Facelift younger patients - Deep Plane or Smas?

Question

Why do some surgeons say deep plane only for heavier cheeks with less laxity than older patients? Will smas lift not be enough to hold the lift in such cases?

Evan Ransom, MD, FACS · Answer

Thank you for the great question! Without getting overly technical, here's the difference: a deep-plane facelift involves an exteneded dissection under the SMAS and platysma muscles into the midface, while SMAS techniques typically involve a more limited dissection in this plane. In addition, the deep-plane technique does not separate the skin from the connective tissue superficially. This results in a more natural-appearing lift and reduces the risk of hematoma. Whether a specific technique is better for a specific face shape or fullness is difficult to say. However, in my opinion, the deep-plane facelift gives a better result in the midface/cheek -- in addition to the other advantages mentioned above. Take care and best of luck moving forward!

Kshem Yapa, MBBChir, FRCS · Answer

Hi Thanks for the question In my opinion a deep plane facelift is a good option for patients considering facelift at a younger age . Facelifts deal with structural laxity in the face. In a SMAS plication the surgeon dissects between the skin/fat layer and an elastic layer called the SMAS. Working above the smas the surgeon uses sutures to lift the smas. With time however as there is no deep release of ligaments which tend to hold the smas fixed the effect of the lift can diminish. I In a deep plane facelift the surgeon works deep to the SMAS and releases ligaments which can tend to hold the SMAS fixed . With this release the smas can be repositioned without tension and the skin and smas remain attached and move as one block and so although a little more complex can give a very natural looking and long lasting outcome. I tend to reserve a smas plication facelift for older patients who have coarse wrinkles in the face for which going in between the skin and smas can be useful.

Jeffrey H. Spiegel, MD · Answer

This is a technical question. A good doctor will be able to recommend the right approach. I advise people to focus on the outcome they want not the method.  Do you care if your dinner is cooked at 400 degrees or 375 degrees or do you just want a perfect meal?  A good chef will get you the right product.  Same story with surgery.  As long as your doctor has facelift experience and can show you good natural results, you should focus on the outcome and not the method.  The decision tree involved is complicated and one of the reason it takes so long to be a facial plastic surgeon!

Alexander Donath, MD, FACS · Answer

I feel the deep plane lift allows the most natural, durable results for our patients of any age. Most surgeons use the term SMAS lift to describe one that stays above the SMAS rather than releasing it and this can limit the ability to move the tissues and maintain the result without permanent sutures. Also important is how well the incisions are placed to hide them as well as possible. We have revised many facelift scars from other offices and not all are able to be corrected if not placed well to begin with. Hope that helps and best wishes, Dr. Donath

Carlos L. Wolf, MD · Answer

Just like rhinoplasty surgery  One type of surgery does not fit all. When considering a facelift you should be seeing a physician who is versed at both a deep plane facelift and a SMAS  facelift.  Not all surgeries fit all patients!. I would talk to you physician about your concerns and what you desire and look at before and after pictures. Based on your confidence in your physician the actual type of surgery he or she does should be based on their experience in treating patients like yourself. You must go into surgery with full confidence in your doctor so choose well.

Benjamin C. Marcus, MD · Answer

HiThanks for your question. This is a subject that often gets debated in our meetings. The majority of the studies from the last 15 years show very little difference in long term outcome between traditional deep plane lifting and SMAS plication. What is missing from those studies is the advent of the high-SMAS lift and the deep plane lift with vertical repositioning and true facial ligament release. These techniques appear to have greater durability and better long term outcomes when one looks at revision rates. Having largely switched to these techniques in my practice I can truly say the results are more impressive and appear to have many fewer tuck ups. The argument for younger patients is that their facial ligaments are even tighter and of course they want maximum duration of their lift. All the more reason to consider an advanced deep plane lift. The issue is you have to make sure that the surgeon is doing the more modern version of the the deep plane or the extra benefit is minimal .

Michael Kulick, MD, DDS · Answer

A great deal of which type of facelift you have is based on what facial concerns you have, your long term desired results and budget. In general, the more time that is spent in the OR, the greater the cost. This time spent in the OR may be necessary to achieve your final result. You are correct in that while a SMAS facelift may work for some, it does not provide the same lasting results for all. If you look at the websites of board certified plastic surgeons, you can see the different facial shapes and their results. Then, look for sites that provide long term results, greater than 5 years. the real answer to your question is not the age of the patient but the facial shape, issues to be improved and selecting the procedure that affords such an outcome.

Robert L. Steely, MD, FACS · Answer

Good afternoon!As in all cosmetic surgery procedures- not every technique is best for every individual patient.  Some people benefit greatly from a deep plane technique, while others do very well with more superficial techniques.  And some people may benefit from deep plane techniques but are not willing to under go the prolonged swelling that these procedures produce- they just do not have the time.  In short, every patient has different needs, goals, and desires.  It is is up to us the plastic surgeon to be able to tailor your procedure to each individual.I hope this helps

Toby Mayer, MD · Answer

Deep plane os SMAS lift? Choose the surgeon who does natural faces without visible incisions and forget the technique used.

Grant A. Fairbanks, MD · Answer

The deep plane facelift is a great procedure for all ages
of facelift candidates.  The decision
depends on the patient's anatomy and the patient's needs.  The youngest I have seen was in a woman with
premature aging in her early 30’s.  I
suggestion is to find a surgeon that provides good examples that you were
pleased with.  The ultimate decision for
the type of facelift is between you and your experienced plastic surgeon.  Best to you in your search.

Grant A. Fairbanks, MD

Facelift younger patients - Deep Plane or Smas?

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