What is the difference in technique between SMAS and a Deep Plane facelift? Is the cost the same? Can all Dr.s preform either?

Question

What is the difference between SMAS and a Deep Plane facelift?

Jason Roth, MBBS, FRACS · Answer

A deep plane facelift is a type of SMAS lift, not a completely different facelift. The SMAS layer is the muscle layer of the face deep to the skin. It is well recognised that lifting the SMAS gives more natural and longer lasting facelift results. Over the years many techniques for lifting the SMAS have been tested. These include removing a section and shortening it and overlapping it. The point where the SMAS is incised and lifted also varies (low SMAS vs high SMAS lifts). A deep plane facelift involves making an incision in the SMAS and lifting it. This is the same principle as every other SMAS lift. The difference with a deep plane lift is where the SMAS is incised and the degree to which it is mobilised. It is now well established that making the SMAS incision close to the problem areas of the ageing face (close to the jaw line, eyes, mouth) gives the most natural and long lasting lift with the minimal down-time. SMAS incisions close to the ear (the classic "SMAS lift") tend to place more tension on the skin edges and also offer less of a lift around the mouth and jawline. The deep plane facelift requires a smaller skin flap than a traditional SMAS lift which means there is less facial bruising and swelling after surgery. With a faster recovery, more minimal skin flap and better results there is really no downsides to a deep plane facelift over a traditional SMAS lift. A traditional SMAS lift may be slightly quicker (and easier) to perform surgically which can reduce costs for the patient. Most plastic surgeons and facial plastic surgeons have learnt how to perform a SMAS facelift. The deep plane type of SMAS facelift is the newest type and not all surgeons have learnt or are comfortable performing this technique.

Alejandro J. Quiroz, MD · Answer

Thank you for your question; The SMAS is part of the deep plane technique and no all the doctors perform this technique. The paltysma is a muscle in the neck that is part of the deep plane support in the neck.

Ercan Karacaoglu, MD, FEBOPRAS · Answer

There are many different ways of performing a SMAS facelift, and many different techniques, called "Deep plane facelift", that is why using these terms can be confusing to the surgeon and the patient. The most general thing that can be said about  "Deep plane facelifs" is that they involve  tightening the deeper structures underneath the SMAS, and the recovery is longer.So, both of the terms can be applieid to a great number of techniques,  and they work great in the experienced hands. That is why I think it  would be reasonable to choose the surgeon you can trust and  whose decision you can rely on; a skilled,  an experienced and an honest doctor will choose  the best for your case technique..I hope this will help..

Jeffrey M. Darrow, MD · Answer

The SMAS is the layer of tissue just deep to the skin and is lifted and sutured in various fashions as an adjunct to lifting the skin during a face lift.  Deep plane lift is done in a tissue plane deep to the SMAS and requires more dissection, creates more swelling and a longer recovery and results have never been shown to be superior to a well done SMAS facelift.  Most surgeons do a SMAS facelift with the deep plane falling out of favor.  Cost is usually more for the longer surgery.

Martin Jugenburg, MD · Answer

Facelift techniques range from Deep Plane (deep to all the facial layers) to Skin Only.  SMAS is Superficial musculoaponeurotic system.  In SMAS facelift (there is a million variations) the SMAS is manipulated in addition to the overlying skin to reposition/lift the facial structures.  Deep facelifts take longer, have longer recovery and tend to be more expensive than more superficial facelifts (but that doesn't automatically translate to deeper=better)

Andrew P. Trussler, MD · Answer

The SMAS or submusculoaponeurotic system is a fibrous and fatty layer under the facial skin which helps to support the tension of a facelift. There are multiple different techniques of SMAS tightening, including sutures plication, SMASectomy and a sub-SMAS (deep plane) face lift. There is really no consensus on which technique is best, though longevity of a face lift may be improved with a sub-SMAS face lift. Facelift surgeons will typically have one primary technique which should be pretty equal on pricing, but facelift surgeons should be able to perform multiple techniques in order to perform secondary facelift surgery.

John T. Lindsey, MD · Answer

The SMAS (superficial musculo-aponeurotic system) is an anatomic description of the connective tissue surrounding your facial muscles.  Deep Plane refers to a technique described by Dr. Hamra where dissection is done underneath this structure, but the overlying skin is not separated from the SMAS.  This is a useful technique where facial contour is the main goal (correction of jowls and neck contour), but the overlying skin is of good quality (not severely sun-damaged or wrinkled).  
Another variation of this is an independent skin-SMAS facelift.  The same sub-SMAS dissection is done as above, but the skin is separated from the underlying SMAS.  This allows use of the SMAS for general facial and neck reshaping, but the skin can also be stretched and re-draped separately.  The independent stretching of the skin allows for more aggressive smoothing of deep wrinkles.  In my practice, most patients are better treated with the independent skin-SMAS facelift.  The recommendations vary according to the specific goals and anatomy of each patient which can only be obtained through consultation with your plastic surgeon.

Julian De Silva, MD · Answer

SMAS refers to the superficial
musculoaponeurotic system, or the underlying muscles tissue found in the face.
A SMAS facelift refers to a surgical technique that can be used to address
sagginess in the jowl and neck area. During a SMAS facelift procedure, the skin
is separated, the muscle layer manipulated and tightened, and the skin redraped
and trimmed. To further improve jawline definition, deposits of fat beneath the
chin may also be removed via liposuction. The result is the face a more
refreshed, taut appearance. A Deep Plane facelift works underneath the SMAS
layer. Most board certified plastic surgeons can perform both procedures, but I
recommend consulting our facial plastic surgeon to find out which procedure
would be best for you.

Matthew H. Steele, MD · Answer

Thanks for your question.  The SMAS refers to the fascial layer that envelopes the muscles in the face that create animation/movement.  A "deep plane" lift implies a dissection underneath the SMAS layer.  The tissue is then advance posteriorly (backward) and superiorly (upward) to reverse the typical signs of aging.  Care must be taken with deep plane lifts because the nerves that make the face move are located just deep to the facial muscles/SMAS layer.  A "SMAS" facelift typical implies either a plication (tightening) of the SMAS or a SMASectomy (cutting and removing a portion of the SMAS).    This also tightens the face to help reverse aging changes, but requires less dissection of the SMAS and therefore less risk of nerve injury.  There is no definiitive study of which I am aware that demonstrates superiority of one technique over the other.  The choice of technique is surgeon dependent and often relies on the surgeon's comfort level.  Surgeons can often get great results with many different techniques.  Spend time with board certified plastic surgeons and look at their before and after photos.  Good luck.

Inessa Fishman, MD · Answer

A SMAS facelift typically lifts and tightens the connective tissue layer enveloping the muscles of facial expression; this tissue layer is called the superficial musculoaponeurotic layer, or SMAS.  There are many variations of SMAS facelifting surgery, with folds or flaps created in the SMAS layer.  A deep plane facelift is a broad term for surgery that involves working in the layers deep to the SMAS.  A surgeon's technique depends on training, personal experience, and continued education.  Terminology in facial rejuvenation surgery can vary widely between practitioners; furthermore, there's no consensus regarding which technique is best or longest-lasting.  Given this, a surgeon's skill, follow-up care, and patient rapport is likely more important than a particular technique.  Choose a surgeon with a keen understanding of facial anatomy and thorough experience; review before and after photos; and undergo an in-person consult and exam to discuss your expected outcome.  Good luck!

What is the difference in technique between SMAS and a Deep Plane facelift? Is the cost the same? Can all Dr.s preform either?

Answers (13)

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