“SMAS” vs. “Deep plane” vs. “SMAS deep plane” facelift...which is best?

The deep plane face lift extensively dissects under the superficial muscle and platysma layer of the face. The method was developed as an alternative to a method called SMAS plication where the deep plane support is performed using sutures to support the SMAS rather than carrying out a surgical dissection under this plane. The deep plane dissection exposes the nerves that supply the facial muscle to direct injury. Even in the best hands, this risk is real and can be seen in as many as 3 to 5% of cases. The SMAS plication is not associated with the risk of motor nerve injury as it does not expose these nerve to risk. Surgical procedures run in fades and the deep plane face lift because immensely popular among surgeons. Unfortunately, it is an open question if the risk of the deep plane face lift  is balanced by a better long term facelift result. Several studies have look at this specific question. The answer is that the SMAS plication facelift, in experienced hands, is associated with higher long term satisfaction that the deep plane face lift. The plane of the surgery is one issue, but there are also other factors that make for a satisfactory facelift. This includes the tailoring (or lack thereof) of the surgical closure around the ears. Does the surgeon also address the neck cords (part of a face/neck lift). Like so many things in surgery, the technique is not the most important factor, it is the artistry of the surgeon, their attention to details, and their sensitivity to aesthetic nuance. It is not as simple as picking a particular surgeon based on which facelift technique they use, unfortunately.

As with other cosmetic procedures, there is no wrong or right technique and the best facelift procedure is the one that produces the most natural and long lasting results with low complications and happy patients. That decision is usually based on the experience of your surgeon. 

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 and what they call the procedure. 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