“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.

Hello Weewers, 

There are many different types of facelift procedures, and the key aspect of each facelift procedure is that it is customised to the individual patient.  There are many variable factors that influence the surgical technique including your skin laxity, elasticity, age, volume loss, and the expertise of the surgeon. Some surgeons prefer SMAS technique over deep plane technique, while others may combine the two approaches to produce better results. In my experience, each technique is tailored to your specific requirements, some patients are better suited to SMAS techniques and other patients to deep plane technique. The best way forward would be to make an appointment with an experienced facial plastic surgeon.

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. 

You are correct that there are various words that are used to describe facial rejuvenation. Then, you have to consider the skill set of your doctor and the communication process. Communication  is important in that your expectations and recovery process need to have this in line. Seek out multiple consultations from board certified plastic surgeons before you have surgery.Sincerely,

Michael Kulick MD

   Board Certified Plastic Surgeon

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

Dear weewers,
Thank you for your question. As you have found in your research, there are many techniques to facelift. Surgeons may also slightly alter how they word certain facelift procedures such as facelift versus mini facelift to distinguish the extensiveness of the procedure and for marketing purposes. I recommend you seek an in-person consultation with a facial plastic surgeon or plastic surgeon who specializes in facelift who can perform a thorough examination and discuss with you the best surgical technique. The technique they may recommend depends on their experience and your anatomy. The deeper techniques have an advantage of being able to suspend the deeper tissues for a more dramatic result but are usually associated with more swelling and downtime. No one technique is considered the best for all patients. I strongly recommend you consider a facelift that does more than resuspend the skin. A successful facelift needs to address the SMAS layer at the minimum as this is a key suspensory layer in the facial layers of the face. 

These are great questions and are unfortunately confusing for patients.  There are various nomenclatures for facelift techniques, some by different names that are essentially the same.  In this case, both techniques can provide natural, improved, lasting results.  But much depends on the patient and what needs to be addressed, and the experience preference of the surgeon.  The details are too much for this response, but can be discussed at length in consultation.  Essentially, the deep plane (in experienced hands) can provide a more robust lift if needed and can be done with a shorter skin flap that can further protect the skin.  However, there are added risks in the sense that the deep plane involves dissection BELOW the SMAS and on top of the nerves that control the face.  I would strongly urge you to meet with surgeons that perform one or both for full explanations and to determine what is best for you.  Personally, I perform both techniques depending on the needs of the patient.Best wishes.

Great question! Having been in practice for over twenty years, I think all techniques have their place.  See a few surgeons in consultation before selecting a surgeon, so you may look at their before and after gallery.  Choose the surgeon, not the technique!

Excellent question! I think it is possible for a surgeon to get a great result with both techniques.  During a face lift, I believe that the SMAS should be treated in some manner to provide the best aesthetic outcome, support to the skin, and improve the longevity of the result.  But whether the SMAS is plicated, excised, or dissected beneath can all give the desired result.   I think the most important thing is that the surgeon is comfortable with the technique he or she is using and the results look natural.

There are so many different ways of performing a facelift and different terms are used to describe those techniques. It can become quite confusing after a while because sometimes you will find different terms are used to describe the same technique. Or two different surgeons will use the same term but their techniques vastly differ. It can be quite confusing and frustrating.
In general, as shown in the plastic surgery literature, there is no one technique that is superior. There are many different facelift techniques that provide excellent results. It really boils down to the expertise and eye of the surgeon. I recommend you see a surgeon who has extensive knowledge and experience with the procedure. Hope this helps.

 The anatomy of the face is very, very difficult and  there is many different varieties of  face lifting techniques. Its best to try to study your prospective facelift surgeon's before and after photo gallery. Make sure the facelift photo gallery is extensive and you like the natural results produced from that surgeon. In our practice we perform a high-SMAS lower face and neck lift which accomplishes tightening loose facial and neck skin, tightening loose facial and neck muscles, lifting the jowls, and removing fatty deposits in the neck above and below the platysma muscle plus a platysma-plasty.