Deep plane facelift or SMAS facelift for 60 year old?

Question

What are the pros and cons of having the deep plane facelift and the pros and cons of the SMAS facelift. With 4 consultations 1 suggests the deep plane and 3 suggest the SMAS.

Farhan Taghizadeh, MD · Answer

Hello, and thanks for your question.  Without seeing you in person it is difficult to discuss the pros and cons of each approach, as it would really differ from person to person.  As you have had many consultations already, I would recommend focusing on which doctor you feel has the most experience and that you are most comfortable with.  Also look at the physician's prior facelift results.  Which physician has the results that look the best to you?  While a specific technique is important, it can be executed differently by each physician.  Seeing their prior work, feeling comfortable with their recommendations, and understanding the support they will provide during and after the surgery are also important considerations.I hope this information helps and wish you the best of luck!

Brian M. Harmych, MD, FACS · Answer

I suspect the main reason why 3 surgeons have recommended SMAS facelift while only 1 surgeon has recommended deep plane facelift is that the surgeons will recommend the procedures they are most comfortable performing. A much smaller fraction of facelift surgeons perform true deep plane facelift surgery. It wasn't until the last decade (2010's) that more modern techniques of deep plane facelift surgery, such as extended deep plane facelift, were described and it will be even longer before those techniques become adopted more widely and, ultimately, taught to surgeons during residency and fellowship training. In my experience, the results achieved from extended deep plane facelift are much more significant than traditional SMAS facelift. As far as pros and cons, the risks are the same with both procedures. Cost of deep plane facelift is usually greater. The procedure simply takes more time and skill to perform. Overall healing time may be shortened with deep plane facelift. However, I have not seen any studies that prove healing time, yet. As of now, this is only expert opinion. Incisions are similar and, in some cases, deep plane facelift incisions may be shorter. When performed correctly, it is my opinion that the results of extended deep plane facelift are more significant. Deep plane facelift is more effective for the midface, nasolabial folds and central neck. With that being said, in my practice I still occasionally offer traditional SMAS facelift to patients with less facial aging, especially those with aging effecting primarily the neck. I hope this information is helpful. 
Kind regards,
Dr. Harmych

Frank P. Fechner, MD · Answer

Many experienced facelift surgeons consider the deep plane lift to be the best procedure for a durable and natural appearing outcome. On the other hand, plastic surgeons who perform SMAS lifts believe in this approach; otherwise they would not be doing it. Because a SMAS lift is technically easier to perform, more surgeons are performing SMAS lifts than deep plane facelifts. Keep in mind that on average, plastic surgeons perform less than 8 facelifts a year and for this small number of surgeries, it is probably not advisable to learn a more challenging surgery - even if it delivers superior outcome.

Akshay Sanan, MD, FACS · Answer

The deep plane facelift is the most powerful technique for facial rejuvenation. By releasing the cutaneous ligaments it allows the surgeon to reposition your deep facial tissues in a vertical vector fashion. SMAS lifting by definition is not as aggressive of a surgery and therefore doesn't have the same results as a deep plane facelift. At the end of the day, it is important to consult with board-certified surgeons, to get an understanding for their aesthetic and look at their surgical outcomes. Have a frank discussion about your anatomy and your surgical goals and then make a decision. I would not base a decision on the specific technique. I hope this helps answer your question.
All the best,Dr. Sanan, MDAkshay Sanan MD Facial Plastic SurgeryDouble Board Certified

Nicholas S. Karter, MD · Answer

Whether to choose a deep plane facelift or a SMAS lift depends on your anatomy and the extent of the aging process, the goals that you and your surgeon have in mind, and the extent of risk you are willing to take to achieve those goals. The deep plane facelift is the best technique to lift excessively sagging or redundant tissue and if you are an appropriate candidate for it, a SMAS lift would not provide as good of results. The deep plane facelift is a longer procedure, requires more technical skill, has a higher risk of complication, and has a slightly longer healing period. I would recommend finding a surgeon who is comfortable performing both, whom you have formed a good relationship with, and have a longer discussion about the pros and cons of each. The choice in the end is going to depend on which procedure is best for you personally, not better in general. I hope this helped, good luck!!

Grant A. Fairbanks, MD · Answer

There are pros and cons to every cosmetic surgical
procedure.  The ultimate decision should
be between the patient and the experienced plastic surgeon.  This SMAS lift elevates and fixes the deeper
tissues, giving a better and longer-lasting result compared to the skin lift.  The deep plane facelift is an extended SMAS
lift with a deeper dissection, giving better and longer-lasting results compared
to the SMAS lift.  The more extensive the
procedure, the longer it takes and the more it costs.  There is some increased risk with a more
extended procedure.  For most, the
benefits outweigh the risks in the hands of a skilled plastic surgeon.  I offer all 3 of the above listed
facelifts.  Most choose the deep plane
facelift.  Others choose the skin lift or
the SMAS lift based on price.  Best to
you in your search.

Grant A. Fairbanks, MD

Ivo Gwanmesia, FRCS(Plast) · Answer

Thank you for your question.It is really an interesting one. I will start off by saying that the SMAS based facelifts are performed by many more surgeons compared to the deep plane facelift. The reason I suspect is that SMAS based facelifts are less tasking when compared to deep plane facelifts. In my experience, a deep plane facelift would be better suited to a patient who has very heavy sagging facial soft tissue structures, as it will allow a better elevation of the soft tissues compared to the SMAS based facelift. The deep plane facelift is performed at a deeper level of the face, so one would suspect that the risks of nerve damage may be slightly higher when compared to the SMAS type facelift. However, no studies have so far confirmed this to be the case. The blood supply to the skin after a deep plane facelift is better when compared to the skin after a SMAS based facelift, as the deep plane facelift is raised as a composite - that is with more layers of tissue.Finally, what really matters is first of all your rapport with the surgeon that you finally decide to go with as well as his experience.Hope the above helps.Kind regards,Ivo Gwanmesia, London Plastic Surgeon (England)

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