What are the indications for either a Deep Plan or a SMAS?

Question

What are the key indicators that would help one to decide whether a Deep Plane Face Lift or a SMAS Lift is the correct option? I know each PS has their expertise but are there reliable key indicators that one would be better than the other? I would love to understand the clinical factors that are key in this decision. Thank you

Brian M. Harmych, MD, FACS · Answer

Great questions! Choosing between deep plane facelift and SMAS facelift, for most surgeons, it probably mostly dependent on the technique they were taught in training. Like several have mentioned, there may not be solid evidence that one technique is overall superior to the other. However, for each individual patient, there like is a superior technique that will produce the best results. In my practice, I often a perform hybrid facelift procedure, incorporating some deep plane facelift technique as well as some SMAS facelift technique, depending on how much aging is present. The key point to understand is that, there must be dissection of the SMAS layer in order to produce long term, significant and permanent results. You will get a good idea of the degree of improvement expected by each surgeon by reviewing their before and after photos. Keep in mind that many patients undergo complimentary procedures, such as eyelid surgery, fat transfer, forehead and brow lifting, lip lift and facial implants, that can dramatically improve the overall result. To assess the result of the facelift, pay close attention to the improvement of sagging skin in the neck, definition along the jawline and nasolabial fold. I hope this information is helpful.

Jigar Sitapara, MD · Answer

Greetings from Washington DC!This is a great question and is one that I get asked frequently. There are many semantic issues in the realm of facelift surgery and when you add additional trademarked names, it gets even more confusing. There was a time that I was offering SMAS lifts as my "mini-lift" and reserving deep plane lifts for patients with more significant jowling or laxity. However, after seeing the superior results of the the deep plane lift, I completely stopped offering the mini-lift/SMAS option. As you may already know, there are facial and neck ligaments that are holding that SMAS/platysma layer in place. If they aren't released in the deep plane, those anchor points are just going to be continuously fighting the sutures that are suspending the SMAS layer. Eventually those ligaments will limit the longevity of your lift and may hinder proper repositioning of the SMAS layer in the first place. There is a marked "release" that can be felt in the SMAS layer during my deep place facelifts once those ligaments are released. In my opinion, I would not be able to move the SMAS back to where it used to be, without that deeper dissection. The degree of skin dissection tends to be very similar so the recovery tends to be about the same. 
I hope that helps! Wishing you the best!Dr. SitaparaChevy Chase Facial Plastic Surgery

Jeffrey Lisiecki, MD · Answer

Most surgeons tend to be well-versed and most comfortable in one of the two techniques, based on their experience, and use this in all or almost all of their patients. There are great facelift surgeons who do some type of deep plane facelift, and there are great facelift surgeons who do SMAS facelifts. They each have relative upsides and downsides. I trained in both and have done both in my own patients. I prefer a SMAS facelift in most patients, especially with significant skin excess or jowls, for a number of reasons. It allows you to undermine and redrape the skin more, allows you to directly excise jowl fat, and keeps the deep facial fat compartments intact for the purposes of fat grafting (which is also a crucial step in most facelifts).

Daniel J. Gould, MD, PhD · Answer

Basically, Deep plane is always the approach I use. There are few exceptions, and I have trained in all methods. Facelift 3.0 is all about releasing the deeper structures for better results.

Jonathan Kulbersh, MD · Answer

With new technology and expertise, several facelift techniques have been created to accommodate various needs and achieve different goals. The SMAS (superficial musculoaponeurotic system or the thin sheet of muscle and connective tissue deep in the subcutaneous fat in the mid and lower face) facelift is the most common type of facelift in which the skin and superficial musculature are stretched and reattached. In contrast, a deep plane facelift involves deeper manipulation by repositioning deep facial soft tissues found beneath the SMAS. A deep plane facelift maintains the skin and its underlying tissues in alignment with each other, repositioning the entire system as a single unit. Both approaches can produce dramatic results. To better determine the right surgical technique which will depend on your skin quality, concerns, and desired aesthetic goals. I recommend scheduling an in-person consultation with a reputable board-certified facial plastic surgeon. Your surgeon will assess your skin and signs of aging, recommend the best surgical procedure, and ensure the best possible outcome.

Ronald J. Edelson, MD · Answer

There has never been any evidence that a deep
Plane is any better than a standard facelift. I believe it's at least as important fir the surgeon to properly place incisions and pay attention to the detail
In tailoring the skin. That's the part that will be seen

Mark Glasgold, MD, FACS · Answer

The key difference is that an extended Deep Plane facelift will reliably correct the marionette line or labiomental frown without the need for fillers which a SMAS lift will not. A Deep Plane facelift will also reposition the cheek fat pad to a more attractive position.Both surgeries are very effective in correcting the jawline (jowls) and neck.

Robert Singer, MD · Answer

There are a variety of procedures that are called “facelifts.”  A well performed facelift which elevates and supports the deeper tissue of the face called the SMAS as well as removing the excess loose skin and adding appropriate amounts of volume to deficient areas of hollows and depressions not only turns back the clock, but also slow the aging process. However, the clock keeps ticking. 
Good results can be achieved with either technique, a SMAS or Deep plane, in the appropriate patient. What is more important than the specific technique is the experience and artistry of the plastic surgeon.

Some surgeons claim that “Deep Plane Facelifts” last longer, but there is no valid scientific evidence to support those claims.

I would suggest your  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

What are the indications for either a Deep Plan or a SMAS?

Answers (8)

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