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A SMAS facelift and a deep plane facelift both lift the SMAS, the firm layer of tissue beneath the skin and fat of the face, rather than relying on pulling the skin. The difference is in how that layer is moved. In a SMAS facelift, the skin is lifted separately and the SMAS is tightened with stitches or partly trimmed. In a deep plane facelift, the surgeon works beneath the SMAS, releases the ligaments that tether the cheek and jaw to the bone, and lifts skin and SMAS together as one unit.
Releasing those ligaments allows the cheek, the fold between the nose and mouth and the jowl to move further and more freely. That is why the deep plane approach usually gives a stronger improvement in the midface. A SMAS facelift, in turn, is a shorter operation and works well for moderate jowling and early neck laxity, especially in good skin.
Neither technique is better for every face. The right choice depends on where your tissues have descended, how heavy they are, the quality of your skin and what you want to change.
What the SMAS is
SMAS stands for superficial musculoaponeurotic system. It is a continuous sheet of fibrous tissue and muscle that lies under the facial fat and connects to the platysma muscle in the neck. As we age, the SMAS and the fat above it slide downwards, and the jawline blurs, jowls form and the fold beside the mouth deepens.
That descent is not free. At certain points, especially over the cheekbone and along the jaw, retaining ligaments hold the tissues to the bone. These ligaments are the key to understanding the two techniques.
How a SMAS facelift works
The incisions run from the temple, in front of the ear, around the earlobe and into the crease behind it. The skin is raised off the SMAS over a measured area. The surgeon then tightens the SMAS, either by folding it on itself with stitches (plication) or by removing a strip and stitching the edges together. Finally the skin is redraped over the tightened layer and the excess is trimmed.
Because the retaining ligaments stay attached, the SMAS can only be moved so far. For jowls and the lower face this is often enough. The improvement in the cheek and the nasolabial fold is more limited. You can read more about the general approach on the facelift page.
How a deep plane facelift works
The incisions are the same. After raising the skin for a short distance, the surgeon passes beneath the SMAS in a specific zone of the cheek and jaw and releases the zygomatic and masseteric ligaments. Skin, fat and SMAS are then lifted together as one composite flap, mainly in a vertical direction, so that the cheek returns to where it used to sit rather than being drawn sideways.
Because the skin stays attached to the layer beneath it, its blood supply is well preserved and it is closed with very little tension. The branches of the facial nerve run close to this plane, which is why the technique demands detailed anatomical knowledge and an unhurried dissection. The deep plane facelift page explains the operation in more detail.
Side by side
| SMAS facelift | Deep plane facelift | |
|---|---|---|
| Layers | Skin and SMAS handled separately | Skin and SMAS lifted as one flap |
| Retaining ligaments | Mostly left in place | Released |
| Midface and nasolabial fold | Limited improvement | Stronger improvement |
| Skin tension | Low to moderate | Very low |
| Operating time | Around 3–5 hours | Around 4–6 hours |
| Time in Istanbul | 7–10 days | 8–10 days |
Which technique suits which face
A SMAS facelift is often a sensible choice for:
- moderate jowling with a still well-supported cheek
- good skin quality and a relatively light face
- someone who prefers a shorter operation and accepts a more limited midface change
A deep plane facelift tends to suit:
- clear descent of the cheek and a deep fold between nose and mouth
- established jowls that break the jawline
- heavier facial tissue that a standard lift may not hold well
- a previous facelift that has relaxed and needs a more structural lift
These are tendencies, not rules. The decision is made after examining your face, ideally with photographs from several angles, and talking through what bothers you most.
Recovery and risks
Recovery is broadly similar. Most people spend one night in hospital, have stitches removed between days five and ten, and feel comfortable in public after two to three weeks. After a deep plane lift the cheeks can look a little fuller for the first weeks, because more tissue has been released. Bruising is often modest because the skin is under little tension.
The risks are shared: haematoma, infection, visible scarring, temporary numbness around the ears, hair loss near the incisions, asymmetry and, uncommonly, weakness of a facial nerve branch. Nerve weakness is usually temporary and recovers over weeks to months. Smoking and high blood pressure both raise the risk of complications, so stopping nicotine at least four weeks before and after surgery and controlling blood pressure matter whichever technique is used.
What about the neck?
Both techniques improve the upper neck and jawline, because the platysma is continuous with the SMAS. Neither fully treats a heavy double chin, strong vertical bands or fat beneath the muscle. In those cases a neck lift through a small incision under the chin is usually added in the same operation.
Frequently asked questions
Is a deep plane facelift riskier than a SMAS facelift?
The list of possible complications is the same. The deep plane dissection works closer to facial nerve branches, so it depends on precise anatomical knowledge. In experienced hands, nerve injury is uncommon with either technique.
Which one looks more natural?
Both can look natural when the deep layer carries the lift and the skin is closed without tension. A pulled or windswept look usually comes from relying on the skin, or from lifting in the wrong direction, rather than from the choice between these two techniques.
How long do the results last?
A well-performed facelift usually keeps you looking younger than you otherwise would for around ten years. Because the lift is held by deep tissues, deep plane results are generally considered durable. The face keeps ageing after either operation.
Am I too young for a deep plane facelift?
Age matters less than anatomy. Someone in their early forties with mild jowls and good skin may gain a similar benefit from a smaller operation with a shorter recovery.
Deciding with your surgeon
The technique should follow your face, not the other way round. If you are weighing a deep plane or SMAS facelift, Dr. Mehmet Özdemir can examine your face at a consultation in Bakırköy, Istanbul, explain which approach fits your anatomy and what recovery would involve for you.
