Why Such Conflict of Opinions on Deeplane Facelifts Being "Natural" or "Windswept Look"?

Whys Such Conflict of Opinions on Deeplane Facelifts Being "Natural" or "Windswept Look"?

Doctor Answers 19

Facelifts - How to get a natural result from a facelift - Look at many photos

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‘SMAS’ is an acronym used to describe the sturdy, collagen-rich connective tissue layer of the face that resides between the skin/subcutaneous fat and the deeper structures such as the parotid gland and the muscles of facial expression. The periosteum is a thin, tough layer of tissue that covers bones. Dissection can be performed between periosteum and bone in order to mobilize the overlying soft tissues. 

Different surgeons use some terms in different ways, but the term ‘deep plane facelift’ generally refers to mobilization of primarily the midface from the anterior and upper lateral cheekbone at the subperiosteal level (separating the periosteum from the bone). One must have a keen understanding of facial anatomy in order to be comfortable with performing surgery on the SMAS and periosteum. You should consult with a board-certified plasticsurgeon for these procedures.

The motivation for working at these deeper levels is this: skin is elastic and stretches out over time, sometime quite rapidly. So a skin-only facelift tends to produce less dramatic results and is not as long-lasting as a facelift that is performed on a deeper plane like the SMAS, which is full of collagen and therefore inelastic. The SMAS and periosteum do not stretch.

If one knows the anatomy well and has experience with SMAS elevation then the surgery can be performed quite safely, and with a recovery that is no more significant than a skin facelift. Deep plane facelifts, on the other hand, can be associated with significant midfacial and eye-area swelling, and therefore tend to have longer recovery times. They also have a higher rate of postoperative facial nerve dysfunction (manifested as asymmetries in the action of the muscles of facial expression). ‘Deep plane’ facelifts were popularized in the 1990’s, but have since fallen out of favor. Most experienced, board-certified plastic surgeons who do a great deal of facial rejuvenation surgery perform some variation of a SMASfacelift.

Another very important concept in state-of-the-art facial rejuvenation surgery is the restoration of facial soft tissue volume by means of fat grafting. Facial volume should be restored first, before the facelift is performed. In many cases this is more important than the soft tissue plane at which thefacelift is performed. If your surgeon does not address this important issue you will not get the most youthful and natural-appearing result, regardless of the tissue plane in which the facelift dissection is performed.

Regarding the cost: that is usually (but not always) commensurate with (1) training/experience and (2) the ability to produce beautiful and natural-appearing results. Thoroughly research a surgeon’s education and training, their practice experience, and look at LOTS of before-and-after images of their facial rejuvenation surgery patients. Look them up on your state's Medical Board website (and other states where they may have practiced previously) to see if there has been any disciplinary action against them. The most talented and experienced surgeons are usually the most expensive, but you need to do your research to ensure that you are in safe hands and that you are getting great value for the fee that you pay.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Deep plane vs SMAS facelift

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A skin only facelift can make the most windswept look because all the tension is on the skin.  A deep plane facelift as described by Dr. Hamra requires "extraordinary tension" in the closure and only moves the tissue in one direction.  A SMAS lift which is my preference allows the surgeon to move the deep tissues in a vertical direction and skin separately in a natural direction with little tension.  Consequently I prefer the SMAS lift.  But in the end, it is an art form and great results and poor results can be seen from each technioque.  It is more the surgeon than the technique that matters.

Face lift techniques and avoiding windswept look

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No patient wants to have that Catagory 3 Hurricane look after a facelift.  This look can occur when only the skin layer is addressed, the skin is pulled too tight and is pulled in an unnatural direction. 

All the different techniques debated and discussed by experienced plastic surgeons can be overwhelming for a lay person.  Sometimes it can overwhelming for a plastic surgeon! 

My advise for patients is to get maybe 2  or 3 consultations from a board certified plastic surgeon, have her/him show some examples of her/his work and get a feel for the surgeon's approach and what she/he thinks looks good.    Go with the surgeon with whom you click and feel comfortable with. 

Windswept facelift results

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one main goal of a facelift is to redistribute volume in the face

skin only facelifts do this by pulling skin

smas flap/deep plane facelifts do this by gently relocating the underlying tissue, rearranging the actual soft tissue structure of the face - thus less pull is needed on the skin

less pull = less distortion in my opinion.

A facelift by any other name is still a facelift

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We are seeing in facelift just what has occured in liposuction, with an ever increasing list of techniques and confusion. With facelift we see deep plane, SMAS, three layer, smasectomy, soft, vertical, vampire (really) and many others. Aspects of all work well if applied when needed. No matter what, windswept is a thing of the past, we learned that lesson.

Why Such Conflict of Opinions on Deeplane Facelifts

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because deep plane is more anatomical, logical and efficient than any  another  technique, but it has several warnings:a.-more  difficult and  risky for deep nerves b.- sweeling last  double to get  solved c.- it  stays a little thighting at first weeks that is why looks  artificial but later looks great and last the  effects much more than other  techiniques. it is ideal for elderly people after 60 y.o.

Ramon Navarro, MD
Mexico Plastic Surgeon

"Windswept" Look With Facelift

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The actual results from a Facelift have much more to do with the artistry of the Surgeon than the specific name given to his/her procedure.  I personally feel that a "high SMAS" imbrication technique (Connell) makes the most sense because it allows for elevation of the mid and lower facial tissues, while still allowing for a slightly different vector with skin removal.  The techniques that are described such as "deep plane", "SMAS", "high-SMAS" are really just templates that a Surgeon usually modifies to suit the needs of the patient's anatomy and aesthetics.  Although most Surgeons perform some type of SMAS based procedure, no two Surgeons perform a Facelift in exactly the same fashion, and variability in results can be expected.

Deep plane facelift and natural appearance.

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The progression of the history of facelifting techniques has served to give better and longer lasting results without the "windswept" look.  Facelift techniques are still evolving and the latest trend is to add fat grafting to the procedure to repace fat volume lost due to normal ageing.  In general, a deep plane facelift or a SMAS lift (if done corrrectly) will give the best results.  This is because most of the tension is placed on the deeper layers to replace them to their proper position and the skin then does not need to be pulled too tight.  It is excess tension or pulling on the skin layer that tends to give the windswept look.  Not only that, skin lifting procedures do not last nearly as long so they are too tight to begin with and loosen too quickly.  Usually, facelift procedures with "catchy" names are variations of skin lifts.  Be sure that you understand what type of procedure your surgeon performs.  It makes a big difference.

Deeplane Facelifts Being Natural or Windswept?

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Any type of face lift can look natural or unnatural based on how it is performed and on whether the face lift was accompanied by other procedures to make the result more natural.  In general, the deep plane lifts have a more natural result since there is less pull on the skin.

Deep Plane Facelifts and Windswept Look

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   The windswept look is a function of vector of pull on the skin and the amount of tension on closure not the individual management of deeper tissues.  Kenneth Hughes, MD Los Angeles, CA

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.