Deep Plane Facelift vs SMAS Facelift: What Is Actually Different and Who Needs Which

6 hours ago

6 min read

Quick answer: A SMAS facelift and a deep plane facelift both lift the SMAS, the muscle-and-fat layer under the skin. In a SMAS facelift the surgeon lifts the skin, then folds or trims the SMAS from above (plication or SMASectomy). In a deep plane facelift the surgeon works under the SMAS and releases the retaining ligaments that hold the cheek down, so the cheek, jowl and neck move up together as one unit with little tension on the skin. The deep plane approach usually gives a stronger midface lift and a more natural look; a SMAS facelift can be enough for milder jowls.

Key takeaways

Both are real surgical facelifts; neither is a "skin-only" lift.
The key difference is the plane of dissection and the release of the retaining ligaments.
Deep plane lifting moves the cheek fat pad and softens the nasolabial area better.
Less tension on the skin can help scars heal finer and lowers the risk of a "pulled" look.
Recovery is similar for most patients: social downtime of about 2 to 3 weeks.

What is the SMAS?

SMAS stands for superficial musculoaponeurotic system. It is a continuous sheet of fibrous tissue and muscle that lies between the fat under your skin and the deeper structures of the face. With age the SMAS loosens and slides down, taking the cheek fat with it. This creates jowls, a heavy nasolabial fold and a softer jawline. Any facelift that aims to last must reposition this layer, not just the skin.

How a SMAS facelift works

In a classic SMAS facelift the skin is lifted off the SMAS over a wide area. The surgeon then tightens the SMAS from above:

Plication: the SMAS is folded on itself with stitches.
SMASectomy: a strip of SMAS is removed and the edges are sewn together.
Skin redraping: the skin is pulled back over the tightened layer and the excess is trimmed.

In plication and SMASectomy the retaining ligaments stay attached, so the pull is strongest near the ear and weaker towards the centre of the face. The jawline improves, but the cheek and the fold beside the nose often change less.

How a deep plane facelift works

In a deep plane facelift the surgeon goes under the SMAS at a defined point and releases the zygomatic and masseteric ligaments, the "anchors" that hold the sagging tissue down. Once these are free, the cheek, jowl and neck can be lifted in one piece and fixed higher. The skin stays attached to the SMAS over much of the face, so it travels with the deeper layer instead of being stretched on its own.

Video: Scarless deep plane facelift before and after: severe cheek sagging, 15 days later. Watch on YouTube

The video above, viewed more than 6 million times on our YouTube channel, shows a patient with severe cheek sagging before surgery and 15 days after a deep plane facelift by Prof. Dr. Suleyman Tas. The incisions were placed in the hairline and around the ear, where they are very hard to see.

Deep plane facelift before and after
Deep plane facelift before and after
Deep plane facelift before and after

Deep plane vs SMAS at a glance

Layer lifted: both lift the SMAS; deep plane lifts it from underneath after releasing the ligaments.
Midface and nasolabial fold: stronger effect with deep plane.
Jawline and jowls: both can improve them; deep plane usually gives a cleaner line in heavier jowls.
Tension on the skin: lower with deep plane, which helps scars and avoids a stretched look.
Swelling: similar overall; some patients have slightly more cheek swelling after deep plane in the first week.
Surgeon experience: deep plane needs detailed knowledge of the facial nerve branches, because the dissection is closer to them.

"The question is not which name sounds stronger. The question is which layer holds your sagging tissue down, and whether we release it or only pull against it." — Prof. Dr. Suleyman Tas

Who suits which technique?

A SMAS facelift can suit patients with mild jowls, good skin and a cheek that has not dropped much, often in their 40s or early 50s. A deep plane facelift tends to suit patients with a heavy midface, deep nasolabial folds, marked jowls and neck laxity, and patients who want a result that does not look "operated". Many patients have features of both, and the plan is made at the consultation after examining the skin, fat, bone support and neck.

Video: Deep plane scarless facelift and neck lift before and after at age 60. Watch on YouTube

The second video shows a 60-year-old patient after a deep plane facelift with neck lift and platysma muscle repair, combined with eyelid surgery, a temporal and brow lift, nano fat grafting and laser skin treatments.

Does a deep plane facelift last longer?

Because the deep plane technique repositions the tissue that actually descended, and fixes it after releasing the ligaments, many surgeons find the lift holds well over time. Published studies comparing techniques have not shown a large, consistent difference in longevity, and ageing continues after any facelift. In practice, the more natural shape and the lower skin tension are the main reasons patients and surgeons prefer the deep plane approach. Read more in how long does a facelift last.

Recovery compared

Days 1 to 3: swelling and tightness; head elevated; a light dressing.
Day 5 to 7: stitches checked or removed; most bruising fading.
Weeks 2 to 3: most patients return to social life.
Months 3 to 6: the final softness and contour settle.

Recovery is broadly similar for both techniques. See the facelift recovery timeline for day-by-day details.

Risks

Both techniques share the general risks of facelift surgery: bleeding under the skin (haematoma), temporary numbness, asymmetry, visible scars and, rarely, weakness of a facial nerve branch, which is usually temporary. The deep plane dissection runs closer to the nerve branches, which is why surgeon training and anatomical knowledge matter. Read our honest guide to deep plane facelift risks.

How to tell which technique you are being offered

Ask your surgeon three questions: Which layer will you lift? Will you release the retaining ligaments? Where will the incisions be placed? Clear answers tell you more than the name of the operation. You can also read how to choose a deep plane facelift surgeon.

Cost difference

A deep plane facelift usually takes longer than a SMAS plication facelift and requires more specialised training, so it often costs somewhat more. The final price depends far more on what is combined (neck lift, eyelids, brow lift, fat grafting) and on the hospital stay than on the name of the technique. See facelift cost in Turkey vs the UK and the US.

Frequently Asked Questions

Is a deep plane facelift better than a SMAS facelift?

Not for everyone. A deep plane facelift lifts the midface and jowls more effectively in patients with significant sagging. A SMAS facelift can be enough for mild jowls with good skin.

Is a deep plane facelift more dangerous?

The dissection is closer to the facial nerve branches, so it requires a surgeon trained in this anatomy. In experienced hands, the complication rates of both techniques are low and similar.

Which facelift looks more natural?

Many surgeons find that deep plane lifting looks more natural, because the skin is not stretched on its own and the cheek moves upward as a whole.

Is recovery longer after a deep plane facelift?

Usually not by much. Most patients return to social life after about 2 to 3 weeks with either technique.

Can a SMAS facelift be revised with a deep plane facelift?

Yes. Secondary or revision facelifts are often performed in the deep plane, because it can reposition tissue that was not released in the first operation.

About the Author

This article was written and medically reviewed by Prof. Dr. Suleyman Tas, a plastic, reconstructive and aesthetic surgeon in Istanbul with over 20 years of experience. He is the author of Rhinoplasty in Practice (CRC Press, 2020), has more than 40 peer-reviewed scientific publications and five patents, and teaches facelift and rhinoplasty techniques to surgeons at international courses. Read more about Prof. Dr. Suleyman Tas.

Individual results vary. Before and after photos and videos are shared with patient consent. This article is for general information and does not replace a personal medical consultation.

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