Deep Plane Facelift vs SMAS Facelift: How the Two Techniques Compare
Ask two surgeons how they perform a facelift and you may hear two different answers: a SMAS facelift or a deep plane facelift. Both are lifting the same face, and both use the same discreet incisions around the ear, but they work at different depths and reposition the tissues in different ways. That single difference in plane is what drives most of the debate about which lasts longer, which looks more natural, and which is right for a particular face. This guide sets the two techniques side by side, explains what each actually does to the anatomy, and helps you ask the right questions at consultation.
The layer both techniques are built around
To compare the two operations you have to understand one structure: the SMAS, or superficial musculoaponeurotic system. It is a continuous sheet of fibrous and muscular tissue lying between the skin and the deeper structures of the face, and it is the layer that carries the muscles of facial expression. When the face ages, it is not only the skin that descends; the SMAS and the fat it supports slide downward too, which is why simply pulling the skin tight tends to look unnatural and does not last.
The superficial musculoaponeurotic system was first described in the parotid and cheek area in 1976, and it reframed the facelift as an operation on the deeper layer rather than on skin alone.
After Mitz V, Peyronie M. The Superficial Musculo-Aponeurotic System (SMAS) in the Parotid and Cheek Area. Plastic and Reconstructive Surgery, 1976
Every modern facelift, whether SMAS or deep plane, is an attempt to reposition this layer rather than to over-tighten the skin. The two techniques simply differ in how they reach it and how they move it.
Deep plane vs SMAS facelift at a glance
The two techniques share incisions, anaesthetic and overall aims, but differ on the points that decide the result. The table below sets them side by side.
| Feature | SMAS facelift | Deep plane facelift |
|---|---|---|
| Plane of work | On or within the SMAS; skin lifted separately | Beneath the SMAS, in a single deeper plane |
| How tissue moves | Skin and SMAS repositioned as two layers | Skin and SMAS moved together as one unit |
| Retaining ligaments | Largely left intact | Released (e.g. zygomatic, masseteric) |
| Strongest effect on | Jawline, jowls and the lower face | Midface, cheek and deep nasolabial folds |
| Skin tension | Some tension taken by the skin closure | Tension held in the deep layer, less on skin |
| Technical demand | Well established, widely performed | More complex, longer operating time |
| Incisions and scars | Around the ear and hairline | Around the ear and hairline (the same) |
| Longevity | Long lasting, commonly cited around a decade | Argued to hold the midface longer |
Read across the rows and a pattern appears: the deep plane technique does more in the midface because it releases the ligaments that tether the cheek, but it asks more of the surgeon. A SMAS facelift is less technically demanding and remains highly effective for the lower face and jawline, which is what many patients are most concerned about.
How a SMAS facelift works
In a SMAS facelift the surgeon lifts the skin off the underlying tissues, then addresses the SMAS as a separate step. That step can take several forms: folding and stitching the layer on itself (plication), removing a strip and re-suturing it (SMASectomy), or elevating a flap of it and repositioning it. The skin is then re-draped without tension and the excess trimmed.
Because the SMAS is treated separately from the skin, the surgeon has fine control over the lower face and can produce a clean jawline and a natural neck transition. The retaining ligaments are largely left in place, which keeps the operation more contained and, in experienced hands, highly reliable. It is the technique against which newer approaches are measured, precisely because it is so well established.
The layer is folded and stitched on itself. Quick and low-risk, with no cutting of the SMAS, well suited to earlier ageing.
A strip of SMAS is removed and the edges re-joined, shifting the deeper tissue upward without a large flap.
A flap of the layer is raised and repositioned, giving a stronger lift than plication while staying above the deep plane.
The dissection reaches further toward the cheek, narrowing the gap with a deep plane lift for suitable faces.
How a deep plane facelift works
The deep plane facelift, introduced by Sam Hamra in 1990, takes a different route. Instead of separating skin from SMAS, the surgeon dissects in a single plane beneath the SMAS and deliberately releases the facial retaining ligaments, the fibrous anchors that tether the cheek soft tissue to the bone. Once those anchors are freed, the skin and SMAS are lifted together as one composite unit and repositioned vertically.
The deep-plane rhytidectomy was described as a way to reposition the cheek and midface as a single composite layer rather than lifting skin and SMAS separately.
After Hamra ST. The Deep-Plane Rhytidectomy. Plastic and Reconstructive Surgery, 1990
The practical advantage is in the middle of the face. Releasing the ligaments allows a stronger, more vertical lift of the cheek and a better effect on deep nasolabial folds, which the classic SMAS techniques address less directly. Because the tension is held in the deep composite layer rather than the skin, the skin itself is closed with little tension, which supporters argue gives a natural, unpulled result. The trade-offs are a more demanding dissection, a longer operation, and the need for a surgeon experienced in working close to the branches of the facial nerve.
Which technique suits which face?
The better question is rarely “which operation is best?” but “which operation is best for this face?” A few patterns help.
- Lower face and jowls
- Where the main concern is a softening jawline and early jowls, a SMAS facelift is highly effective and well proven, and may be all that is needed.
- Heavy midface and folds
- Where the cheek has descended and the nasolabial folds are deep, the ligament release of a deep plane lift offers more correction in that specific area.
- Skin quality
- Thin or sun-damaged skin benefits from a technique that holds tension in the deep layer rather than the skin, which is an argument often made for the deep plane approach.
- The neck
- Both facelifts are frequently combined with neck work. If the neck is a major concern, that is discussed alongside the lift; see our guide on turkey neck treatment.
- Timing
- There is no single right age. What matters is the degree of ageing and your general health, as we cover in what age is best for a facelift.
- Previous surgery
- A face that has had a facelift before needs careful planning, which we discuss in our guide to revision and secondary facelifts.
Recovery: what actually differs
Recovery from the two techniques is more alike than different. Both are carried out under general anaesthetic or deep sedation, both leave the same incisions, and both involve swelling and bruising that settle over the first few weeks. A deep plane dissection can produce more early swelling because it works deeper, but the overall timeline is broadly comparable.
Typical recovery
- Rest with the head elevated for the first week
- Most bruising and swelling settle over two to three weeks
- Many people return to desk work in about two weeks
- Sutures are removed in stages over the first one to two weeks
- Final result emerges as swelling fully resolves over months
Avoid in the early weeks
- Strenuous exercise and heavy lifting
- Smoking or vaping, which impair wound healing
- Alcohol in the first days, as it worsens swelling
- Sun exposure on healing scars
- Rushing back to a physical job too soon
Whichever technique is chosen, no facelift is without risk, and recovery advice should be tailored to you. General guidance from the NHS on cosmetic procedures stresses allowing proper healing time and following your surgeon’s aftercare instructions closely.
Risks, and how to choose well
Both operations carry the risks common to any facelift: bleeding or a collected pocket of blood (haematoma), infection, altered sensation, scarring, and, uncommonly, temporary or rarely permanent injury to a branch of the facial nerve. The deep plane technique works closer to those nerve branches, which is one reason surgeon experience matters so much for it.
The single most useful thing you can do is choose the surgeon before you fix on the technique. In the UK, that means a surgeon on the General Medical Council’s specialist register with genuine facelift experience, who can explain honestly why one approach suits your face over another.
FAQs
What is the main difference between a deep plane and a SMAS facelift?
The depth at which the surgeon works. A SMAS facelift lifts the skin and the SMAS layer as two separate steps, working on or within the SMAS. A deep plane facelift works in a single plane beneath the SMAS and releases the facial retaining ligaments, so skin and muscle move together as one composite unit, giving a stronger midface lift.
Does a deep plane facelift last longer than a SMAS facelift?
It is often claimed to, particularly in the midface, but this is not firmly established by high-quality comparative studies. Both are durable operations whose results are commonly said to last around a decade. The surgeon’s assessment and skill influence longevity more than the label of the technique.
Is a deep plane facelift more natural looking?
Its supporters argue so, because the tension is held in the deep layer and the skin is closed with little tension, avoiding a pulled appearance. That said, a skilled surgeon achieves a natural result with a well-executed SMAS facelift too. Naturalness depends more on technique and judgement than on the plane alone.
Which facelift is better for the jawline and jowls?
The lower face and jowls respond well to a SMAS facelift, which is highly effective in this area and very widely performed. A deep plane lift adds its main advantage higher up, in the cheek and midface, so the best choice depends on where your main concerns lie.
Are the scars different between the two techniques?
No. Both use the same incision pattern, hidden around the ear and into the hairline. The difference between the techniques is beneath the skin, not in the scars, which fade over months in both cases.
Is a deep plane facelift riskier?
It is a more complex operation that works closer to the branches of the facial nerve, so it demands a surgeon experienced in the technique. In the right hands the safety profile is comparable to a SMAS facelift, but surgeon experience matters more with the deep plane approach.
How do I decide which one I need?
Choose the surgeon first, then let the assessment guide the technique. A good surgeon examines your anatomy, skin quality and neck, listens to your goals, and recommends the approach that fits, rather than offering only one operation. See our facelift surgery page to arrange an assessment.
Sources
- Mitz V, Peyronie M. The Superficial Musculo-Aponeurotic System (SMAS) in the Parotid and Cheek Area. Plastic and Reconstructive Surgery, 1976.
- Hamra ST. The Deep-Plane Rhytidectomy. Plastic and Reconstructive Surgery, 1990.
- NHS. Cosmetic procedures – Face lift. National Health Service, United Kingdom.
- British Association of Aesthetic Plastic Surgeons (BAAPS). Patient guidance on facelift surgery.
This article is for general information and does not replace a personal surgical consultation. Any decision about facelift surgery should be made with a suitably qualified surgeon after an in-person assessment.
