose skin in the neck. People who want a smaller scar, a shorter operation or local anesthesia.
Trade-offs. The effect on the neck is limited. In twins randomized to a full or short incision, the full incision scored better in the neck at about five years. MACS patients returned to work at about 2 weeks.
1971 · Thomas J. Baker, Howard L. Gordon
Mini facelift
Layer. Limited incision with less skin undermining
Thomas Baker and Howard Gordon published the temporal face lift, called the mini-lift, in 1971. Suzanne Noel's petit operation, with short incisions hidden in the hairline and low skin tension, is the basis of the mini-lift and the short-scar facelift. Limited incision facelift is the umbrella term for short-incision approaches.[1][2][3]
Suits. People who want a smaller scar, a shorter operation or local anesthesia. Most limited incision facelifts are done awake or with light sedation.
Trade-offs. Complications followed about 3 in 100 limited incision facelifts in a review, most often hematoma. In the twin study the neck is where the short incision gave up the most.
1989 · Paul Tessier, Oscar M. Ramirez
Subperiosteal facelift
Layer. Under the periosteum, on the bone
The surgeon frees the soft tissue from the cheekbones, cheekbone arch and eye socket rims and lifts skin, fat, SMAS and periosteum as one unit. Early versions injured facial nerve branches too often. Ramirez changed the temple dissection in 1991 and reported no nerve injuries.[1][2][3]
Suits. Cheeks that have dropped below the eyes, leaving a long lower lid and a hollow under the eye.
Trade-offs. About 1 in 20 patients had a complication in a large series. Open versions can cause swelling, hair loss and scalp numbness. It accounts for about 1 in 100 facelifts among board-certified plastic surgeons.
2025 · K. Sadati, P. Quinodoz
Preservation facelift
Layer. Under the SMAS, separating as little skin as possible
Preservation lifts leave the skin attached to the deeper layer as much as possible and keep deep structures in place. One published version combines deep plane and high SMAS methods and rotates a flap of SMAS along the jaw. A conservation lift moves the cheek fat pad, skin and fat as one unit.[1][2][3]
Suits. Endoscopic deep-plane lifts through small temple incisions, a related tissue-sparing approach, suit mild to moderate skin laxity.
Trade-offs. The term has no standard definition, and published preservation and conservation lifts are different operations. The preservation lift had shorter drain times and fewer complications than the same surgeons' extended deep-plane lifts. Most reports come from the surgeon who developed the technique.
1980 · Richard Ellenbogen, Joel J. Feldman, T. Gerald O'Daniel
Neck lift with a facelift
Layer. Platysma muscle, and the deep fat, glands and digastric muscles under it
Ellenbogen and Karlin argued that tightening the platysma at the front of the neck matters more than pulling it from behind, and that fat under the muscle must come out in a heavy neck. Feldman's corset platysmaplasty joins the muscle edges with one continuous suture. O'Daniel found most of the volume removed in deep neck lifts lies under the platysma.[1][2][3]
Suits. A full neck from fat, glands or muscle under the platysma. Reducing them sharpens the angle under the jaw.
Trade-offs. Injury to the nerve to the lower lip is the most common complication of gland reduction. Submental liposuction with skin and platysma tightening alone leaves the deep structures untreated.
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