Facelift younger patients - Deep Plane or Smas?

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?

Doctor Answers 7



Thanks 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 .

Madison Facial Plastic Surgeon
4.7 out of 5 stars 43 reviews

SMAS is deep plane

There is some confusion when discussing level of facelifts: subcutaneous, SMAS, subperiosteal.  Let me simplify for you.  Subcutaneous means the skin is elevated just below the skin/fat level.  It is theoretically the safest as no nerves live here.  It is also the shortest lasting since skin will loosen after being pulled on.  A "deep plane", "sub-SMAS" or "SMAS lift" uses the deeper structure of the face, the SMAS, to support the facial tissues lifted for a more long lasting lift.  The SMAS is in direct contact with the nerves of the face and hence makes the surgery higher risk.  Most surgeons who do not perform many facelifts each year will elevate the SMAS partially and call it a "SMAS lift" or "deep plane" lift but never do enough dissection to encounter the facial nerves but do not get the maximum benefit of a full SMAS lift.  Experienced facelift surgeons know where the nerves are, protect the nerves during surgery but fully mobilize the SMAS to get the greatest lift and longevity.  You  may see the term "extended SMAS" in this context.  No one does subperiosteal (at the level of the bone) anymore due to poor results and complications.  Some plastic surgeons think that "deep plane" means subperiosteal but they are mistaken.  Not everyone needs a SMAS lift so discuss this with your facelift surgeon, certified by the American Board of Plastic Surgery.

Dr. Z

Michael Zenn, MD
Durham Plastic Surgeon
5.0 out of 5 stars 65 reviews

Deep Plane or Smas facelift ?

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. 

Michael Kulick, MD, DDS
San Francisco Plastic Surgeon
4.3 out of 5 stars 12 reviews

Everyone is different

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

Robert Steely, MD, FACS
Houston Plastic Surgeon
4.8 out of 5 stars 56 reviews

Facelift Deep Plane vs Smas

Hi Millie, 

I prefer to do a deep plane Facelift in all of my patients. Not doing a deep plane, I feel, comprises the longevity of the results in any patient. 

Hope this helps, 

Javad Sajan, MD

Javad Sajan, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Deep plane os SMAS lift?

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

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Deep-plane facelift vs. SMAS

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!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 113 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.