What are the risks of current deep plane facelift techniques ?

What are the risks of current deep plane facelift tecnhiques and in what situations / faces do some doctors use this in place of smas? Is the risk of nerve injury a remote one or is it significant enough that this technique can never justify the risk?

Doctor Answers 11

What are the risks of current deep plane facelift techniques ?

Every type of face surgery carry some risks. There is always a risk of injury to one of the branches of the facial nerve as there is with a SMAS implication facelift.

Deep plane, SMAS or extended SMAS or High SMAS or even Foundation Face lift  or mini face lift, there is always a risk of injury to one of the branches of the facial nerve

The important issue is what you need. And second in which technique is your surgeon will feel better. 

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. 


Best 


Turkey Plastic Surgeon
5.0 out of 5 stars 22 reviews

As with any surgery there are risks

As with any surgery there are risks. There is always a risk of injury to one of the branches of the facial nerve as there is with a SMAS implication facelift. As a very experienced facial plastic surgeon with almost 25 years of doing facelift surgery, I personally prefer the deep plane technique for patients who have heavy jowls and/or a heavy neck. The surgery takes a little longer and is technically more demanding but I believe I am able to achieve better long term results and a better lift. I hope this answers your question and as always you should seek consultation with someone who specializes in facial rejuvenation surgery and is experienced.

Edwin F. Williams, III, MD
Latham Facial Plastic Surgeon
4.8 out of 5 stars 18 reviews

What are the risks of current deep plane facelift techniques ?

Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts. Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front. Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin. Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face. I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift. The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last). The excess skin is then removed and the facelift incisions closed.

My most popular facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:

  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure. When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.

In my opinion the risk of skin injury, nerve injury, infection, prolonged bruising and prolonged swelling (lasting months) are all exponentially greater with any of the more invasive type facelifts. The deep plane facelifts also has the aesthetic issue of raising the outer corners of the eyebrows and mouth that can give the face a "joker" look.  Additionally based on the direction of the tissue elevation, the deep plane facelift can create cheeks that are wide and broad, towards the outside, which is not a feminine cheek shape or feature. For these reasons, I have never liked the deep plane facelift technique.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Deep plane

The deep plane is the same as a SMAS facelift but the skin flap and the SMAS flaps are raised as one flap.  So the plane of dissection is the same in both, only that in a typical SMAS flap lift the  skin flap is elevated separately from the SMAS flap.  As long as your surgeon is experienced with the anatomy, this should be safe.  It is commonly indicated in smokers in order not to create a very thin skin flap that can have difficulty healing.   Best wishes, Dr. T.

Face lifts - what are the risks of deeper techniques

Thank you for asking about your face lift.

  • The deeper that surgery goes in the face, the nearer one gets to the nerves to the muscles.
  • So the SMAS flap and deep plane lifts have more risk of nerve injury.
  • That said, the most common nerve injured in a face lift is the greater auricular nerve to the ear -
  • And overall the risk of nerve injury of any kind is 1% or less.
Always see a Board Certified Plastic Surgeon.
Best wishes - Elizabeth Morgan MD PHD FACS

Deep plane facelift

i prefer the SMAS technique. I feel that I have more control of movement of the soft tissues and then redraping the skin separately.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

What are the risks of current deep plane facelift techniques ?

I do believe the risk of facial nerve injury is greater using the deep plane technique. In addition in some cases the procedure can create an unusual pull on the mouth.

In my opinion the SMAS plication technique is safer and produces equally good results.

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Dear milliemills9


Thank you for your question!  The Deep plane face lift and the SMAS facelift both have more risk of nerve injury than a SMAS plication.  That being said- it is a good technique - and as with all procedures and aesthetics, there is variation in results with surgeons.

With Warm Regards

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 107 reviews

Deep plane facelift

The deep plane technique is an effective method of repositioning the soft tissues of the face. It is particularly useful at improving the midface region in addition to the lower face and neck. 

It is considered a more invasive or aggressive approach due to the deeper layer of dissection, however, in experienced hands the risks are no greater than other methods, and often the results are more natural and longer lasting.

Justin Cohen, MD
Washington DC Otolaryngologist
5.0 out of 5 stars 21 reviews

Deep Plane Facelift

The deep plane facelift is an excellent way to release and mobilize the deep retaining structures of the face and reposition them to a more youthful appearance.  Doctors use this technique to lift a "composite flap" of skin, muscle and soft tissue as one layer.  There is only minimal skin undermining (only to the deep plane entry point).  The SMAS layer is actually still dissected out and that is the tissue layer that is resuspended for the facelift.  While it is very common to see the facial nerve branches as they exit the anterior parotid gland, an experienced facial plastic surgeon who utilizes this technique should know and understand the anatomy.  A lot of research has been done on this topic and the results have shown that there is no higher risk of nerve injury with a deep plane technique that with standard lateral SMAS methods.  I would talk to a board certified facial plastic surgeon for a consult in order to completely understand the techniques that he/she will be used and the risks to the procedure.

Jason D. Bloom, MD
Philadelphia Facial Plastic Surgeon
5.0 out of 5 stars 20 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.