SMAS vs. Deep Plane Facelift – Which is Right for You?

Facelift surgery has come a long way. If your idea of a facelift still includes looking "pulled" or "windblown," it’s time for an upgrade on the latest & greatest in facial aesthetic medicine!

Modern facelifts aren’t about looking done—they’re about restoration, not alteration. Today’s techniques are far more advanced than those of the ‘60s and ‘70s, when everyone could spot the draping, skin-tight, mismatched cheeks and barely corrected necklines from across the room. Now, we focus on lifting and supporting deeper facial structures, allowing for natural movement and expression to shine through.

When it comes to facelifts, two methods stand out: the SMAS facelift and the Deep Plane Facelift. Both techniques go beyond simple skin tightening. So, if you're considering a facelift and wondering which one is right for you, let’s break it down.

The SMAS: What Is It & Why Is There A Facelift Named After It?

As a facial cosmetic surgeon, I’ve seen firsthand how the aging process can subtly—but relentlessly—change the contours of the face. One area that really shows the effects of time is the jawline, neck, and lower face. It’s in these areas that gravity and the loss of skin elasticity start to take their toll. This is where the SMAS (Superficial Musculoaponeurotic System) comes into play.

Common signs of gravitational and age-related changes in the face.

The SMAS is a fibrous layer of tissue that sits beneath the skin, covering and investing the expression muscles and fat pads of the face. The SMAS begins roughly in the mid-cheek area and extends down into the jawline before transitioning into the platysma muscle of the neck. Think of it as the structural framework that holds everything in place—the skin, fat, and muscles that all contribute to your facial contour. As we age, the SMAS begins to lose its firmness and begins to sag. This contributes to the creation of jowls, deepening nasolabial folds, descending cheeks, and a loss of definition along the jawline. I call this the gravitational changes (descent) of the face and neck.

So, why is there a facelift named after it?

Because the SMAS is the real villain in the anatomical aging process! The SMAS Facelift works by specifically addressing and tightening this fibrous tissue layer. By isolating and lifting the SMAS, we can restore the natural contour of your face and jawline—without the need for any pulling on the skin. This is because by lifting the SMAS, the skin follows passively, as the two are connected together. After the SMAS is lifted and secured in a new position, the excess skin is trimmed along the original incisions, much like tailoring fabric along the hemlines. This more contemporary approach gives patients natural-looking results that last much longer than a skin-only lift, making it the go-to procedure for those experiencing mild to moderate sagging.

What I really respect about the SMAS Facelift is that it’s a time-tested and reliable method. For decades, this procedure has been the standard of care when it comes to facial rejuvenation, and for good reason: it’s safe, effective, and can provide long-lasting results with relatively small risk. This technique replaced the outdated skin-only facelifts, which often resulted in an unnatural, "pulled" appearance because they didn’t address the underlying causes of sagging. Many iconic surgeons of our country have built monumental reputations and practices delivering beautifully executed SMAS Facelifts.

However it’s also important to note that there are many variations of the SMAS Facelift, each offering a further detail on the exact surgical thing being done to the SMAS. Each surgeon chooses their preferred version of SMAS manipulation. More experienced surgeons are more comfortable dealing with the SMAS in more complex ways to reach for the best possible outcome. It’s worth mentioning some of these SMAS techniques as many still exist in plastic and cosmetic surgery websites:

• SMAS plication: This technique involves folding a small portion of the lateral SMAS layer to simply tighten it. It’s great for those who want a subtle improvement and hence is a common method employed in “mini facelifts”.
• SMAS imbrication: Similar to plication, but the SMAS is cut, overlapped, and sutured in place to tighten the tissue. Another commonly used method in “mini facelifts”.
• Lateral SMAS lift: Incisions are made along the sides of the SMAS layer to lift the lower face, jawline, and reduce jowls. The SMAS may be removed to create a gap, which is then sewn together to tighten and lift the area.
• High SMAS lift: Cuts are made higher within the SMAS layer, focusing on the cheeks and midface to lift and restore youthful volume in the upper face.

There are many variations beyond what’s covered in this blog, such as how much skin to lift off the SMAS before and after manipulation. These variations allow the surgeon to tailor the procedure to the patient’s anatomy and aging concerns. To add another layer of complexity, some advanced SMAS techniques are technically deep-plane in nature, as they involve elevating the SMAS from its underlying tissues to get a better bite of it, and hence, pull. Throughout my career, I've used all these techniques, but in my experience, plication and imbrication are the least effective forms of SMAS lifting.

Actual results of my patient who underwent a revision lateral SMAS facelift along with eye and lip lifting. Results shown at 6 months after surgery. The jowl, jawline, and neck bands are improved. The cheeks are also restored and lifted. I believe this procedure allowed a lower-risk surgery in a patient who had otherwise waited several years to “touch up” her prior facelift. We were both very pleased with this result.

Introducing the Deep Plane Facelift – So What’s Deeper Than the SMAS?

When it comes to facelift techniques, the Deep Plane Facelift takes facial rejuvenation to the next level. While the SMAS Facelift focuses on manipulating the SMAS itself and sometimes goes below it into the deep plane, the Deep Plane Facelift goes even further by addressing the ligaments that hold the structures of the face in place. If you’ve seen me as a patient, you know I love using analogies to explain complex concepts. So, let's break it down with an analogy...

Imagine the face as a thick quilt pinned down by thumbtacks—those thumbtacks represent the facial ligaments that provide structural support and “position” the facial tissues, including the SMAS. A Deep Plane Facelift is about finding and releasing those ligaments, essentially removing the thumbtacks from the quilt. This step can be challenging, as these ligaments are closely connected to major motor nerves of the face, so experience, proper training, and knowledge are essential. By releasing the ligaments, the skin and underlying tissues can move more freely and naturally, without being held back. This allows for a more dramatic and natural repositioning of facial tissues—without relying on tension or pull to keep everything in place.

Now, circling back to the SMAS Facelift technique—does the SMAS approach create tension? To simplify an otherwise complex surgical debate that’s been ongoing for years, the answer is: YES. A traditional SMAS technique creates tension on the SMAS layer. While it certainly provides a powerful lift by repositioning the soft tissue to a more elevated position, the lingering question has always been: how long does that lift last, and does it truly stand the test of time?

Nothing lasts forever (surgically) - that’s a fact. Biologically and mechanically, any structure under constant tension will eventually yield, whether partially or fully. Regardless of the facelift technique, gravity and time will eventually loosen the lift, and a secondary procedure will be needed to restore youthful contours. However, and likely speaking for all cosmetic surgeons here…we as surgeons aim to achieve the longest-lasting result possible. Today, the argument favors the Deep Plane Facelift as the more powerful and longer lasting surgery due to the anatomical concept that the SMAS is free of tension. Unfortunately, duration of surgical results aren’t solely dependent on the surgical technique (though that plays a significant role). Normal surgical relaxation and continued aging are influenced by many factors—something I’ll dive deeper into in another blog soon.

So, are those the only differences between these two facelift techniques?

Not at all. Several other factors differentiate a Deep Plane Facelift from a SMAS one, including the direction (or vector) of the lift, the suturing technique, the extent of SMAS released and elevated both horizontally and vertically, and how scar tissue from prior procedures or injectables is managed. Additionally, addressing deeper neck structures, where the SMAS transitions into the platysma muscle, is often the most technically challenging part of any facelift. The key takeaway is that it’s not just the name of the technique that matters—it’s the series of precise, meticulous steps within each approach that ultimately shape the final outcome. Simply releasing facial ligaments and working in the deep plane doesn’t magically create youthful results.

Actual results of my patient after a primary deep-plane facelift, necklift, and lip lift. Notice the dramatic improvements in the jowls, neck, jawline, and enhanced cheek height. This first-time procedure is designed for long-lasting results.

However, the general steps of a Deep Plane Facelift start similarly to a SMAS Facelift, with incisions typically made along the hairline, around the ears, and sometimes under the chin. However, unlike the SMAS technique, the deep-plane approach requires less skin dissection to reach the underlying structures. This is often referred to as a “preservation” technique because minimizing skin disruption helps maintain the integrity of the tissues, leading to less bruising and swelling during recovery. Once the SMAS layer is accessed, it’s carefully incised to enter the sub-SMAS space—or the “deep plane” we’re talking about.

But simply entering the deep plane isn’t enough. As mentioned before, the key to this technique lies in releasing the facial ligaments that tether the SMAS to its bony anchor points. Once they’re freed, the SMAS layer—along with all the soft facial tissues it supports—can be lifted and repositioned as a cohesive unit. This allows for a more natural, balanced result without the tension often seen in traditional SMAS lifts, where tissues are pulled against ligaments that remain intact. While the merits of this approach are debated among surgeons, in my personal experience, with all factors being equal, the Deep Plane Facelift delivers a more powerful and natural rejuvenation than a traditional SMAS technique.

Who Chooses the Technique—Patient or Surgeon?

While it might seem like the patient should decide between a Deep Plane or SMAS Facelift, the truth is—it’s really the surgeon’s call. In my experience, the choice depends on a variety of factors that go beyond personal preference. There are cases where a SMAS lift is safer, more appropriate, or simply the better option—like complicated revision surgeries, patients of advanced age who may not tolerate extended anesthesia, or younger patients who only need a subtle mini-lift. Conversely, I’ve performed “mini-lifts” using the deep plane technique when dealing with heavier skin and tissues, such as in male patients with hair-bearing skin, or when I need a more powerful lift of the cheeks and midface. The consultation sets the tone, allowing me to evaluate your unique anatomy, goals, and health considerations to determine the most effective (and safe) approach.

A youthful woman is shown here—her unique features are one of a kind. Regardless of age, beauty is often defined by the natural individuality that can’t be replicated. With today’s advancements, surgical results are subtle and virtually undetectable, making it impossible to know for sure.

Here’s the advice I give every patient: don’t choose the technique—choose the results. Select the surgeon whose before-and-after photos resonate with you, whose aesthetic aligns with your vision, and whose expertise you trust. It’s unlikely that two surgeons will have the same exact treatment plan for you–there will always be subjective differences in the analysis & approach. Every surgical technique has limitations, and no method guarantees perfection (because perfection in nature doesn’t exist). What matters most isn’t the name of the technique but how skillfully it’s executed. Knowing that a “deep plane facelift” was performed won’t matter if the result isn’t adequate—the surgeon will still need to follow up, manage expectations, and discuss potential options to enhance the outcome. A well-performed facelift, regardless of the approach, will always outshine one that’s technically trendy but poorly done.

In other words, focus on the artistry, not just the name.

Thanks for reading.

Xo, Dr. Renata