Deep Plane vs SMAS Facelift: How the Two Techniques Differ

Deep plane and SMAS facelifts both lift the SMAS (the deep layer of muscle and connective tissue beneath the skin), but they do it differently. A SMAS facelift tightens that layer from above by folding or trimming it; a deep plane facelift releases the ligaments holding the face down and repositions the skin, fat, and SMAS together as one unit. The deep plane approach tends to look more natural and last longer, which is why Dr. James Rosing, MD, FACS, performs it as his primary facelift technique at Allure MD in Newport Beach. For a full overview of his approach, see our deep plane facelift technique, variations, and recovery page.

If you have started researching facelifts, you have probably run into the terms "SMAS" and "deep plane" and wondered whether the difference actually matters for your result. It does, but not in the way most marketing suggests. Both are legitimate, time-tested techniques. The right one depends on your anatomy and your goals. This article explains what each technique does, how they differ, and how that translates into the look, longevity, and recovery you can expect.

First, what is the SMAS?

Underneath your skin and facial fat lies the SMAS, the superficial musculoaponeurotic system. It is a continuous sheet of muscle and connective tissue that wraps the face and connects down into the platysma muscle of the neck. The SMAS is the structural layer that sags with age, pulling the cheeks down, deepening the nasolabial folds, and blurring the jawline.

This is the key idea behind modern facelifting: a youthful result comes from repositioning the SMAS, not from pulling the skin tight. A skin-only facelift (the outdated approach that produced the "windswept" look) puts all the tension on the skin and relaxes within a year or two. Every credible facelift today works on the SMAS. The question is how.

What a SMAS facelift does

In a SMAS facelift, the surgeon lifts the skin off the underlying tissue, then tightens the SMAS layer separately. There are a few common variations:

• SMAS plication: the SMAS is folded over on itself and stitched into a higher position.
• SMASectomy: a strip of the SMAS is removed and the edges are sewn together to take up the slack.
• Lateral SMAS techniques: the SMAS is tightened mainly toward the ear and cheekbone.

Because the skin and SMAS are handled as two separate layers, some of the lift is carried by the skin. SMAS facelifts are well established, predictable, and effective, particularly for patients whose aging is concentrated along the jawline and upper neck rather than the midface.

What a deep plane facelift does

A deep plane facelift works one layer deeper. Instead of separating skin from SMAS, the surgeon dissects beneath the SMAS and releases the retaining ligaments, the zygomatic and masseteric ligaments that tether the cheek tissues to the bone and cause them to sag in place.

Once those ligaments are released, the skin, fat, and SMAS move together as a single composite unit and are repositioned along a natural, vertical vector. Because everything moves as one and the lift is anchored on the deep tissue, there is little to no tension on the skin itself.

That distinction is what gives the deep plane facelift its reputation:

• It repositions the midface and cheek fat, which softens the nasolabial folds, an area a traditional SMAS lift addresses less directly.
• The skin lies back down without tension, so the result avoids a pulled or operated look.
• Because the foundation is structural rather than skin-deep, results tend to last longer.

The trade-off is that working beneath the SMAS, near the branches of the facial nerve, is technically more demanding and requires specific training and experience.

How they compare, point by point

What gets lifted SMAS: skin and SMAS handled as separate layers. Deep plane: skin, fat, and SMAS released and moved together as one composite flap.

The midface and nasolabial folds SMAS: improved indirectly, with the strongest effect along the jawline and neck. Deep plane: directly repositioned, which is why it is often favored for midface flattening and deeper folds.

Where the tension sits SMAS: some tension carried by the skin. Deep plane: tension on the deep tissue, skin redraped without tension, which is a key reason the result reads as natural.

Longevity SMAS: long-lasting and reliable. Deep plane: generally longer-lasting, with many results holding well for 10 to 15 years because the correction is structural.

Recovery The two are broadly similar. Most patients look presentable in two to three weeks either way. A deep plane dissection can produce a bit more early swelling, but it does not meaningfully lengthen overall recovery for most patients. (For a week-by-week breakdown, see our guide to deep plane facelift recovery and candidacy.)

Scarring Essentially the same. Both use the same well-hidden incisions around the ear and hairline; the difference between the techniques is beneath the surface, not on it.

Who it suits best SMAS: excellent for patients whose concerns center on the jawline and early neck laxity. Deep plane: well suited to patients with midface descent, prominent nasolabial folds, and those who want the longest-lasting, most natural-looking correction.

Is a deep plane facelift "better"?

Not universally, but for the right candidate it offers advantages that are hard to match. The honest answer is that technique matters less than the surgeon performing it. A meticulously executed SMAS facelift by an experienced surgeon will outperform a poorly executed deep plane facelift every time.

What matters is matching the technique to your anatomy. At Allure MD, Dr. Rosing performs the deep plane facelift as his primary approach because, in his experience, releasing the retaining ligaments and repositioning the deep tissues delivers the most natural and durable result for the majority of facelift patients, especially those addressing the midface and seeking longevity. During your consultation he evaluates your skin quality, the degree and location of laxity, your underlying bone structure, and your goals, and recommends the approach that fits your face rather than a one-size-fits-all procedure.

Procedures often combined with a facelift

A facelift rejuvenates the lower two-thirds of the face and the jawline. Many patients combine it with adjacent procedures so the result looks balanced:

• A neck lift to address banding and laxity below the jaw.
• Eyelid surgery (blepharoplasty) to refresh the upper face, which can otherwise look tired next to a rejuvenated lower face.
• Fat transfer or skin-resurfacing treatments to restore volume and improve skin texture.

Choosing your surgeon matters more than the label

Because the deep plane technique involves working close to the facial nerve, it should be performed by a surgeon with specific training and a consistent track record. When you consult, ask which technique the surgeon recommends for your face and why, how often they perform it, and ask to see before-and-after results of patients with anatomy similar to yours.

Dr. James Rosing is a board-certified plastic surgeon (American Board of Plastic Surgery) and a Fellow of the American College of Surgeons (FACS), practicing on Avocado Avenue in Newport Beach and serving patients throughout Orange County.

Schedule a consultation

The best way to learn which facelift technique suits you is an in-person evaluation. Schedule a consultation with Dr. Rosing to discuss your goals and review your options. Investment varies based on technique and any combined procedures; a personalized quote is provided at your consultation.

Frequently asked questions

What is the difference between a SMAS and a deep plane facelift? A SMAS facelift tightens the SMAS layer from above, by folding or removing part of it, while handling the skin as a separate layer. A deep plane facelift dissects beneath the SMAS, releases the facial retaining ligaments, and repositions the skin, fat, and SMAS together as one unit with the tension on the deep tissue rather than the skin.

Does a deep plane facelift last longer than a SMAS facelift? Generally, yes. Because the deep plane technique corrects the structural cause of sagging and places no tension on the skin, results commonly last 10 to 15 years. A well-performed SMAS facelift is also long-lasting, but the deep plane approach tends to hold longer.

Is a deep plane facelift more natural-looking? It can be, because the skin is redraped without tension and the deeper tissues do the lifting, which avoids the pulled, overly tight appearance associated with older skin-only techniques. Result quality ultimately depends on the surgeon's skill.

Is the recovery longer with a deep plane facelift? Not significantly. Most patients look socially presentable in about two to three weeks with either technique. A deep plane dissection may cause slightly more early swelling, but overall recovery is comparable.

Which facelift technique is right for me? That depends on where and how your face is aging, your skin quality, and your goals. Midface descent and deep nasolabial folds often favor a deep plane approach; isolated jawline and early neck laxity may be well treated with a SMAS technique. Dr. Rosing recommends the right approach for your anatomy at your consultation.

Are the incisions and scars different between the two? No. Both use the same discreet incisions around the ear and hairline. The difference between the techniques is in the deeper tissue work, not in the visible incisions.