Facelift roulette: Which option has the best odds of meeting your desired look postop?
For many patients considering facial rejuvenation, the world of facelift terminology can feel truly overwhelming. Terms such as deep plane, SMAS, mini lift and nonsurgical facelift are often used in marketing and online discussion, often creating confusion about what each procedure actually does. While it may seem like choosing the "right" facelift technique is simply a matter of selecting the most advanced option, the reality is far more nuanced.
The most successful facelift outcomes depend on a combination of factors, from facial anatomy and skin quality to degree of aging and personal goals. For patients in their mid-50s and beyond, understanding these distinctions is key to making confident, informed decisions. To learn more about the most common facelift approaches, what each is designed to address and how individualized treatment planning with a qualified surgeon is key, we reached out to ASPS Member Surgeons Sheila Nazarian, MD, and Omar Hussain, MD.
Deep plane facelift
Concerns it best addresses
Dr. Hussain: This is ideal for patients with heavy nasolabial folds, marionette lines, jowls and platysmal bands.
What makes it different
Dr. Hussain: What distinguishes it from other techniques is the complete release of all three retaining ligaments, allowing soft tissue to be maximally repositioned without tension. This results in a more powerful and longer-lasting lift. The trade-off is an increased risk of motor nerve injury during dissection, though in experienced hands this risk remains low. Reduced wound tension also translates to fewer scar-related complications.
Realistic results
Dr. Hussain: Operative time is longer, but so are the results. Patients can expect outcomes lasting 10 to 15 years, with an average time to revision of approximately 11 years.
Good candidates
Dr. Hussain: This is ideal for patients with heavy nasolabial folds, marionette lines, jowls and platysmal bands.
SMAS facelift
Concerns it best addresses
Dr. Nazarian: Moderate to advanced facial aging – jowls, nasolabial folds, marionette lines and lower-face descent.
What makes it different
Dr. Nazarian: This technique lifts and repositions the SMAS (superficial musculoaponeurotic system), not just the skin. By addressing the deeper structural layer, results are more natural and longer-lasting.
Realistic results
Dr. Nazarian: Comprehensive rejuvenation of the lower two-thirds of the face with results lasting 10 to 15 years, depending on patient factors.
Good candidates
Dr. Nazarian: Patients with visible structural descent and skin laxity who want meaningful, durable improvement.
Who should avoid
Dr. Nazarian: Patients with very minimal laxity (who may be overtreated) or those medically unfit for surgery.
Mini facelift
Concerns it best addresses
Dr. Hussain: The term "mini facelift" is, at best, nebulous. It encompasses a wide range of procedures without any shared or standardized definition. Most commonly, it refers to a SMAS plication lower facelift, often performed under local anesthesia. The confusion arises because the term is used loosely across practices to describe a less aggressive version of whatever a given surgeon typically performs.
What makes it different
Dr. Hussain: In my hands, a mini facelift refers to any deep plane facelift that addresses fewer than all three retaining ligaments – whether that's a single ligament release in the upper face for mid-cheek lifting or release of the lower two ligaments for a lower deep plane lift. For this reason, comparing one surgeon's mini facelift to another's is largely meaningless.
Realistic results
Dr. Hussain: The term has obvious appeal to patients because it implies a less aggressive procedure and quicker recovery, but I caution patients against pursuing a mini facelift if their anatomy actually requires more extensive work.
Good candidates
Dr. Hussain: Ideal for patients looking to address one area.
Mid-facelift
Concerns it best addresses
Dr. Nazarian: Volume descent in the cheeks, flattening of the midface, deep nasolabial folds and tear trough elongation.
What makes it different
Dr. Nazarian: Unlike traditional lower facelifts, a mid-facelift focuses on elevating the malar fat pad and restoring cheek projection. It does not primarily treat the neck or jawline.
Realistic results
Dr. Nazarian: Improved cheek contour, softened nasolabial folds, and a more youthful transition between the lower eyelid and cheek.
Good candidates
Dr. Nazarian: Patients whose primary complaint is "tired" or hollow cheeks rather than jowls or neck laxity.
Who should avoid
Dr. Nazarian: Patients whose main concern is neck aging or heavy lower-face laxity.
Lower facelift
Concerns it best addresses
Dr. Hussain: The lower facelift targets the jowls and marionette lines at the corners of the mouth, sharpening the jawline without addressing the mid-cheek. It is most commonly combined with a neck lift to further define the jawline.
What makes it different
Dr. Hussain: In most surgeons' hands, this is performed as a SMAS plication (a surgical technique to tighten tissue). Dissection proceeds just beneath the skin, and sutures are placed in the superficial fascia to resuspend the tissues while leaving the masseteric ligament intact.
Realistic results
Dr. Hussain: It is a relatively quick procedure with a fast recovery that addresses the concerns most patients present with. When performed as a deep plane technique, the masseteric and deep cervical ligaments are released to achieve the same goals, with a modestly longer recovery but more durable results.
Good candidates
Dr. Hussain: This is ideal for patients with primarily marionette lines, jowls and neck laxity.
Neck lift
Concerns it best addresses
Dr. Nazarian: Platysmal banding, submental fullness, loose neck skin and loss of cervicomental angle.
What makes it different
Dr. Nazarian: A neck lift focuses specifically on tightening the platysma muscle and removing excess skin and/or fat in the neck. It may be performed alone or with a facelift.
Realistic results
Dr. Nazarian: A sharper jawline and more defined neck contour. It does not significantly lift midface structures.
Good candidates
Dr. Nazarian: Patients whose primary complaint is neck aging, even if their mid-face remains relatively youthful.
Who should avoid
Dr. Nazarian: Patients with significant lower-face descent who would benefit more from a combined facelift/neck lift approach.
Thread lift (nonsurgical)
Concerns it best addresses
Dr. Nazarian: Very mild sagging in younger patients seeking subtle improvement without surgery.
What makes it different
Dr. Nazarian: Temporary sutures are placed under the skin to provide mild lifting and collagen stimulation. It is minimally invasive with minimal downtime.
Realistic results
Dr. Nazarian: Subtle lift lasting approximately three to nine months. It does not replicate surgical results.
Good candidates
Dr. Nazarian: Patients in their 30s or 40s with early laxity who are not ready for surgery.
Who should avoid
Dr. Nazarian: Patients expecting surgical-level lifting or those with moderate-to-severe skin laxity. Thin-skinned patients can show the pulling of the thread through their skin, especially when they animate.
Liquid facelift (nonsurgical)
Concerns it best addresses
Dr. Hussain: Facial aging involves a combination of bony resorption, ligament laxity and descent of skin and fat, and the premise of a liquid facelift is that restoring volume can reverse this process.
What makes it different
Dr. Hussain: A liquid facelift uses volume – whether through injectable fillers or fat grafting – to expand facial tissue compartments and elevate soft tissues through inflation rather than repositioning.
Realistic results
Dr. Hussain: In practice, however, it falls short of what surgical lifting achieves. Inflating compartments to "lift" lax ligaments and fill stretched skin requires significant overcorrection, which distorts facial proportions rather than restoring them. This is most evident beneath the zygomaticocutaneous ligament in the upper face, where a liquid facelift characteristically produces excessive width in the upper face and mid-cheek. While volume restoration is a valuable adjunct to surgical rejuvenation, it should not be conflated with a facelift – the mechanisms and outcomes are fundamentally different.
Good candidates
Dr. Hussain: Ideal for younger patients who aren't candidates for facelifts and just need focal volume restoration.
Endoscopic facelift
What makes it different
Dr. Hussain: One of the most significant advancements in facelift surgery has been the integration of endoscopy. Using small incisions and high-definition video, surgeons can enter, release and reposition tissues without the need for lengthy incisions, minimizing scarring and allowing scars to be placed in better-concealed locations.
Realistic results
Dr. Hussain: Younger patients are often candidates for purely endoscopic procedures, with incisions hidden entirely within the hairline rather than in front of it. Even in full facelift cases, the upper portion of the procedure can be performed endoscopically as part of a hybrid approach, limiting incision length while preserving the full benefit of the lift.
Good candidates
Dr. Hussain: Ideal for patients needing to address the upper face with ligament laxity and minimal skin redundancy.
Ponytail facelift
What makes it different
Dr. Hussain: The ponytail facelift is a specific type of endoscopic facelift pioneered by Dr. Chia Chi Kao.
Realistic results
Dr. Hussain: It involves a novel and powerful release and suspension of lateral brow and upper face tissues, replicating the lifting effect seen when the hair is pulled back into a tight ponytail.
Picking the facelift option right for you
At the end of the day, there isn't one "best" facelift technique, only the one that best matches a patient's anatomy, concerns and desired results. Whether someone is exploring surgical options, such as deep plane or SMAS lifts, or considering nonsurgical treatments for subtle refinement, the most important factor is a personalized approach from a board-certified plastic surgeon.
By focusing on individual needs rather than terminology alone, patients can achieve natural-looking, long-lasting results that align with their unique goals.
To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.
