Why do most doctors not do the composite lift? I mean deep plane, with fat repositioning under the eyes and lateral lift.

What is more important than the specific technique is the experience and artistry of the plastic surgeon. In a SMAS procedure, the tissue deep to the skin is either tightened, parially resected, or elevated which generally achieves a longer lasting and better result. Each surgeon has his or her own approach of how they dissect and what they do with the SMAS. Artistic natural results need to be individualized depending on the patient's anatomy. Some surgeons claim that “Deep Plane Facelifts” last longer, but there is no valid scientific evidence to support those claims.
I would suggest your a 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 

Unforuntately what makes compelling anatomy for surgoens does not always translate into a natural serene facelift result.  These are very mechanical procedures that often result in very unnatural results.  They are often associated with an extreme appearance. Also due to the anatomic necessary for these radical procedures, they are associated with a significant rate of motor nerve injury (about 5%) even in the best of hands.  There is also very persistent swelling associated with these procedures.  In my expereince, there can also be unexpected fat atrophy with these procedures that contributes to a skeletonized appearance in some patient. The counter trend is small incision facelifts featuring more natural results.  Be careful what you look for and you might find it.