Objective To analyze the effect of high superficial musculoaponeurotic system ( SMAS ) rhytidectomy in the treatment of patients with facial sagging and its influence on aesthetics. Methods A total of 1400 patients with facial sagging received by the Department of Plastic Surgery of Jiangyou Second People's Hospital from September 2016 to February 2024 were randomly divided into control group and observation group, with 700 patients in each group. The control group was treated with traditional facial lifting, and the observation group was treated with high SMAS rhytidectomy. The excellent and good rate of treatment, facial aesthetics and incidence of complications were compared between the two groups. Results The excellent and good rate of treatment in the observation group (98.57%) was higher than that in the control group (90.43%) (P <0.05). The proportion of complete improvement and obvious improvement of facial aesthetics in the observation group was higher than that in the control group, while the proportion of improvement and inefficiency was lower than that in the control group (P <0.05). The incidence of complications in the observation group (2.14%) was slightly higher than that in the control group (1.57%), but the difference was not statistically significant (P >0.05). Conclusion High SMAS rhytidectomy can achieve good results in the treatment of facial sagging, which is conducive to the improvement of facial aesthetics, and has fewer complications.