Do Deep Plane facelifts last longer & have more natural results than SMAS? If so, typically how much longer?

Doctor Answers 33

Do Deep Plane facelifts last longer & have more natural results than SMAS? If so, typically how much longer?

Hello SamStevenson,

Given the fact that 27 people have answered this question, I'm sure you've seen a lot of opinions on which is better.  There was a study done with twins, where one twin got a SMAS lift by one surgeon who likes to do that type of lift, and another did a deep plane/composite lift on the other twin because that is the surgery he liked to do.  At one year, the results were comparable.  Many people will say the deep plane facelift looks better earlier.  The reason is that it requires a lot more dissection which leads to more swelling.  That swelling will improve the wrinkles around that area more.  But as the swelling goes away and the real results show through, you will see comparable results (and they will last the same).  The risk of the deep plane facelift is that it takes longer and puts the nerve that controls the muscles of your face at greater risk.  

What I would recommend is you consult with several surgeons in your area, preferably facial plastic surgeons and plastic surgeons.  Look at their before and after and see what you think.  Make sure you develop a rapport with your surgeon, which is the most important aspect of choosing a surgeon.  

I hope this helps and good luck.  

The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Deep Plane vs SMAS facelift

The SMAS is more of a first-generation facelift from 1976 1987. I developed the deep plane facelift at that time and it was published in 1990. The best appearance and longest lasting is the composite facelift which incorporates all of the anatomy of the deep plane and SMAS operations. See the link below to my website which explains what I do. Good Luck to you. 

Sam T. Hamra, MD
Dallas Plastic Surgeon
4.8 out of 5 stars 12 reviews

Do Deep Plane facelifts last longer & have more natural results than SMAS? If so, typically how much longer?

Dear Sam Thank you for your question. As you may imagine every cosmetic procedure has a certain period to have its effect and results last. In that sense deep plane lifting has longer lasting result. Properly performed Deep Plane Facelift can take 10 up to 15 years off your appearance, but it can not stop the process of natural aging. Even with aging you will  always remain younger, than if you hadn't done your facelift at all. I hope this helps you. Best wishes

Ercan Karacaoglu, MD
Turkey Plastic Surgeon
5.0 out of 5 stars 23 reviews

Comparing Facelift Techniques

Hello and thank you for your question.
This is a question that has been professionally debated since the ‘90s. The basic difference is that a traditional Deep Plane, while elevating beneath the SMAS layer, leaves most of the skin attached to the SMAS. This allows a relatively thick flap to be pulled as a unit. A SMAS based technique usually releases the fibrous attachments between skin and SMAS so that the two layers can be pulled in different directions. I prefer the latter as it allows a more vertical pull on the SMAS; this vector repositions against the descent of soft tissue which occurs with aging. Having a separate skin layer allows this to be pulled superolaterally for trimming and suturing around the ear for concealment.
I recommend seeking out a consultation with a Board Certified Facial Plastic Surgeon.

R. James Koch, MD
Danville Facial Plastic Surgeon
5.0 out of 5 stars 2 reviews

What is the most effective facelift technique

Hi Sam, the question is what is the safest, least invasive type of facelift that will result in thorough, long lasting results. There is no absolute right or wrong answer. The most important factor is surgeon experience and results with the technique that he or she is most comfortable with. Many surgeons get great results with a SMAS lift. Some surgeons prefer the deep plane technique. I would choose a surgeon who you like and trust and then allow him or her to use the technique that they are most experienced with.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Deep plane versus regular facelifts

Studies have shown no difference, but in my hands a SMAS facelift can last five to ten years with nice results.

Jeffrey E. Schreiber, MD, FACS
Baltimore Plastic Surgeon
5.0 out of 5 stars 202 reviews

Deep Plane Facelift, Facelift

Thank you for the question. You will get the best answer to your question by scheduling an in person consultation with a plastic surgeon certified by the American Board of Plastic Surgery and discuss your unique situation and concerns. The surgeon would meet with you, examine you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure in person and what to realistically expect. Communicate your areas of concern and goals with your plastic surgeon, preferably in front of a mirror and it often helpful to bring in photos of yourself at an age you would like to refresh your personal look to. Then you can make an informed decision on which procedure(s) to start with according to your desires, recovery time necessary, your history and current health. Surgery is very rewarding for our patients that are already so lovely and just want a refresher as they gracefully age.

It is important to understand your facial anatomy and how a procedure is performed when considering a facelift. From outer to inner levels there is the skin, the subcutaneous fat, the Submuscular Aponeurotic System (SMAS), the facial nerves, the facial muscles, the periosteum (covering tissue of bone) and then bone. The deep plane facelift was developed with the thinking that elevating the tissues in the deepest plane (sub-periosteal) would elevate the sagging overlying tissues enbloc with less dependence on the skin to hold tissues in place. This is a relatively difficult procedure with risks to facial nerve injury so many have modified the technique. It would be important to know what this modification is why it's being consider in your case.

I usually leave the level of dissection for facelift at the SMAS and no deeper. This layer is a fibrous tissue that can hold sutures in elevating the deeper tissue and take pressure of the skin for an optimal result. The SMAS layer is contiguous with the platysmal muscle. This is a wide muscle under the skin of the neck. Elevating the SMAS layer elevates the platysmal muscle and gives elevating support for the neck as well.

"Skin only" and mini facelifts: When the skin is used soley to elevate tissue in a facelift it will usually stretch again over time. The results look good for about 6 to 12 weeks and then the skin stretches under the forces of the underlying tissues. Patient will often be surprised to see the jowls, marionette folds, and loose neck they were trying to correct months after their procedure.

Again, communicate your goals carefully with your plastic surgeon. Working together you will come up with a plan to achieve an outcome you will be pleased with for years. Facelift results will last for years, though the longevity depends on several factors including skin quality, significant weight changes and environmental factors such as excessive sun exposure.Be sure you surgeon is Certified by the American Board of Plastic Surgery and can describe what he-she plans for your case with how the tissues will be held into place.

Mark Schoemann, MD
La Jolla Plastic Surgeon
5.0 out of 5 stars 14 reviews

Wow-- you have been doing your homework!

hello-- Wow ! I am impressed with your question -- you have been doing your homework!
All plastic surgeons have their own way to do things, and I like to individualize it for each patient. The facelift is the most personalized because of the age differences--  from late 40s to 80s ! and the skin  differences-- from fair to african-american or latina!
I would recommend a few consultations and hear about how each one of us would approach your situation!
Good luck!

Anne Taylor, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 38 reviews

Does deep plane last longer and look more natural than SMAS technique?

How long a facelift lasts is determined by the quality of the skin (which doesn't change with surgery), the inherent 'clock' of the patient, as well as weight fluctuations and sun damage .. among many other variables. There is no reliable evidence that 1 single facelift technique 'lasts longer' than others. As far as what is more natural, again we are in a bit of a quagmire in terms of defining results. A facelift surgeon determines the best technique for the patient based upon the patients goals and anatomy. The best advice I can give is that you need to see an experienced facelift surgeon who is familiar with all available techniques and can therefore make an individualized recommendation. I hope this helps.

Bryan Correa, MD
Houston Plastic Surgeon
5.0 out of 5 stars 15 reviews


There is no evidence that SMAS flap vs deep plane results in more longevity of results or vice versa.  The SMAS flap technique allows for a more vertical vector of pull than the deep plane and is generally the more universally preferred technique. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 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.