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For years, facelifts were the beauty industry’s open secret—easy to spot, rarely discussed, and often a little too obvious for comfort. Tight skin, confusing jargon, and a “worked-on” look defined the era. That’s no longer the case. As headline-making transformations spark curiosity (and more than a few group-chat deep dives), today’s patients aren’t just asking if a facelift looks good—they’re asking why. What technique was used?
How natural is the result? And will it still look like them? According to internationally recognized facial plastic surgeon Sam Rizk, MD, FACS, the answers often come down to one critical distinction: the SMAS facelift versus the deep plane facelift. Though frequently grouped together, he notes that understanding the difference can mean everything between a face that looks pulled—and one that simply looks refreshed.
“A facelift isn’t one procedure,” Rizk explains. “It’s a category of techniques. And the technique matters more than most people realize.” The SMAS facelift—short for superficial musculoaponeurotic system—targets a thin layer of tissue just beneath the skin. In a traditional SMAS approach, that layer is tightened and repositioned, typically in a more horizontal direction, while excess skin is removed. It’s a technique that’s been around for decades and is often referenced in celebrity coverage. (Hello, Kris Jenner!)
“In the right patient, a SMAS facelift will absolutely deliver beautiful results,” details Rizk. “But because it works at a more superficial level, the lift can be limited—especially in the midface. If too much tension ends up on the skin, that’s when results can start to look pulled or overly sculpted.”
Rizk’s signature approach, the Vertical Deep Plane Facelift, takes things several layers deeper. Rather than separating the skin from the underlying tissues, the deep plane technique lifts the skin, muscle, and fat together as a single unit. This allows the deeper facial structures to be repositioned vertically, restoring youthful contours in a way that mirrors how the face actually ages.
“When we age, everything moves downward,” Rizk says. “So true rejuvenation comes from lifting those deeper tissues back up—vertically—not pulling the face sideways.” For patients, that difference shows up in subtle but powerful ways. A deep plane facelift can naturally restore cheek volume without fillers, soften nasolabial folds, redefine the jawline, and improve the neck—all while preserving facial expression.
Because the skin isn’t stretched tight, scars tend to heal more discreetly, and results often look softer, more believable, and more expensive—both early on and years later. In a traditional SMAS facelift, the skin is lifted off the underlying tissues, which can affect small blood vessels; in a deep plane lift, the skin and deeper layer are elevated together, maintaining tissue integrity and allowing a more natural vertical repositioning.
“The goal is never to look tight,” Rizk says. “It’s to look rested and refreshed.” That philosophy aligns with a broader shift in luxury aesthetics: less drama, more discretion. Today’s patients aren’t chasing a new face—they want their own, just on a really good day. “Every face ages differently,” says Rizk. “My role is to restore balance, not impose a new look.”
That commitment to natural, long-lasting results is why Rizk isn’t just sought after by patients, but by surgeons around the world. This February, he will return as faculty to the Baker Gordon Educational Symposium in Miami, the longest-running aesthetic surgery conference in the United States, which is marking its 60th—and final—year. There, Rizk will teach his deep plane facelift method to an international audience of leading plastic surgeons, sharing the same techniques he uses in his own practice.
“Education is how the field moves forward,” Rizk says. “When surgeons collaborate and share refined techniques, patients everywhere benefit.” As interest in facial rejuvenation continues to grow—fueled by high-profile results and a cultural shift toward aging well rather than aging dramatically—the difference between SMAS and deep plane facelifts has never mattered more. For Rizk, the takeaway is simple: the most beautiful results don’t announce themselves, they simply allow patients to look like the best version of themselves.
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