| Service | 🇺🇦 Ukraine | 🇨🇿 Czech Republic | 🇹🇷 Turkey |
|---|---|---|---|
| Cost of SMAS facelift | from USD 1,332 | from USD 1,909 | from USD 3,350 |
| Average price with pre-operative preparation (consultation, tests, anaesthesia) | from USD 1,384 | from USD 3,570 | from USD 5,303 |
| Rehabilitation after surgery | from USD 62 | from USD 3,570 | from USD 5,303 |
Prices in the “Ukraine” column come from MediUkraine’s partner clinics. The Czech Republic and Turkey columns show the lower bounds of prices published by clinics there (for Turkey, also the Turkish Dental Association’s recommended 2026 tariff), collected in August 2026 and converted to US dollars at the rate on the day of collection. A dash means we could not find a comparable published price. In any country, the final cost is set by the clinic after an examination.
Beneath the skin of the face lies the superficial musculoaponeurotic system, or SMAS. This is a continuous layer of dense connective tissue with muscle fibres woven into it: it runs down from the temple, covers the cheek and continues into the platysma of the neck. The cheek fat pads and the retaining ligaments, which hold the soft tissues on the bones of the facial skeleton, are attached to it. It is this layer that stretches and descends over the years, and everything attached to it slides down with it.
Hence the difference between techniques. If only the skin is lifted and tightened, the tension rests on the skin alone: the tissues underneath stay where they were, and because skin is elastic it stretches again within a few months. Trying to compensate with stronger tension produces stretched white scars, a displaced earlobe, a pulled corner of the eye and the characteristic "pulled" look by which others recognise the operation. When the tension is transferred to the SMAS, the skin is then laid back loosely, without strain, and the shape is held by the dense layer beneath it, which is why the result is both longer-lasting and more natural.
A SMAS facelift is considered when there are changes that this particular layer deals with: sagging cheeks with a well-defined nasolabial fold, jowls along the jawline, a lost angle between the chin and the neck, drooping corners of the mouth. Patients are typically aged 45 to 65, but what decides is not age on paper but the condition of the tissues: in some people these changes appear earlier, in others much later.
Who is not operated on, or has surgery postponed: uncontrolled high blood pressure, uncontrolled diabetes, blood clotting disorders, autoimmune connective tissue diseases in an active phase, serious heart disease, cancer under treatment, acute infections, pregnancy and breastfeeding. Smoking is a separate issue: in smokers the blood supply to the lifted skin flap is impaired and the rate of edge necrosis rises several times over, so the surgeon either requires you to give up cigarettes or does not operate at all. Another reason to decline is unrealistic expectations: a facelift changes the position of the tissues, not your features and not your age on paper.
MediUkraine is a treatment search and coordination service, not a clinic. We select a medical centre and a surgeon with the right specialism, arrange the dates and support you throughout, including if you are travelling from abroad. The indications, the scope of the procedure and the choice of technique are determined by the surgeon after an in-person examination.
Travel. Ukrainian airspace is closed, so there are no commercial flights. Uzhhorod lies right on the border with Slovakia and close to Hungary, so patients usually arrive overland from one of these two countries, by car, bus or train.
Visas. Citizens of the EU, the United Kingdom and the United States do not need a visa for short stays in Ukraine. Rules depend on your citizenship, so check your own before booking.
Safety, plainly. Ukraine is at war. Air raid alerts occur across the country, including in Uzhhorod, and an appointment can be interrupted by one. Several governments advise against travel to Ukraine, and while that advice stands, ordinary travel and medical insurance is often void — confirm your cover with your insurer before you commit to anything.
Language. MediUkraine handles correspondence, scheduling, the written treatment plan and the quote in English. The clinic's team communicates with international patients in English.
Payment. You pay the clinic directly. Our coordination service is free of charge for you.
More on travel, safety and insurance: Safety and travel.
The access is roughly the same in all variants and follows the boundaries where the scar is hidden: from the temple within the hair, down in front of the ear or in the fold behind the tragus, around the earlobe, up behind the ear and out into the hair at the back of the head. The length of the incision depends on the scope: when the neck is also treated, a short incision under the chin is added for access to the platysma. The surgeon then lifts the skin over the required distance and exposes the SMAS, the layer the operation actually works on.
Historically, the first facelifts lifted and tightened only the skin. They were abandoned not because they were difficult but because of the result: the tension rested on tissue that by its nature stretches, so the face "let go" within a few months. Transferring the tension to the deeper layer solved this problem: the skin is then laid back without strain, and the excess is simply trimmed away.
SMAS plication works without cutting the layer: it is gathered into a fold and secured with sutures in the required direction. The procedure is shorter, blood loss is lower and the risk of touching a branch of the facial nerve is lower, because the surgeon stays superficial. Plication is chosen for patients aged roughly 40–50 with moderate sagging and a thin layer. The limitation is also clear: the fold can partly loosen over time, and for marked jowls and a deep nasolabial fold this level of correction is not enough.
SMASectomy involves removing a strip of the layer, usually along a line from the angle of the jaw to the outer corner of the eye, after which the edges are stitched together. The pull is stronger and more even than with a fold, and no excess tissue is left as a lump under the skin. This option is appropriate when the layer is dense and redundant. Because the layer is cut, the surgeon works closer to the branches of the facial nerve, so the demands on anatomical knowledge are higher.
An extended SMAS facelift differs not in the type of suture but in the area of dissection: the layer is released further towards the middle of the face, towards the cheekbone, and the retaining ligaments (the zygomatic and mandibular ligaments) are also divided. While these ligaments are intact, they act as tethers: the tissues can be pulled, but they do not move upwards, and the midface stays where it is. The extended version produces movement in exactly this area, so it is chosen when the cheeks have descended and the nasolabial fold is pronounced, not only when the jawline is blurred.
A deep plane facelift is built on a different principle: the skin is not separated from the SMAS at all; instead they are lifted as a single block by entering the plane beneath the layer itself. The blood supply to the skin is not disrupted, because the flap stays intact, and the tissues are moved at a deeper level, so movement in the cheek and nasolabial area looks more natural. The price is technical difficulty and work in close proximity to the branches of the facial nerve, so the method is justified in the hands of a surgeon who performs it regularly. For patients with very thin soft tissues it achieves less than is expected of it.
No less important than the technique itself is the vector of pull, the direction in which the tissues are moved. With age the face descends mainly downwards, so the tissues need to be returned upwards and slightly outwards, along the axis of the cheekbone, roughly perpendicular to the nasolabial fold. If the pull is horizontal, back towards the ear, the jawline will indeed become sharper, but the cheek will stay low, the corner of the mouth will be pulled sideways and the face will take on the "wind-swept" look that patients describe as "pulled". So the sutures holding the layer are placed in different directions: more vertically in the cheek area, and more backwards and upwards along the jaw and neck.
It is worth agreeing on the limits of the method before surgery, not after. A facelift moves tissues and does not change skin quality: fine lines around the mouth and eyes, photoageing, pigment spots and enlarged pores stay as they were, and they need laser resurfacing, peels or botulinum toxin. It does not restore lost volume either: hollow temples and a flat cheekbone have to be filled with fat grafting. Hooding of the upper eyelid and bags under the eyes are not removed by tightening the deep layer: that is a job for blepharoplasty. And a lower-face lift on its own does not work on the midface unless the surgeon has extended the dissection and released the ligaments.
For this reason the operation is rarely done on its own. It is most often combined with a neck lift, since the layer continues into the platysma and treating them separately makes no sense; next in frequency come blepharoplasty, fat grafting to the cheekbones and nasolabial area, and a brow or temple lift. A combination lengthens the anaesthetic, so the scope is limited by a reasonable operating time and the patient's health.
The technique is chosen not by fashion or by a line on a clinic's website but by what is seen at the examination: the thickness and density of the layer, the condition of the skin, the depth of the nasolabial fold, the amount of tissue on the neck, the structure of the jaw and chin, and any existing asymmetry. In many patients the surgeon combines approaches, for example extended dissection in the cheek area and plication on the neck. If a technique is named before the examination, that is a reason to ask more questions.
You spend the first day in hospital. Your head is raised, a compression dressing is on your face, and sometimes thin drains are in place, which are removed the next day. Pain is mostly moderate and relieved by ordinary painkillers; tightness, numbness of the skin and a feeling of firmness in front of the ears are more bothersome.
Swelling and bruising build up until the second or third day and then start to subside. Most of the bruising goes within 10–14 days, while swelling takes longer and goes down unevenly: one side of the face often "gets ahead" of the other, and this is not a sign of a mistake. Stitches in front of the ear are removed on day 5–7, and in the hair-bearing scalp on day 10–14. The compression mask is usually worn for 2–3 weeks: at first around the clock, then only at night.
Restrictions apply for the first two weeks: sleeping on your back with a high pillow, no bending forward and no lifting. Sport, saunas, swimming pools and alcohol are allowed no earlier than a month later; the surgeon will give you the specific timing. You can colour your hair after about 4–6 weeks, once the incisions have healed.
Most patients return to work that does not involve dealing with people after 2 weeks. To look normal to others takes closer to 3–4 weeks, and longer if fat grafting or blepharoplasty was done at the same time. The signs of surgery cannot be hidden in the first days, so it is best not to plan important events for this period.
Numbness of the skin in front of the ear and in the cheek area is expected and lasts from a few weeks to a few months: during the dissection small skin nerves are divided, and sensation returns gradually. Firmness and unevenness under the skin in the first months are also normal: they soften on their own, and you should not massage them unless it has been prescribed.
The interim result is visible after about 1–1.5 months, and the final one after 6–12 months, once the swelling has fully gone down and the scars have matured. No one can say in advance how long it will last: on average, it takes 7–10 years to return to the original state, and throughout this time the face ages at the usual rate. Smoking, sharp changes in weight and unprotected sun exposure shorten this period.
Step 1. Consultation and planning. The surgeon examines the face at rest and in motion, assesses the thickness of the tissues, the condition of the skin and neck and any existing asymmetry, and takes standardised photographs. The technique and scope are decided here, along with what the operation will and will not change and whether any additional procedures are needed. For patients from abroad, this first stage is often done remotely from photographs and confirmed in person the day before surgery.
Step 2. Tests and preparation. You take the pre-operative tests and have an ECG and assessments by a general physician and an anaesthetist. Two weeks beforehand you stop non-steroidal anti-inflammatory drugs and supplements that affect blood clotting, while the plan for anticoagulants and antiplatelet drugs is set by the doctor who prescribed them together with the anaesthetist. Smoking is stopped at least four weeks beforehand. The evening before, a light dinner; no solid food for 6–8 hours before anaesthesia, and no clear fluids for 2 hours, unless the anaesthetist says otherwise.
Altogether the operation takes from 3 to 5 hours, and everything else fits between the first examination and discharge: tests and preparation, anaesthesia, incisions and dissection, tightening of the SMAS layer itself, layered closure and a day of observation in hospital. Then come dressings, stitch removal on day 5–14 and follow-up examinations, at which the surgeon checks how the swelling is going down and how the scars are maturing.
Let us start with the price. According to published prices, the operation itself starts cheaper in Ukraine than in the Czech Republic, from USD 1,332 versus from USD 1,909, and with pre-operative preparation Ukraine is cheaper too, both than the Czech Republic and than Turkey, which mainly sells packages with a hotel and transfers. So the reason to come is not that it is "cheaper" but how the cycle of treatment is put together.
The first factor is the full cycle in one place. The whole sequence takes place at one facility and in one visit: the consultation, tests, ECG, assessments by a general physician and an anaesthetist, the operation, a day in hospital, dressings, stitch removal on day 5–14 and the first follow-up examination. No referrals between facilities are needed, and you do not have to look separately for somewhere to have your stitches removed or someone to check the scars in the second week.
The second factor is waiting times. MediUkraine shows the free slots in the surgeon's schedule together with the proposal, and the date of surgery can usually be set within the next few weeks. The initial consultation is done remotely from photographs and the in-person examination the day before surgery, so there is no separate trip "for a consultation".
The third is a coordinator for patients from abroad. They take care of choosing a surgeon for your specific needs, booking, translating documents and supporting you at visits, and can advise on transfers and help you find accommodation near the clinic. The discharge summary, operation note and recommendations are prepared so that a doctor where you live can read them, and follow-up examinations at the second and sixth months can be done remotely if needed.
When it comes to money, compare like with like. The Ukrainian figure in the table is the operation with a hospital stay; the Czech one is the operation separately and a package with anaesthesia and a night at the clinic separately; the Turkish one is almost always an "all-inclusive" package that includes a hotel and transfers. MediUkraine prepares a specific estimate for the trip together with the quote, before you arrive, with a list of items, the number of days in the country and the dates of follow-up examinations.
The main risk of this operation is injury to branches of the facial nerve. Two are the most vulnerable: the temporal branch, which controls raising the brow, and the marginal mandibular branch, which controls the muscles of the lower lip. In the first case the brow does not lift and the forehead stays smooth on one side; in the second the smile is asymmetrical and the lip does not pull down. According to pooled data, such weakness occurs in about 1–2 cases in every hundred, and in the vast majority it is temporary: the branch is not cut but stretched or compressed by swelling, so function returns within a few weeks or months. Permanent injury is rare, and its likelihood depends directly on how many of these procedures the surgeon performs a year and in which plane they work.
The second most significant complication is a haematoma, a collection of blood under the lifted flap. Its rate when working with the deep layer is roughly 1–3%, and it is noticeably higher in men and in patients with high blood pressure: men's skin is thicker and has more blood vessels, and a spike in blood pressure on waking from anaesthesia opens up bleeding from a small vessel. An expanding haematoma is a situation that requires a return to the operating room the same day, and that is exactly why the patient is kept in hospital for the first day rather than sent home. So blood pressure is controlled before, during and in the first days after surgery, and for people with hypertension adjustments to treatment are agreed in advance.
Necrosis of the skin at the edge of the flap occurs most often in smokers but is possible in non-smokers too: it is caused by excessive tension on the flap, a haematoma under it and diabetes. The blood supply to the lifted skin depends on small vessels, and nicotine constricts them: in smokers the risk of edge necrosis is several times higher according to various estimates, and in some series more than tenfold higher. To put it plainly: smoking means either being turned down for surgery or a substantially higher risk, and the decision here lies with the surgeon. The minimum requirement is not to smoke for at least four weeks before the procedure and four weeks after, including vapes and nicotine replacements. Necrosis is treated conservatively for weeks and ends in a scar that is then corrected separately.
Scars always remain; the question is where they run and how they mature. In front of the ear or in the fold behind the tragus, a scar usually becomes barely noticeable within 6–12 months, and in the hair-bearing scalp it is covered by hair, but under excessive tension it stretches into a white band on which hair no longer grows. The same excessive tension pulls the earlobe down and distorts the outer rim of the ear, known in English as pixie ear, which is corrected with a separate minor procedure no earlier than six months later. It is also worth knowing in advance that the hairline in the temple shifts after surgery, and temporary, sometimes permanent, thinning of hair is possible in the incision area.
Prolonged numbness of the skin in front of the ear, in the cheek area and on the earlobe is not a complication but a natural consequence of small skin nerves being divided: sensation returns over several months, and in some patients a small area of reduced sensation remains permanently. Less common are infection in the suture area, seroma, persistent asymmetry, and injury to the great auricular nerve with prolonged numbness of the ear. General anaesthesia adds its own set of risks, which is why pre-operative tests and assessments by a general physician and an anaesthetist are not a formality, and patients with uncontrolled chronic diseases are not accepted for planned aesthetic surgery.
What the clinic does to reduce these risks: it checks blood clotting and blood pressure before surgery, stops medicines that increase bleeding, carefully controls bleeding during surgery, keeps the patient under supervision for a day, gives written recommendations for the first weeks and stays in contact for any unscheduled check-up. You sign an informed consent form in which the listed complications are named plainly, not hidden in small print. If the proposed scope raises doubts, it makes sense to get a second opinion: you keep the photographs, the surgical plan and the report, and they can be shown to another surgeon.
📍 Uzhhorod, Ukraine
A multidisciplinary hospital in Uzhhorod, part of a network of medical facilities in western Ukraine: an outpatient clinic, a surgical centre covering 15 specialties and a 30-bed inpatient unit. Its 52 doctors include professors and PhDs; many operations are done as day surgery, with discharge after 1–2 days.
The difference lies in which layer carries the tension. In a skin-only lift, the tissues underneath stay low and the elastic skin gradually stretches: the result lasts months, and excessive tension produces stretched scars and the characteristic "pulled" look. When the SMAS is lifted (the dense musculoaponeurotic layer to which the cheek fat pads and retaining ligaments are attached), it holds the shape and the skin is laid back loosely. Hence a result that is both longer-lasting and more natural.
At MediUkraine's partner clinic in Uzhhorod, the cost starts from USD 1,332. The average price with pre-operative preparation (consultation, tests and anaesthesia) is from USD 1,384, and in Ukraine rehabilitation is charged separately, from USD 62. For comparison: according to published prices, in the Czech Republic the operation itself starts at about USD 1,909, and a package with anaesthesia and a night at the clinic from USD 3,570; in Turkey the operation starts from USD 3,350, but clinics there mainly sell "all-inclusive" packages with a hotel and transfers, from USD 5,303. The surgeon gives the final figure after an in-person examination, once the scope of the operation has been determined.
Plication, a fold without cutting the layer, is chosen for moderate sagging and a thin layer. SMASectomy, the removal of a strip followed by stitching the edges together, is used when the layer is dense and redundant. The extended version, with division of the retaining ligaments, is needed to lift the cheek and soften the nasolabial fold. A deep plane facelift moves the skin and SMAS as a single block and gives more natural tissue movement in the midface, but it is technically more demanding.
The surgeon decides after the examination, taking into account the thickness of the tissues, the condition of the skin and neck, the depth of the folds and the structure of the jaw. Several approaches are often combined in one patient.
It does not improve skin quality: fine lines around the eyes and mouth, pigment spots and photoageing remain, and these need laser, peels or botulinum toxin. It does not restore lost volume, so hollow temples and a flat cheekbone are filled with fat grafting. Hooding of the upper eyelid and bags under the eyes are dealt with by blepharoplasty, not by tightening the deep layer. And on its own it does not work on the midface unless the surgeon has extended the dissection and released the retaining ligaments.
Temporary weakness of a branch of the facial nerve occurs in about 1–2 cases in every hundred. The branches most often affected are the temporal branch, which controls raising the brow, and the marginal mandibular branch, which controls the lower lip: outwardly this looks like an asymmetrical smile or a brow that does not move on one side. In the vast majority of cases the branch is not cut but stretched or compressed by swelling, so function returns within a few weeks or months. Permanent injury is rare, and its likelihood depends on the surgeon's experience in this specific area.
You spend the first day in hospital, stitches are removed on day 5–14 depending on the area, and the compression mask is worn for 2–3 weeks. Bruising mostly goes within 10–14 days, while swelling takes longer and goes down unevenly. Most people return to work that does not involve dealing with others after two weeks, and look normal to others closer to 3–4 weeks. Sport, saunas and swimming pools are put off for at least a month, and the final result is assessed after 6–12 months.
On average the face returns to its original state after about 7–10 years, and throughout this time it ages at the usual rate: the operation does not stop the process but turns it back. The specific period depends on the technique, the thickness of the tissues, genetics and lifestyle; smoking, sharp changes in weight and unprotected sun exposure shorten it noticeably. No surgeon can give an exact number of years, and if you are promised such a figure, it is marketing rather than a prognosis.
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