Deep plane/SMAS facelift. What is the difference in technique with incisions in front of vs behind the ears?

Hi, Deep plane is also a type of SMAS facelift which involves cutting and lifting under the SMAS at a specific location and separating the SMAS layer from its underlying attachments. Thus the name deep plane meaning it is going under (deep) the plane of the SMAS. A SMAS plications does not cut the SMAS and plicates or “folds” (French work for fold is “Plié” also used as a ballet position) the SMAS if the SMAS is very thin and the surgeon doesn’t want to cut any of it away, or wants to fold some of the layers on top of each other to add some volume. Also there is SMAS imbrication which involves cutting a strip of SMAS and simply sewing the cut edges together. The strip of SMAS sometimes was used for lip augmentation back in the day prior to lip fillers. If there is only an incision in front of the ear, that could be classified as a mini-facelift or S-lift. If there is only an incision starting at the earlobe and behind the ear into the hairline, but not in front of the ear at all, then that would be a necklift incision to help remove some of the excess skin on the neck. To get the best neck results for the majority of patients is the combination of the lower facelift and necklift, to be able to remove enough skin under the chin and neck. I’ll end my response here, but there is much more to this topic. Hope this provides some value to you. Keep doing your research, and good luck. Best, Dr. Yang

In a SMAS procedure, the tissue deep to the skin is either tightened, partially resected, or elevated which generally achieves a longer lasting and better result than a skin lift alone. A high SMAS divides and reattaches the SMAS farther up on the cheek. Deep plane lifts dissect all of the tissue at a deeper level but may result in a higher level of facial nerve injury, generally have a longer recovery and there is no valid scientific evidence that they last longer or produce a more natural result.
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The incisions are in the same place for both procedures and good results can be achieved with any of the techniques in the appropriate patient. What is more important than the specific technique is the experience and artistry of the plastic surgeon.

I would suggest your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with who has all of the modalities of treatment available. You should discuss your concerns with that surgeon in person. Facial rejuvenation needs to be individualized. What would be an ideal approach for one patient is not necessarily the same for someone else. Based on the examination and discussion at the consultation, you should have a better understanding of the various options that can achieve the best cosmetic result for you.

Robert Singer, MD FACS

La Jolla, California