SMAS Facelift in Canberra: Technique, Candidates and What the Surgery Involves

By Dr Scott J Turner — Specialist Plastic Surgeon (FRACS) Canberra

The SMAS facelift has been the workhorse of facial surgery for almost fifty years — not because nothing better exists, but because it remains genuinely appropriate for a significant proportion of patients. It addresses the structural layer beneath the skin, produces results that last, and carries a well-established safety record. For many Canberra and ACT patients considering facelift surgery, it’s the technique that fits.

What follows is a practical guide. It covers what the SMAS layer is and why it matters, how the surgery works, who it may suit and who it may not, how the SMAS facelift compares to deep plane surgery, and what recovery typically looks like for patients travelling from Canberra and the ACT to Sydney for the procedure.

What the SMAS Actually Is

SMAS stands for Superficial Musculoaponeurotic System. What it describes is a connected layer of muscle, fibrous tissue, and fascia that sits beneath the skin of the face and extends down into the neck.

The face isn’t a single layer — it’s a stack. At the surface is the skin. Beneath that is a layer of fat. Beneath that is the SMAS. And beneath the SMAS — critically — run the main branches of the facial nerve, which controls movement and expression.

The SMAS has structural function. It’s anchored to the facial skeleton through ligaments, and it moves with expression. As we age, those ligaments weaken, and the SMAS — along with the fat and skin above it — gradually descends. That descent is what produces jowling along the jawline, deepened nasolabial folds (the lines running from the nose to the mouth corners), and laxity in the neck.

The anatomy was first formally described in 1976 by Mitz and Peyronie, and it changed facelift surgery permanently. Before that, facelifts were skin-tightening procedures. Surgeons pulled the skin tighter and removed the excess. Results looked artificial and didn’t last, because skin under tension stretches. The SMAS layer gave surgeons something structurally meaningful to work with.

How the SMAS Facelift Works

The surgery begins with incisions placed around the ear — in the natural skin folds and hairline — to keep them as discreet as possible. The skin is elevated from the tissue beneath, which exposes the SMAS layer. What happens at the SMAS level is where the different approaches diverge.

There are three main ways of addressing the SMAS:

Plication involves folding the SMAS on itself and securing it with sutures, without cutting into it. It’s the least involved SMAS technique, keeps dissection away from deeper structures, and suits patients needing a moderate degree of repositioning.

Imbrication is similar but involves a partial incision into the SMAS before overlapping and suturing. This allows a slightly greater degree of lift.

SMASectomy — sometimes called SMAS excision — removes a segment of the SMAS and closes the edges, creating tightening without dissection beneath the layer.

In all three, the SMAS is repositioned and secured before the skin is re-draped. Because the lift comes primarily from the SMAS rather than skin tension, the skin can be closed without being pulled tight — which is what tends to avoid the artificial appearance associated with older techniques.

The neck is commonly addressed during the same operation, through the facelift incisions and, when needed, a small incision beneath the chin. Excess fat, platysma muscle work, and neck skin management can all be incorporated.

SMAS Facelift vs Deep Plane: What’s the Actual Difference?

Both techniques address the SMAS. The difference is where the dissection happens relative to it.

An SMAS facelift — whether plication, imbrication, or SMASectomy — works on the SMAS layer or just at its surface. The deep plane technique goes beneath the SMAS entirely. The surgeon enters a plane between the SMAS and the deeper structures, releases the facial retaining ligaments directly, and lifts the SMAS together with the overlying fat and skin as a single composite unit.

Deep plane surgery allows direct ligament release, which may enable more substantial repositioning — particularly in the midface. For patients with significant midface descent, deep nasolabial folds, or more advanced tissue changes, the deep plane approach may offer more comprehensive correction. It’s also a more technically demanding operation, with dissection that passes closer to the facial nerve.

For patients with moderate laxity — earlier-stage jowling, less pronounced midface descent, good tissue quality — a well-performed SMAS facelift can be the appropriate and effective choice. The question isn’t which technique sounds most advanced. It’s which technique addresses what your anatomy actually requires.

The table below summarises the key differences:

For a more detailed comparison of both techniques, see the Deep Plane vs SMAS Facelift: What Canberra Patients Need to Know article, or visit the Deep Plane Facelift procedure page.

Who May Be a Candidate for SMAS Facelift Surgery

Candidacy is determined at consultation after a thorough assessment — not by reading an article. That said, patients who tend to be well suited to SMAS facelift surgery generally present with some combination of the following:

Jowling along the jawline. Descending soft tissue along the lower face disrupts what was once a defined jawline. SMAS surgery addresses the structural cause rather than just the surface.

Lower facial and neck laxity. Loose skin in the neck, early platysma muscle banding, or loss of the cervicomental angle — the definition between the jaw and neck — are features that respond to combined face and neck lift surgery.

Moderate midface descent. For patients with early to moderate changes in the midface, SMAS techniques can achieve meaningful repositioning. More pronounced midface descent with deeply folded nasolabial folds may be better addressed through deep plane surgery.

Good overall health. Facelift surgery is elective and requires appropriate anaesthetic fitness. Smokers are advised to stop well in advance, as smoking significantly affects wound healing and tissue perfusion.

Realistic expectations. Facelift surgery may create a meaningful improvement from the pre-operative starting point. It doesn’t stop the ageing process or produce a different face — it addresses descended anatomy.

Age is not the primary determinant. Most patients presenting for facelift surgery are between their mid-forties and early seventies, but the degree of anatomical change is what matters, not the number on a birth certificate.

Who May Not Be Suited to SMAS Facelift Surgery

Not every patient presenting for a facelift consultation is suited to this particular technique — or to surgery at all at the time of assessment.

Patients with significant midface descent and deeply folded nasolabial folds may be better served by deep plane surgery, which enables direct ligament release and composite tissue repositioning that SMAS techniques alone may not fully achieve.

Patients whose primary concern is the neck — excess submental fat, significant platysma banding, or advanced neck skin laxity with minimal lower facial change — may be better assessed for a more neck-focused approach. Facelift incisions aren’t always required for isolated neck concerns.

Patients with minimal laxity — where the anatomical changes are early and the face hasn’t descended substantially — may not yet be surgical candidates. Non-surgical options may be more appropriate at that stage, and a consultation with Dr Turner will clarify this.

Active smoking, poorly managed medical conditions, or unrealistic expectations are factors that would delay or preclude surgical planning. These are discussed frankly at consultation.

What Surgery Day and Recovery Involve

Facelift surgery is performed under general anaesthesia in an accredited Sydney private hospital. The procedure typically takes three to four hours, depending on the technique and whether additional procedures are incorporated.

An overnight hospital stay is standard. You won’t go home on the day of surgery.

The first week

Swelling and bruising are expected — most pronounced in the first three to five days. Drains, if placed, are typically removed at the first post-operative review, usually within 48 to 72 hours. Dressings will be in place initially; your surgical team will advise on wound care and when they can be removed. Suture review typically occurs around the seven to ten day mark, after which most external sutures are removed.

Plan for a full week away from work and normal activity. If your role involves significant public-facing interaction or physical demands, allow longer.

Travelling back to Canberra

For ACT patients, returning to Canberra after surgery requires some planning. Most patients stay in Sydney for at least five to seven days post-operatively before travelling home — long-distance driving or being a passenger for extended periods immediately after surgery is not advisable. Your surgical team will give guidance on when it is appropriate to travel based on your specific recovery.

Weeks two to six

Most patients are socially presentable by the end of the second week, though residual swelling and some bruising will still be present. Desk-based work is typically manageable within two weeks for most patients. Driving can generally resume once you’re off prescription pain relief and able to respond normally — usually around ten to fourteen days. Strenuous exercise is typically restricted for four to six weeks.

Tissue settling continues for three to six months. What you see at six weeks is not the final result.

Combining SMAS Facelift With Other Procedures

Facelift surgery is frequently performed alongside complementary procedures. Common additions include:

Neck lift. The face and neck age together. For many patients, addressing both in the same operation produces a more cohesive result. Platysma work, neck liposuction, and neck skin management can be incorporated through the facelift incisions with or without a small incision beneath the chin.

Blepharoplasty (eyelid surgery). Upper or lower eyelid surgery at the same time addresses ageing across the face without requiring separate operations and separate recovery periods. For Canberra patients, this has the practical advantage of a single trip to Sydney and a single recovery period.

Fat grafting. Volume loss is part of how the face changes over time. In appropriate patients, fat grafting — using the patient’s own fat harvested from elsewhere — can be incorporated at the time of facelift surgery.

Brow lift. Where brow descent is contributing to heaviness in the upper face, an endoscopic brow lift may be considered.

Whether combining procedures is appropriate depends on what your anatomy requires and how long you can commit to recovery. These decisions are made at consultation.

Surgical Risks

All surgery carries risk, and facelift surgery is no exception.

Specific risks associated with SMAS facelift surgery include bleeding, infection, wound healing complications, unfavourable scarring, temporary or permanent changes to sensation, facial nerve injury affecting movement, asymmetry, hair loss along incision lines, and anaesthetic complications.

Facial nerve injury is the risk patients most frequently raise. In experienced specialist hands, the risk is low for both SMAS and deep plane techniques — but it is not zero. The surgeon’s specific experience with the technique they’re recommending is the relevant factor, not the technique name alone.

Dr Turner discusses these risks in detail at every consultation. Expect a frank conversation, not a reassurance list.

Consulting for Facelift Surgery as a Canberra or ACT Patient

Dr Turner consults in Canberra at The Clinic Skin Health & Wellness, Campbell — on Fridays. A consultation fee of $450 applies at the Canberra clinic. All surgical procedures are performed in Sydney at accredited private hospital facilities.

For patients from across the ACT — including surrounding areas such as Queanbeyan and the wider capital region — the process begins locally. At the initial consultation, Dr Turner will assess your anatomy, explain which approach may be appropriate, discuss risks and recovery, and answer your questions. There is no obligation to proceed.

Under current cosmetic surgery requirements, a minimum of two consultations is required before any procedure can be scheduled, and a psychological screening process forms part of the pre-operative assessment pathway where indicated. A mandatory cooling-off period also applies.

To arrange a consultation, visit the Face and Neck Lift page for Canberra patients or get in touch via the contact page.

Frequently Asked Questions

What is the difference between an SMAS facelift and a skin-only facelift? A skin-only facelift addresses only the surface layer — skin is pulled tighter and excess removed. Results tend to look artificial because the structural changes beneath haven’t been addressed, and skin under tension eventually stretches. An SMAS facelift works on the deeper layer, so the skin can be re-draped without excessive tension. This is why SMAS-based techniques produce more durable outcomes than skin-only procedures.

Is the SMAS facelift still relevant now that deep plane surgery is available? Yes. The SMAS facelift is still widely performed because it remains clinically appropriate for a significant number of patients — those with moderate laxity who don’t require the more extensive dissection of a deep plane approach. The right technique depends on your anatomy. Not every patient needs or benefits from a deep plane procedure, and recommending a more complex operation for a patient who doesn’t require it isn’t good surgical practice.

Can an SMAS facelift address the neck as well as the face? Yes. Neck work is commonly incorporated through the facelift incisions, with a small additional incision beneath the chin when needed. Platysma treatment, liposuction, and neck skin management can all be addressed in the same operation. The face and neck are always assessed together at consultation.

What are the main risks of SMAS facelift surgery? Risks include bleeding, infection, wound healing complications, scarring, temporary or permanent sensory changes, facial nerve injury affecting movement, asymmetry, hair loss along incision lines, and anaesthetic complications. Facial nerve injury is most commonly raised by patients. The risk is low in experienced specialist hands — but not zero — and applies to both SMAS and deep plane techniques. Dr Turner discusses all risks in detail at consultation.

How long do SMAS facelift results typically last? Facelift surgery doesn’t stop ageing — it repositions tissues that have descended. Results can remain apparent for many years, but longevity varies according to anatomy, tissue quality, lifestyle, sun exposure, and the ongoing ageing process. Most patients continue to look different from where they would have been without surgery, even as natural change continues. Dr Turner discusses realistic expectations at consultation based on your individual assessment.

This content is intended for adults (18+). All surgery carries risk. The information provided is general in nature and does not constitute medical advice or a doctor–patient relationship. Individual outcomes vary depending on anatomy, health status, and other factors. A consultation with a qualified Specialist Plastic Surgeon is required before any surgical decision is made.