What is the difference between deep-plane and SMAS lower facelifts?

Hello, hope you are well. I will start by saying that there are as many facelift variations as there are plastic surgeons. Find someone you trust who has demonstrated good results (it is less the technique that is important, and more the surgeon's capabilities). The key differentiator of a 'deep-plane rhytidectomy' is release of a midfacial ligament called the zygomatic cutaneous ligament which allows for further mobilization and repositioning of the midface and malar fat pad. The deep-plane facelift was first described and the term coined by Hamra, a surgeon in Texas, in 1990. Since then, facelifts have evolved even further into 'extended deep-plane' techniques, and beyond. If this sounds technical, it's because it is! Amazing results can be achieved with either a SMAS, a deep plane lift, or their modifications, especially in the lower face, jowls and neck. SMAS lifts are more limited in the midface. I offer my patients whatever suits their particular anatomy and stated goals. Like any surgeon, a deep plane lift takes me longer to perform than a SMAS lift because of the additional dissection. Healing and longevity of results are comparable. In skilled hands, there is no greater risk to nerve injury with one technique versus the other. Facelifts of any variety can be performed under GA or with sedation monitored by an anesthesiologist. Endoscopic brow lifts are routinely performed concurrently.

Thank you for your question.

In essence both the deep plane and the SMAS facelift represent forms of SMAS facelift which means that apart from tightening of the skin to reduce laxity there is an intervention in the layer below the skin, the SMAS layer.

The differences are essentially at the entry point below the SMAS layer which some surgeons prefer to place more forward (the deep plane approach) and some surgeons prefer to place slightly closer to that year (the SMAS facelift). Both techniques provide an opportunity for comprehensive improvement in the facial features and it always depends on how the surgery is carried out not only on which technique was adopted.

It is important that you discuss with several surgeons and examine their results to form an opinion about what you feel reflects better this style of improvement that you seek to achieve.

Both procedures can be done under general anaesthesia or sedation but depending on how much work needs to be carried out for the neck contouring some surgeons may favour a general aesthetic in particular if you are planning to have a deep plane neck lift also.

Both procedures can be carried out in conjunction with an endoscopic brow lift or a temporal lift. This point also requires some more detailed discussion because we have moved more and more into the territory of shaping the eyebrows rather than just lifting the eyebrows which allows you to select the type of change that you would like to achieve.

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

The first thing to consider in your consultation process is the Surgeon and his/her results. After 22 years in practice, I have seen excellent results from both techniques, and results are more individual Surgeon specific than technique specific. That having been said, I prefer the deep plane technique, which allows for a composite lift of skin and SMAS, release of ligamentous structures, and harmonious repositioning of the cheek, jawline and neck. Bear in mind that all modern facelift techniques are SMAS based, but extended SMAS usually means a bilaminar approach: fist elevation of skin, followed by separate elevation of SMAS. In skilled hands, both techniques should take about the same time, about 3 hours in an uncomplicated deep plane facelift in my hands. The exception is a pure plication technique which is quick, doesn't involve lifting SMAS, but doesn't last very long. A deep plane facelift can easily be performed alongside an endoscopic forehead lift, which takes about 30 minutes. You can separate procedures but this means two down-times and two recoveries. I prefer level III sedation, which means that you won't remember anything, nor feel any pain during the procedure.

A deep plane facelift involves dissection in the cheek area in Direct proximity of the facial nerve branches, and has a higher incidence damaging those nerves. A SMAS facelift involves tightening the Facial muscles/fascia safely without seeing the facial nerve branches. Study your prospective surgeon's before and after facelift photo Gallery, which should be extensive with natural results that you like.
In our practice, we do not perform endoscopic brow lift, but perform a coronal approach which can address not only raising the eyebrows, but adjusting asymmetric eyebrows, raising or lowering the hairline, and softening the vertical and horizontal Lines in the forehead as well. A full set of facial photographs from all angles are required to make a determination about how best to proceed with both surgical procedures