Deep Plane Facelift
Why Are the SMAS Layer and Retaining Ligaments So Important in a Facelift?
There are two key anatomical structures that determine the success of a facelift: the SMAS (Superficial Musculoaponeurotic System) and the retaining ligaments.
Many people wonder why procedures that tighten only the skin tend to lose their effect over time. The reason is simple: the face is supported by much more than just the skin.
✔️ What is the SMAS layer?
The facial soft tissues are composed of multiple layers: skin, dermis, subcutaneous fat, the SMAS, and the underlying muscles and facial skeleton.
The SMAS (Superficial Musculoaponeurotic System) is a thin fibrous layer located between the subcutaneous fat and the facial muscles.
Rather than being a simple membrane, the SMAS serves as a structural support system that connects and stabilizes the facial soft tissues while transmitting the movement of the facial muscles to the skin.
As we age, the SMAS gradually loses its support under the constant effects of gravity. As this layer descends, the nasolabial folds become deeper, the cheeks begin to sag, and the jawline gradually loses its definition.
If only the skin is pulled and sutured without repositioning the SMAS, the skin alone cannot withstand the downward forces of gravity. Because skin is naturally elastic, the lifting effect is more likely to diminish over time.
For this reason, proper management and repositioning of the SMAS is not optional—it is an essential component of modern facelift surgery.
✔️ Why do skin-only facelifts relapse?
The retaining ligaments are fibrous connective tissues that anchor the facial soft tissues—including the muscles, fascia, subcutaneous fat, and dermis—to the underlying facial bones.
These ligaments play a crucial role in maintaining the natural position and stability of the facial tissues.
With aging, the retaining ligaments gradually become elongated and lose their supportive strength.
During a facelift, even if the SMAS is lifted, the tissues cannot be adequately repositioned unless the retaining ligaments are carefully released.
If these ligaments are left untouched, they continue to restrict tissue movement, making it difficult to achieve effective lifting of the descended facial tissues.
Ultimately, the quality of a facelift is determined not by how tightly the tissues are pulled, but by how precisely the SMAS and retaining ligaments are surgically managed.
✔️ Hugo Plastic Surgery's "Perfect Fit" Facelift
Immediately after a facelift, fixation of the SMAS with sutures may temporarily create slight surface irregularities, and in some patients the SMAS itself may have reduced elasticity due to age-related changes.
To address these concerns, Hugo Plastic Surgery applies radiofrequency (RF) energy directly to the SMAS layer during surgery.
This technique is designed to produce two beneficial effects simultaneously:
▪️ Immediate contraction of existing collagen fibers.
▪️Stimulation of new collagen production during the natural healing process.
Radiofrequency energy causes collagen fibers to contract, allowing the loosened SMAS to tighten naturally. At the same time, the controlled thermal stimulation activates the body's healing response, promoting the formation and remodeling of new collagen.
As healing progresses, the elasticity of the SMAS gradually improves, helping to enhance the long-term durability of the facelift results.
However, direct application of radiofrequency energy to the SMAS requires considerable surgical expertise. In some patients, the SMAS layer is extremely thin or weakened by aging. If excessive or inappropriate RF energy is applied, it may further weaken the tissue rather than improve its elasticity.
For this reason, the procedure should only be performed by an experienced, board-certified plastic surgeon with a thorough understanding of facial anatomy and surgical technique.
If you have any questions about facelift surgery or would like to learn more about our surgical approach, please feel free to contact Hugo Plastic Surgery. We would be happy to provide you with more detailed information.
Written by Seong-Hyeok Yang MD, board-certified plastic surgeon specializing in facial rejuvenation surgeries at HUGOPS
