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

Question

I am 65 years old, 5'6", 150 lbs., in good health. I have had no previous plastic surgeries. I have used tretinoin for about 5 years and my skin is in good condition I believe. I am wondering what is the difference in technique if the facelift is performed with the incisions in front of ears versus incisions in front and/or behind the ears. Is the skin and muscle being pulled up and cut away in both of these techniques? I hope this layman's question makes sense! Thank you.

Zachary Farhood, MD · Answer

The extent of your facelift incisions is largely determined by the amount of rejuvenation you need.  Those are less aging can tolerate shorter incisions, and still get a good result. Typically, someone in their 60s needs incision around the sideburns, in front of the ears, around the earlobes, behind the ears, and into the hairline posteriorly. This, however, is patient dependent as everybody ages differently. Some people are recommended a brow lift at the same time of their facelift. If they do not undergo brow lift, then the temporal incision (the incision around the sideburn) will need to be extended further up to prevent skin budging after performing a lift. Regardless, if the incisions are placed well, and the surgery is executed properly, then they are barely perceptible at the 6 to 12 month mark.

Matthew Tamplen, MD · Answer

Hi,The main difference between a Deep plane and SMAS facelift is mostly just terminology used to describe the level and amount of dissection. Both operations typically require incisions in front and behind the ear. The length of the behind the ear incision can be shortened depending on technique of the surgeon.
A Deep Plane facelift typically describes a procedure where most of the dissection is preformed below the level of the skin in effort to raise the deeper layer of SMAS containing ligaments and fat to a higher level for facial rejuvenation. It is by far my recommended approach to facial rejuvenation. Some SMAS procedures do the same thing with more skin elevation and other SMAS procedures just manipulate the SMAS without elevating it. Different surgeons use differently terminology for similar procedures. The SMAS procedures don't provide as long term and natural results but are faster to do and can be done in the office. 
SMAS procedures typically involve more skin elevation and more skin cutting away in the end. Deep Plane procedures also cut away a little bit of skin, but the majority of the lift comes from the deeper layers and thus less skin cutting away. 
Hope that helps! Best,Matthew Tamplen MD

Ronald J. Edelson, MD · Answer

Most facelifts have very similar incisions. In front and behind the ear is usually needed to get the best improvement

George Yang, MD · Answer

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

William Portuese, MD · Answer

Both techniques of facelifts require incisions in front and behind the ears due to the excess skin shift  when tightening loose facial and neck skin, the SMAS and neck muscles.  Also important to lift the jowls and remove fat in the neck  and perform a platysma-plasty to rejuvenate the jawline.  Study your prospective surgeon's facelift photo gallery, which should be extensive with natural appearing results

Robert Singer, MD · Answer

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

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

Answers (6)

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