Deep Plane Facelift vs. SMAS Facelift | Dr. Kerem Sami Kaya

Oct 1

5 min read

When patients from around the world travel to Istanbul for facial rejuvenation, one of the most common questions I hear is:

What is the difference between a Deep Plane Facelift and a SMAS Facelift, and which technique is right for me?

Both Deep Plane and SMAS facelift techniques are established approaches to facial rejuvenation. The main difference lies in the anatomical plane in which the surgeon works and how the deeper facial tissues are mobilized.

There is no single facelift technique that is appropriate for every patient. The choice depends on facial anatomy, the pattern of aging, skin quality, the condition of the neck, and the patient's goals.

What Is a SMAS Facelift?

SMAS stands for the Superficial Musculoaponeurotic System, an anatomical layer beneath the skin and subcutaneous tissues.

A SMAS facelift involves modifying or repositioning this layer. Different SMAS techniques include plication, imbrication, excision, advancement, and other variations.

For many patients, SMAS-based techniques can effectively address lower-face and neck laxity. The term "SMAS facelift" therefore describes a group of techniques rather than one standardized operation.

What Is a Deep Plane Facelift?

A Deep Plane Facelift involves dissection beneath the SMAS and selective release of facial retaining ligaments.

This allows deeper facial tissues, particularly in the cheek and midface, to be mobilized and repositioned as part of the facelift.

The operation requires detailed knowledge of facial anatomy, especially the relationship between the deep plane and the branches of the facial nerve.

The objective is not simply to operate "deeper." The important consideration is how the tissues are mobilized and repositioned according to the patient's anatomy.

Deep Plane vs. SMAS Facelift: The Main Difference

	Deep Plane Facelift	SMAS Facelift
Surgical plane	Beneath the SMAS	Involves manipulation of the SMAS layer
Retaining ligaments	Selected ligaments may be released	Depends on the specific technique
Midface mobilization	Can allow significant mobilization in appropriate patients	Depends on the technique
Lower face	Can address lower-face descent	Commonly addresses lower-face laxity
Neck	Can be combined with a neck lift	Can also be combined with a neck lift

The distinction is more nuanced than simply choosing between "deep" and "superficial." Facelift surgery exists on a spectrum, and individual techniques may overlap.

Why Does the Surgical Plane Matter?

Facial aging involves multiple anatomical layers.

Skin loses elasticity, facial fat compartments may change position or volume, and supporting ligaments contribute to changes in the cheek, lower face, and neck.

A facelift therefore involves more than removing excess skin.

One of the potential advantages of a Deep Plane approach is the ability to release selected retaining ligaments and mobilize deeper facial tissues. This can be particularly relevant when there is significant midface or cheek descent.

Does Deep Plane Provide Better Midface Rejuvenation?

Midface rejuvenation is one of the main reasons Deep Plane techniques have attracted attention.

Earlier comparative research reported greater improvement in selected midface areas following deep-plane facelift compared with SMAS plication.

More recent systematic reviews, however, show that both Deep Plane and SMAS techniques can produce high patient satisfaction, while direct comparative evidence remains limited and outcome measures vary between studies.

For this reason, I do not recommend a technique simply because it is currently popular. The patient's anatomy remains the starting point.

Does Deep Plane Last Longer Than SMAS?

This is one of the most common questions patients ask.

It is sometimes claimed that a Deep Plane Facelift automatically lasts longer than a SMAS facelift. Current evidence does not allow such a simple conclusion.

The longevity of a facelift depends on multiple factors, including:

Age and tissue characteristics
Skin quality
Degree and pattern of facial aging
Surgical technique
Tissue repositioning
Healing
Natural aging after surgery

Recent systematic reviews have highlighted the need for longer-term and more standardized comparative studies before definitive conclusions can be made about durability.

Is Deep Plane More Dangerous Than SMAS?

Deep Plane surgery involves a deeper anatomical dissection, so detailed knowledge of facial anatomy is essential.

At the same time, recent systematic reviews have not established a simple conclusion that Deep Plane is inherently unsafe compared with SMAS. Reported complication rates vary between studies, and permanent facial nerve injury is rare.

For me, the important issue is appropriate surgical planning, anatomical knowledge, and careful patient selection.

When Might I Consider a Deep Plane Facelift?

A Deep Plane approach may be considered for patients with:

Midface or cheek descent
Jowling
Lower facial laxity
Loss of jawline definition
Deeper soft-tissue descent
Combined facial and neck aging

Not every patient needs a Deep Plane Facelift. Depending on the anatomy, another facelift technique may be more appropriate.

Deep Plane Facelift and Neck Lift

The face and neck often age together.

When there is significant neck laxity, platysma-related changes, or loss of the cervicomental angle, a Deep Plane Facelift may be combined with a Neck Lift.

The decision depends on the anatomy observed during examination.

My Approach to Choosing Between Deep Plane and SMAS

I do not believe facelift surgery should be based on a technique name alone.

During consultation, I evaluate:

Midface and cheek position
Lower-face laxity
Jowls
Jawline definition
Neck anatomy
Skin quality
Facial proportions
Previous facial procedures
Volume changes
The patient's aesthetic goals

In suitable patients, my preferred approach is a Modified Composite Deep Plane Facelift, sometimes combined with a Neck Lift.

The exact technique is individualized rather than applying the same operation to every face.

If you are considering facial rejuvenation in Istanbul, you can explore our Before & After gallery or request an online consultation to discuss your facial anatomy and treatment options.

Can a Deep Plane Facelift Look Natural?

One of the most common concerns patients have is looking "pulled" after surgery.

My goal is to preserve the patient's characteristic facial features while addressing the visible effects of aging.

A natural result depends on many factors, including patient selection, anatomy, tissue repositioning, skin management, healing, and realistic expectations.

The technique itself is only one part of the process.

Which Facelift Is Right for You?

There is no single facelift technique that is right for every patient.

Both Deep Plane and SMAS approaches can provide meaningful facial rejuvenation. Current research continues to evaluate their relative advantages and limitations, particularly regarding long-term outcomes.

For patients with significant midface descent, a Deep Plane approach may be considered because it allows mobilization of deeper facial tissues.

For another patient, a SMAS-based approach may be more appropriate.

The surgical plan should therefore be based on the patient's anatomy and goals following a detailed consultation.

Frequently Asked Questions

Is Deep Plane Facelift the same as SMAS Facelift?

No. They involve different surgical planes and methods of tissue mobilization, although some modern facelift techniques overlap.

Is Deep Plane better than SMAS?

Neither technique is universally appropriate for every patient. The choice depends on anatomy, facial aging, tissue characteristics, and surgical goals.

Does Deep Plane improve the midface?

Deep Plane techniques can allow mobilization of the cheek and midface tissues. Some comparative studies have reported advantages in midface rejuvenation, although the overall evidence remains limited.

Can Deep Plane be combined with a Neck Lift?

Yes. When the neck also requires correction, the procedures can be combined as part of an individualized treatment plan.

Does a Deep Plane Facelift last forever?

No facelift stops the natural aging process. The longevity of results varies between patients.

Do I need a Deep Plane Facelift?

Not necessarily. An examination is needed to determine which facelift approach is appropriate for your anatomy and goals.

About Prof. Dr. Kerem Sami Kaya

Prof. Dr. Kerem Sami Kaya is an otolaryngologist with a focus on facial aesthetic and facial plastic surgery in Istanbul, Turkey.

His facial aesthetic practice includes Deep Plane Facelift, Neck Lift, brow lift, eyelid surgery, facial fat transfer, and other facial rejuvenation procedures.

His academic work includes publications related to facial aesthetic surgery and facelift techniques. He co-authored “Facelift Techniques: An Overview,” published in Facial Plastic Surgery in 2022.