Deep Plane Vs Short Scar SMAS?

Assuming the two best qualified facial surgeon with 150+ facelifts per yr with one using deep plane technique under IV sedation and the other using the SMAS mini lift under oral sedation which facelift would, on the same 60 yr old female with moderate jowling and neck laxity have the best near term and long term result. When, in either case, would you predict a redo would be necessary.

Doctor Answers 4

Deep Plane Vs Short Scar SMAS?

It seems you are in the middle of a decision for two different approaches for face lifting. In face, there are more than two technique of facelift techniques. Each technique has its pros and cons.  

Both deep plane and SMAS mini liftting  can be applied to a great number of techniques, there is no one and the same method called  Deep plane lift and there is no very definite technique called SMAS. 
If try to describe in few words the difference between them, the Deep plane is the technique, which involves  tightening the deeper structures of the face and  more frequently used for the patients with  moderate to severe signs of aging. It can provide overall better results, as this technique allows the surgeon  to lift the looser tissues up. Besides, it is more complicated technically and has more inherent risk of facial nerve damage.
In a SMAS technique we more have a neck and jaw as an object of lift, than a face and cheek. A dramatic improvement in the neck and jowls  can be achieved with experienced surgeon with less injuries, less recovery time and less cost.
That is why I think choosing the surgeon you can trust and  whose decision you can rely on, should be prior to choosing surgical method. 
I wish you best of the luck!

Turkey Plastic Surgeon
5.0 out of 5 stars 23 reviews

SMAS Vs. Deep Plane Facelift

The SMAS facelift is a general term for the lifting of the face with two separate planes of lift. The first plane is the deep tissues of the face which includes fat, muscle and fascia. The second plane is the superficial fat and overlying skin. This is the basic description for the best of all facelift techniques.

The first techniques attempted utilized pulling of only the skin. Early on it became apparent that pulling of the skin alone led to early recurrence and excess scarring - not an ideal outcome. Other techniques have been attempted with a modicum of success. The most prominent of these other procedures is the deep plane technique whereby the entire sandwich of tissue (Skin, fat, muscle and fascia) is lifted together. This technique leads to a large amount of swelling but an early recurrence of the signs of aging. But most importantly, this technique does not allow us to lift the tissues vertically.

The process of aging is caused by gravity, facial animation, stresses on the skin (weight gain, smoking, drinking, sun damage and age). The combination of gravity and facial animation pulls the tissues of the face in a downward and inward direction. Smiling reverses the sag - so look in the mirror and smile to see where your facial tissues use to be and where you hope that surgery would replace them. It is for this reason that the SMAS lift should move all tissues in a vertical direction - put the tissues back to where they once were.

So with that said, what are the risks and benefits of the Vertical SMAS Facelift.
  1. More natural lifting of the fascial tissue avoids the windblown or pulled look of many other techniques.
  2. Vertical lift adds to the volume of the cheek, removes the jowl and marionette lines to yield a more oval face.
  3. Vertical lift often eliminates the malar depression or tear trough.
  4. The SMAS facelift has a lower risk of facial nerve injury than the deep plane facelift and recovery from swelling is significantly shorter.
  5. Perhaps the only really increased risk relative to other techniques is the risk of bleeding or hematoma. The creation of two flaps of tissue can result in an increase risk of bleeding. But these small blood clots under the skin are still infrequent and ultimately resolve.
  6. All facelift procedures have risks to the sensory and motor nerves of your face. This technique does not have the same risks as a deep plane for motor nerve injury.
  7. A SMAS facelift does not address the forehead (Brow lift) or the lower lid bags (Blepharoplasty) but they are often performed together.
In the end, the SMAS facelift is an ideal procedure when performed in a vertical fashion. Find a board certified plastic surgeon with experience in performing this technique.

If you would like more information on facelifts, please read my book " A More Beautiful You - Reverse Aging Through Skincare, Plastic Surgery and Lifestyle Solutions".

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

Results of all Facelift varieties depend on how well the SMAS is addressed

Sounds like you are deciding between two different surgeons - not always an easy task. There are so many types of facelift techniques and terms out there that the whole topic can be confusing for patients and doctors alike!

The absolute key to  success for any facelift procedure including Deep Plane Facelifts and Short Scar Facelifts is that your surgeon must be able to advise you well as to which procedure applies to your specific needs and which ones do not. Then they must be able to execute that procedure well so that the results desired are achieved.

Advice comes from training, experience, honesty and dedication to a specific area of expertise.

Execution comes with inherent skill, experience with time and desire to deliver successful outcomes for all patients.

End of the day you have to go with a Surgeon you trust and let him or her be the professional they have worked so hard to become and let them advise you and execute for you - as Surgeons we want only the best for our patients. 

Lastly sometimes it is hard to choose between surgeons with all things being equal - in that case don't forget one thing you have in your favor - listen to your gut feelings.

Be well and hoped this helped,

Dr. Jafri

Kamran Jafri, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Deep plane vs. Short scar.

In my opinion, a deep plane facelift performed well is the gold standard.  

Although the scars by definition are longer, they will also be very well disguised if performed by a meticulous surgeon.  My inherent bias is that of a properly executed deep plane facelift because of it's natural appearance and long-lasting results.

William Numa, MD, FACS
Boston Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.