Six different operations sit under the single word “facelift” on the menu of one Houston practice, and they differ more in depth than in name. A mini facelift and an extended deep plane facelift both lift the lower face, yet they reach different layers, suit different faces and ask for different recoveries.
Leo Lapuerta, MD, FACS, a triple board-certified plastic surgeon and Chairman of Plastic Surgery at St. Joseph Hospital in Houston, offers each of them. His practice’s overview of facelift surgery in the Houston area makes the governing rule clear: the right procedure depends on where the laxity is, how advanced it is and what kind of correction will look believable on a given face.
This guide follows the practice’s own descriptions, sorted from the lightest option to the most involved.
Three layers, three depths
A face ages in layers. Skin sits on top. Beneath it lies the SMAS, short for superficial musculoaponeurotic system, a sheet of fibrous tissue and muscle that acts as the support layer for the cheeks and jaw. Below the SMAS are deeper tissues, including fat pads that descend with time.
Each facelift type reaches a different depth in that stack. The deeper the work, the more tissue the surgeon can reposition, and the more involved the operation and recovery become.
For mild aging: the mini facelift
The practice describes the mini facelift as a less invasive option for the first signs of aging in the lower face and neck: mild loose skin, early jowls and a softening jawline or chin. Dr. Lapuerta places small incisions around the hairline and behind the ears.
According to the practice, mini facelift surgery typically takes 2 to 3 hours as an outpatient procedure, under local anesthesia with sedation or under general anesthesia. Most patients return to light activities within one week and to more strenuous activity after about two weeks. With proper care, the practice says results can last 5 to 10 years, depending on skin quality and the natural aging process.
The limit is clear. The practice states that the mini facelift is not the right answer for significant excess skin or advanced changes in the face and neck.
For visible laxity: traditional and SMAS lifts
Traditional facelift
The traditional facelift is the established option for patients with more visible signs of aging. It addresses loose skin, deeper folds and laxity in the lower face, and the surgeon can extend treatment into the neck. The practice calls it the most practical path to meaningful rejuvenation for many patients.
SMAS facelift
A SMAS facelift tightens the support layer rather than the skin alone. The practice says that approach improves facial contours in a more natural way and reduces the risk of a surface-pulled appearance. It fits moderate laxity that needs more support than a skin-level lift can give.
For advanced descent: deep plane options
Deep plane facelift
The deep plane facelift works beneath the SMAS, releasing and repositioning deeper tissues as a unit. The practice describes it as useful for heavy jowls, deep nasolabial folds and descent through the midface. The practice lists usually one to two weeks of visible social downtime, with refinement continuing for months.
Depth brings trade-offs. The practice lists the deep plane facelift as more involved surgery with a more involved recovery, and it says the technique is not better by default than a SMAS lift. Some patients do well with the lighter operation.
Extended deep plane facelift
When a broader release of deeper structures is needed, the extended version may be considered. The practice frames it as better only when it fits the anatomy in front of the surgeon.
For a second lift: revision
A revision facelift serves patients who had a facelift before and now want correction, refinement or renewed lifting after further aging. The practice notes that revision work requires careful assessment of scar tissue, remaining skin and the technique used the first time.
Across all six, the consultation decides the match. Dr. Lapuerta reviews facial structure, skin elasticity and the pattern of aging across the cheeks, jawline and neck, along with medical history. Patients with neck laxity often need a neck lift at the same time, and each type carries the risks of surgery.
He brings more than 30 years of experience and more than 30,000 surgical and non-surgical procedures to that decision, and his practice keeps more than 3,000 before-and-after images on file. Asking to see results from the specific facelift type a surgeon recommends, on faces that started out like yours, gives you the most direct look at what that choice can produce.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.