What is a Deep Plane Facelift?

Deep Plane face lifts lift not only the jowls and neck areas, but also release the cheek ligaments and elevate the cheek fat pads and muscles. This is called the malar fat mound, and when lifted reduces the nasolabial folds and gives the face a youthful heart shape.

A deep plane facelift elevates the SMAS - the structural support layer of the face - by releasing key ligaments and repositioning the facial structures back to where they belong. SMAS facelifts, in contrast, lift the superficial muscular layer by pulling or tightening the SMAS.

A deep plane facelift lifts the skin and muscle in one layer. Because it is performed underneath both the skin and muscle, it avoids, particularly in patients with thin skin, telltale facelift lines that occur when the muscle lift line can be seen under the skin.  Because it is deeper, it has a better blood supply, so that there is less worry about skin loss. It also provides better access to the ligaments and muscles of the cheek, so that it is easy to produce uniformity of "structure lift", resulting in a natural, non-facelift appearance. Having said all of this, good, experienced surgeons produce excellent results, regardless of technique.  Trust your face to an experienced facial plastic surgeon.

The name of a facelift is not what is important. What IS important is that your plastic surgeon creates a surgical plan just for you to address your concerns and to help you acheive your goals. During the consultation process, your plastic surgeon should discuss the particulars of the surgical plan so you know how he will address concerns and what this will mean in terms of results and recovery.No matter what the specific type of facelift, the goal should be a look that is natural appearing. My goal is to make scars so inconspuicuous that even your hairdresser can't tell. Other signs to look for as you review before and after images are the position of the ears and hairline following a facelift. These can be dead giveaways that one has had a facelift, in addition to maiing a person look odd and unnatural.  Hollowed areas above and below the eyelids can also be aging and make a person look unnatural. Likewise, a face that is Over-filled with fat or another filler can also take on an unnatural appearance. Before and after photos should not be a before of a patient the morning of surgery with hair pulled back, no makeup and a smile, with the after being a fully made up person with a smile. Look for accurate and consistent photos. Dozens of them. In doing your research to find a plastic surgeon to make a permanent change in your face, and trusting with your health, look at many many before and after photos. Photos (many of them) are evidence that your plastic surgeron is able to accomplish a facelift that is beautiful, natural looking and long lasting. Take your time checking your plastic surgeons record of safety.- Where  did they received surgical training and how many years of formal surgical training they received after medical school?- Were they trained at a top tier university medical center?  - Do they have hospital privileges - ideally at multiple local hospitals- to perform the procedure(s) of interest to you?- Is their surgical facility accreddited by the Joint Commission, AAAASF, or both?- What is the post-operative experience like? - Who is in the room with you during surgery? Does your PS have a team of extraordinary medical professionals?- Is anesthesia administered by a board-certified MD anesthesiologist?

A deep plane facelift is not significantly
different other than the recovery takes several weeks longer, but the long-term
results are no different.

A deep plane face lift is similar to a sub-SMAS face lift with dissection beneath the muscle-fascia layer, however, only limited dissection is performed above the muscle-fascia layer. Proponents claim that the minimal dissection between the skin, fat, and muscle-fascia layer gives the skin an even smoother appearance and faster recovery time while still providing dramatic, longer lasting results than with a standard skin-only face lift.

The deep plane facelift is an advanced surgical technique that achieves a natural looking and long lasting result. This technique represents the state of the art in facelift surgery. Rather than just tightening the skin, this procedure lifts and tightens the underlying muscle while repositioning fat to achieve a three dimensional rejuvenating result. This procedure is best performed by an experienced facial plastic surgeon who performs facelift surgery as a routine part of his or her practice.

Best of luck,

Dr, Clevens

The deep plane facelift involves disscting in the tissue layer (the SMAS) that contains the muscles and some of the inelastic tissue of the face.  The SMAS is then pulled "up and back," helping restore a more youthful appearance to the face.  Although its use has decreased in popularity over the last few years due to the risks of nerve damage and the fact that some of the benefits of the lift can be achieved through other techniques (such as fat grafting), it remains a valuable tool for facelift surgeons.

There are many different types of facelifts, each one having a different take by different surgeons.  I use a variant of a deep plane facelift and find it provides the most robust changes while still keeping the face looking natural.  Some things to consider when discussing deep plane facelifts:

Anatomy- This facelift is not for every surgeon.  It requires much more knowledge of facial anatomy.  However, an experienced facelift surgeon can perform this lift with little risk to the facial nerves.  A surgeon's knowledge of anatomy is more critical to avoiding damage to nerves than technique.

Results- A deep plane facelift is a results driven procedure.  Patients wanting the best results will want to have the more robust changes to the face while still looking natural. 

Downtime- The deep plane facelift has a reported longer period of recovery.  However, I have found the opposite to be the case.   I vary my technique to minimize postoperative edema so that patient's have the benefits of a more robust lift without the downtime.  Dissection below the platysma muscle (see article, yes it is in the face) is a natural embryologic glide plane which is bloodless and can expedite recovery.

Incisions and Longevity of Lift- Several biomechanical studies have looked at the strength of tissues being held.  Deeper plane tissues is a stronger flap and has less chance of sliding back to original position

Overall, deep plane facelifts (which is a large category of lifts) can provide excellent rejuvenation in the right hands.  There are risks with any facelift, so pick a rejuvenation procedure by surgeon not by technique.  Not all deep plane facelifts are the same.

While there are a dizzying number of Facelift techniques described, all are a variation on the way the SMAS layer is effected.  Generally, the "deep plane" is that plane of facial tissues below the SMAS layer.  In the original description by Sam Hamra, he discussed cutting through the SMAS layer just in front of the ear and elevating the SMAS all the way past the nasolabial fold.  The benefits:


You can really smooth out every wrinkle on the face

The results last a very long time

You are able to free the SMAS from some of the suspension ligaments of the face


The downside:


The muscles of facial expression are enveloped in the SMAS layer.  The nerves that go into these muscles come from below.  When lifting the SMAS, those nerves are at extreme risk of injury, both temporary (some weakness in every deep plane Facelift) or permanent (small percentage).

The risk of having a final result that is wind swept and somewhat unnatural is high.  This is in part due to the fact that the suspension ligaments of the face have been mobilized.


Although in the right patient the deep plane face lift may be the right choice, I feel the risks outweigh the benefits.  I do a SMAS imbrication, where a strip of SMAS in front of the ear is excised and the SMAS layer is elevated an inch or so out and then sutured back and up.  This allows for many of the benefits of the deep plane Facelift (longevity, excellent tightening) without some of the risks.