What’s the difference between the High SMAS facelift & deep plane facelift? How does high SMAS facelift work?

You like others have concerns regarding the terminology of the word "facelift." Deep plane, SMAS, vertical lift, etc. The video attached will help you understand some of these concerns. The weblink will allow you to see short and long term results. Hope this helps.Sincerely,Michael Kulick MD - San Francisco, Ca
   Board Certified Plastic Surgeon

   Member of ASPS, ASAPS
   Recipient of the Klingbeil Award – Teaching Safe Techniques and Advanced Technologies

Thank you for your question. The main differences between the high SMAS facelift and deep plane facelift are in the point of access under the SMAS which is more lateral in the high SMAS and more anterior in the deep plane technique. Both techniques represent a SMAS lift approach.

There are aspects discussed about the degree of mobilisation of the SMAS from the facial ligaments with the two techniques but there are also surgeons that produce similar levels of ligaments release with the high SMAS as with the deep plane.

The more important consideration is to examine the types of results that your surgeon of choice achieves and if you feel satisfied that they reflect your aspirations, whether you are dealing with a high SMAS or deep plane, the longevity of the treatment is relatively similar.

From personal experience I would say that the deep plane approach may have a marginal benefit for improvement in the jown and marionette lines, but I have seen over the years in presentations very elegant results with a variety of techniques.

Thank  you for your question.  The SMAS  is part of the deep plane technique in a facelift.  We believe the results are more natural and longer lasting.  Also not all surgeons perform this technique.  The high SMAS goes high to the level of the chick bone.

Great question!  A facelift of any type turns back the clock but can not stop the aging process, and a well-performed facelift using either technique mentioned can last ~10 years.  Most surgeons are partial to one technique or another, and their before-and-after portfolio demonstrates the type of results that are achievable with their technique.  In general the happiest people are those who find a surgeon who shares their goals and expectations.  Hope this helps!

There are several different types of facelift techniques that are currently performed by facelift surgeons. The most important factor is that the technique that is used by a facial surgeon will create a youthful, natural with long lasting result. An ideal facelift result includes in part not having anyone assume you have had a face lift procedure.  I think a patient that desires improved appearance but wants a natural, non-operated result will have to communicate this to his or her prospective surgeon but also seek out an experienced facelift surgeon that prefers to achieve these types of results.  Experience is the key in facial rejuvenation. Vectors of facial tightening vary from patient to patient. For a 45- 50-year-old patient, I would not apply the same vector and tension that I normally apply to a 70-year-old face. In addition, direction of vectors must be modified during secondary or tertiary facelift to avoid artificial look.  I have performed well over 3,500 face and neck lifts and published a specific technique that describe the rotational angles and amount of tension that must be applied during SMAS plication to avoid over or under tightening.  A well-performed neck lift during facial rejuvenation is the paramount in a youthful-appearing face. I apply gradual tension on my SMAS as follow: starting at temple area there is only 20-30% tension on muscle plication, once at the jawlines the muscle is tightened 100%. This prevent pulled looked at the corner of mouth. In neck area the muscle must be tighten with greater tension than 100%, depending on the neck laxity.  Look at the doctor’s before and after pictures, a talented and experienced facelift surgeon will have a smooth and well-contoured neck that enhances the facelift results.  The face ages through a combination of changes including volume loss, skin changes, and soft tissue drooping.  When facial rejuvenation is desired all of these changes must be addressed.  Therefore, fat grafting, a facelift, and skin resurfacing frequently must be combined to accomplish a natural result.

 It's best to choose your surgeon based upon producing natural results, rather than the technique that they are using. The deep plane facelift and a high SMAS face lift differences are only minimal at best. The deep plane facelift involves dissection in the area of the facial nerve branches, and has a higher incidence of facial nerve paralysis. In our practice, we perform a high SMAS lower face and neck lift procedure which accomplishes  not only tightening the SMAS, but also lifts the jowls, tightens loose facial and neck skin, tightens loose facial and neck muscles, and removes fatty deposits in the neck including a platysma plasty.  A deep plane facelift may or may not include neck work, so make sure your surgeon is rejuvenating the neck as well. All facelift procedures usually last approximately 10 years,  and the reason for this is usually the inelasticity of the skin, genetics, sun exposure and smoking. For many before and after examples of high SMAS face/ neck lift procedures, please see the link and the video below

What is more important than the specific technique is the
experience and artistry of the plastic surgeon. In a SMAS procedure, the tissue
deep to the skin is either tightened, partially resected, or elevated
which generally achieves a longer lasting and better result. Each surgeon has
his or her own approach of how they dissect and what they do with the
SMAS. Artistic natural results need to be individualized depending on the
patient's anatomy.
Some surgeons claim that “Deep Plane
Facelifts” last longer, but there is no valid scientific evidence to support
those claims. 
I would suggest your a 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 

 Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Non smiling photos of the face from the front and side would help in the evaluation.   The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  Price is determined by the reputation, location and experience of the Facelift Surgeon.
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.  I recognize the difficulty in differentiating between different opinions and even the types of facelifts themselves so let me say a few things in that regard.  
1. The primary indication for any form of facelift is the presence of "jowls" in the lower face.  This is regardless of "age" so any arbitrary age limit is well, just arbitrary.  While it is less common for 30-something year olds to have "jowls", they certainly do exist and many have undergone appropriately performed SMAS type facelifts. 
2. The reality is that there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  So it's paramount for you to understand exactly "what" any proposed facelift is designed to accomplish.
3. It's helpful to think of the facial tissues in layers from the inside out:  The bone, the muscles that move the face/nerves that operate those muscles, the SMAS muscle layer, the subcutaneous fat layer and finally the skin.  Facelifts are by nature designed to reduce the appearance of "jowls", tighten and remove excess skin.  In the 1980's it became standard that the SMAS muscle layer was also lifted as it was shown to not only improve the aesthetic appearance, following a facelift, but add longevity to the results.  Over the years there have been numerous methods of addressing the SMAS, with "imbrication" being the "gold standard" and most effective.  Imbrication means the SMAS layer is dissected, lifted, trimmed and re-sutured back together in the elevated position.  Plication means the SMAS is not dissected, lifted or trimmed but is "folded" upon itself. While this method is faster and easier for the facelift surgeon it's not accepted as effective as SMAS imbrication.  Finally, even less effective are suspension SMAS techniques using sutures or threads.
 Modification and shaping the face then should address the fat layer and the skeletal structure to create either a soft, feminine heart shaped face in women or a chiseled, angular handsome face in men.  Liposuction is a tried and true method of reducing subcutaneous fat in the face which I have used for over 30 years.  Dissecting the fat, by itself, would just split the fat layer into an upper and lower layer and would not remove or shape the fat and face.
4. In my experience when evaluating the face, it's key to determine the following:  Are the cheeks, chin and lips the ideal aesthetic shape?  Are "jowls" present and is there excess fat and skin in the face and neck.  Once these factors are determined, the proper aesthetic plan can be determined to make the face balanced, (for women) feminine and more naturally youthful and beautiful (while for men creating a more chiseled, angular and handsome face).
5. In my humble opinion, no facelift technique alone can properly shape all of the "key" aesthetic facial features.  For this reason, I always aesthetically shape the face when performing facelifts in order to make the face more naturally attractive.  
 The facelift is designed to lift the sagging SMAS muscle layer (and jowls) as well as remove excess skin from the face and neck.  Other procedures must be applied to properly shape the cheeks, chin, lips, chin and jaw line as needed.  
And finally. 
6. Aesthetically improving the face so that it is soft, feminine and youthful (for women) or chiseled, angular and handsome (in men) requires the proper aesthetic judgement to accomplish that goal.  All "Facelift Surgeons" are not the same, nor do they all share the same aesthetic judgement.  So don't be surprised if you get different opinions on suggested procedures and treatments.
  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
proper SMAS Imbrication technique
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  When the cheeks are flat or concave in the front, the cheeks can and should be shaped and augmented with precise placement of a dermal filler or by using silastic cheek implants (permanent enhancement) to create full, round cheeks that will feminize the entire face.  Conversely, a male face is made more chiseled and handsome by creating angularity in the cheeks, chin and mandibular angles.  This degree of facial shaping can't be accomplished by any type of facelift alone.  It requires a very specific and comprehensive understanding of facial aesthetics.  The goal of any facelift technique, as described below is the reduction of excess skin from the face and neck while tightening the underlying SMAS and/or Platysma muscle.
 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective. Hope this helps.