Deep Plane Facelift Question. Why Do Some Doctors Do a Deep Plane Face-Lift vs A SMAS?

Why do some doctors do a deep plane face-lift vs a SMAS. From looking at pictures, it looks to me as if the deep plane works best for the jowl and neck area. Most pictures that I see after a Smas, I can still see residual looseness under the neck.

Doctor Answers 49

SMAS facelift should tighten the jawline as well as a deep plane lift

Thank you for your question.  A properly performed SMAS facelift should provide as good a result as a deep plane facelift throughout the face including the jawline and neck.

In the SMAS facelift the neck muscle the platysma is tightened in the neck and along the jawline as well as the mid and upper face.

I seriously recommend that all patients considering facelift surgery choose their surgeon based on the surgeon's experience  and reputation as a facelift surgeon and let the surgeon decide the best technique to achieve the best result and your face.

The deep plane facelift can achieve excellent results in the hands of an experienced plastic surgeon however deep plane facelift does increase the risk of nerve injury which is why many experienced plastic surgeons choose not to use this technique.

Deep Plane Facelift

The Deep Plane and SMAS facelifts are both very effective procedures.  Both operations dissect deep to the SMAS fascia to mobilize the face. The main difference is that in the SMAS facelift is more of a two-layer dissection (skin and SMAS separately) and the deep plane operation is more of a "composite" procedure (skin and SMAS together).  There are advantages of each technique and some surgeons, such as myself, vary the type of facelift they perform depending on the patient's anatomy.  In both procedures the surgeon must release the retaining ligaments of the face to achieve a natural appearance that is not "pulled" or "swept back". 

Brock Ridenour, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 112 reviews

Deep plane versus SMAS facelifts

The deep plane facelift is more technically demanding and has more inherent risk of facial nerve damage than a SMAS lift does. That being said, a surgeon experienced in the deep plane technique will likely have very few complications. The deep plane technique is potentially more useful for a very heavy face, requiring more aggressive suspension of the underlying tissue. The increased depth of dissection also typically increases the post-operative swelling. I would heed a common and valid theme on this board and find a surgeon who you are comfortable with and trust his or her judgement regarding the technique that he or she chooses.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Deep Plane Facelift Question. Why Do Some Doctors Do a Deep Plane Face-Lift vs A SMAS?

 It's a matter of preference.  I have performed facelifts for over 25 years and in my opinion achieving a natural, beautiful result from a facelift relies more on the ability to understand and follow the aesthetics of facial beauty than it does with the tissue layer that's dissected.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Training and Surgeon's experience will determine which Facelift you will be offered

Deep Plane Facelifts and SMAS Facelifts will give the exact same results in the "average patient". By "average patient" and for sake of discussion, let's say this means a female patient who is 55 years old with mild to moderate jowls and decent but not great skin tone and quality. When done properly a SMAS facelift will give you the same results that a Deep Plane Facelift will with quicker recovery and lower cost.

Now, let's take a female patient who is 45 years old with mild jowls and pretty good skin tone and quality. A Deep Plane Facelift may be a bit aggressive for her while a well executed SMAS Facelift will get her excellent excellent results with long lasting benefits.

Finally we have a 65 year old female patient with moderate to severe jowls and poor skin quality and tone. For her a Deep Plane Facelift will provide overall better results since the dissection is deeper and allows for heavier / looser tissues to be lifted up. A SMAS lift will certainly provide nice results as well but will not be easy to execute unless the surgeon knows who to get the most impact out of a SMAS facelift (and the fact is most surgeons know exactly how to do this!).

All facelift techniques can improve the neck but if neck problems are more than mild a dedicated neck procedure like a neck lift will be needed with both a Deep Plane Facelift or a SMAS Facelift.

The technique individual surgeons will choose will be based on their training level, depth of experience, overall comfort with each of the procedures and their ability to make sound judgement as to which procedure will offer the best outcome for each individual patient's needs.

Lastly it should be mentioned that some surgeons will only offer one procedure over the other to all patients because it offers the most financial benefit to them - sad but this can be reality.

Keep asking questions & do your research and all will be well,

Dr. J

Kamran Jafri, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Deep plane facelift vs a SMAS lift

Dear Loveseasons,

  • I perform deep plane facelifts because, in my hands, I think it gets my clients better results
  • The difference is the amount and level of dissection, both are safe in experienced hands
  • You are very astute to look at the jowl area before and after, as that portion is often missed or unimproved after facelifting
  • If you find a surgeon with great before and after pics, it does not matter which technique is used, as long as you get the result you want

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

Who performs a Deep Plane Facelift and is a Deep Plane Facelift better?

A Deep Plane facelift can have different definitions.  Most surgeons in the country will perform a SMAS Plication lift or a variation of that lift instead of a deep plane because it is what they are most comfortable with and their patients are happy with the results.  A SMAS plication lift inherently is more of a neck and jowl lift than a face and cheek lift.  The heft of the procedure is a skin dissection with minimal movement of the SMAS performed by suture pull maneuvers. Still you can get a dramatic improvement in the neck and jowls with better results coming from more experienced surgeons.

A deep plane facelift when performed by a specialist will result in a more dramatic improvement of the face and cheek because this is the only type of procedure which can truly and durably affect the face, cheek and nasolabial folds.  Some surgeons perform a very limited deep plane dissection while a handful will perform an extended version of the procedure. The results can be dramatically different.  The benefit of an extended deep plane lift is that it avoids the need for fat grafting to improve the face in most cases.  It also lasts much longer (by several) than a typical facelift even though patients tend to get revisions on average around 8-10 years regardless of durability of either procedure.  When performed by an experienced surgeon, the risk of nerve injury is the same and the risk of skin scarring and skin sloughing is much much lower especially in smokers.  The classic belief is that it is a riskier procedure but research studies have shown otherwise. Also for a revision facelift I would only perform a deep plane in most cases for many reasons. 

Overall, the only way you know what you're going to get is by looking at before and after photos and seeing which aesthetic you like specifically. Every surgeon is different and ultimately it doesn't matter what title they use to describe the procedure.  The problem is, how do you know what you're evaluating?  Some good things to start with are:  make sure the lighting is the same in the before and after photos; look for changes in the cheek and around the nose and mouth as well as the neck; look at the angle of the jaw on the side view to see if this is blunted after surgery or more well defined; look a the base of the earlobe to see if it is stretched or attached properly; make sure the hair is pulled back behind the ears and not hiding scars; make sure the patient does not look like they've had surgery; look to see if the sideburns and hairline look nice or if they have an irregular appearance. 

Ben Talei, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 45 reviews

Face Lift techniques, is one better than another?

There are many facelift techniques including deep plane, SMAS, composite, MACS, full and mini. Each of these techniques have unique benefits and risks and will all obtain excellent results in well trained and experienced hands. The best surgeons will carefully evaluate the patient's anatomy and desires in order to choose the technique which will reliably achieve the best results in a safe manner. Ask your surgeon to explain the technique they think will work best for your particular goals.

Andrew Goldberg, MD
Fairfax Plastic Surgeon
4.7 out of 5 stars 9 reviews

SMAS vs Deep Plane lifts

Good question. I do both. Ithink it depends on the issues that the patient has with their face. I generally think that the deep plane lifts are a bit more powerful, which can require additional procedures, like a midface lift and browlift, in order to keep the face looking natural. The SMAS type lifts can be varied a bit more but have some limitations. That's just my opinion and you'll get as many opinions as surgeons who choose to answer the question. There is not really any right or wrong. It's the "art", not the "science".

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.9 out of 5 stars 77 reviews

Deep Plane Facelift Question. Why Do Some Doctors Do a Deep Plane Face-Lift vs A SMAS?

Dear Seasons,

Thank you for your question.  Both SMAS and Deep planes are good techniques.  However, more important than the technique itself, is the surgeon.  The Techniques will have different results with different surgeons.

Best Wishes,

Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 47 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.